Hepatitis C Virus Infection Among Young Drug Users What Can Viral Hepatitis Coordinators and Health Departments Do? Dan Church Massachusetts Department of Public Health Bureau of Infectious Disease 1
Goals of presentation Describe recent HCV surveillance trends among young IDU in in Massachusetts Provide an overview of what MDPH has done to address the situation Discuss options for Health Departments to consider for their own jurisdictions 2
Background Hepatitis C virus infection has been reportable to the MDPH since 1992 MDPH receives reports of 8,000 to 10,000 newly diagnosed cases of HCV infection annually 55% of reported cases are among people born between 1945-1965 Over 2,000 of annual reported cases are among people between the ages of 15-29 years Adolescent and young adult cases appear to be directly related to use of prescription opiates and heroin Other jurisdictions have also reported this trend (CT, HI, KY, ME, MN, NY, PA and others) There is less focus on HIV prevention among IDU in recent years
MMWR: Age distribution of newly reported confirmed cases of hepatitis C virus infection --- Massachusetts, 2002 and 2009 * N = 6,281; excludes 35 cases with missing age or sex information. N = 3,904; excludes 346 cases with missing age or sex information. 4 Source: Onofrey et al MMWR: May 6, 2011 / 60(17);537-541
Confirmed and probable reported HCV cases in Massachusetts, 2012 Number of cases 180 160 140 120 100 80 60 40 20 0 Suspect perinatal cases Male Female 0 7 14 21 28 35 42 49 56 63 70 77 84 Age in years Data as of 13AUG2013 and subject to change
What has MDPH done to address this? Fully integrated HCV services (prevention education, screening, testing) with all HIV prevention and screening programs (34 programs) Requirement of completing case report form recently implemented for those conducting point-of-care testing, including rapid HCV tests 5 needle exchange programs, pilot Narcan distribution program, pharmacy access to sterile syringes Integration of HCV medical management into HIV case management services (5 programs) Education by MDPH staff and community partners Ongoing data collection and dissemination of findings
Service delivery outcomes at prevention and screening programs: CY2012 In CY2012, 66,434 HIV tests were conducted (0.5% antibody positive) 7,065 HCV tests were conducted (28% antibody positive) Of clients testing for HIV, 7,972 (12%) reported past IDU 1,060 (13% of all IDU seen) were tested for HCV Of clients testing for HCV: 27% were between 13 24 years of age 19% were Black, 33% Hispanic, and 40% White
Other service delivery outcomes In FY2011, 330 (25%) of enrolled needle exchange program clients were between 18 and 29 years of age In CY2011, there were 116 new clients enrolled at funded needle exchange programs, 53% of which were between 18 and 29 years of age In CY2012 approximately 1,000 clients received some level of service at the 5 HCV case management programs
What should health departments prioritize for HCV activities? HCV related mortality is increasing among people born between 1945-1965 HCV transmission is increasing among adolescents and young adults Resources are limited How is the ACA going to change the landscape? What impact could the CDC/USPSTF baby boomer testing recommendation have? Where can health departments make the biggest impact?
What can health departments do - 1 For those with adequate HCV surveillance: Use your data If you do not have risk data, use age to estimate recent transmission Create ongoing reports to share with community partners with a focus on the younger population Identify other reports that HCV data can be included in (e.g. MDPH World AIDS Day Report) Share data at statewide and national meetings whenever possible
Integrated World AIDS Day Report http://www.mass.gov/eohhs/docs/dph/aids/shifting-epidemics-report.pdf
What can health departments do - 2 For those without adequate HCV surveillance: Find other data sources that support the issue Service utilization data from CBOs serving people who use drugs Drug treatment admission, overdose data Cite publications from jurisdictions conducting HCV surveillance Anecdotal information can be useful Talk with key staff from CHCs about what they are seeing with drug use, HCV infection Use other infectious disease data (including, but not limited to, HIV/AIDS)
Reported IDU-related cases of invasive Group A streptococcus infection in Massachusetts, 2011-2013 Proportion of IDU vs Non-IDU GAS Cases by Age Group 1 Jan 2011-17 Oct 2013 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% <10 10 to 15 15 to 20 20 to 25 25 to 30 30 to 35 35 to 40 40 to 45 45 to 50 50 to 55 55 to 60 >60 Percentage of Cases IDU Non-IDU Age Group Total number of invasive GAS cases between 1/1/2011 and 10/17/2013 = 574 8.01% of all invasive GAS cases were IDU
What can health departments do - 3 Policy Strategies Encourage integration of HCV with other communicable disease prevention and care efforts Prioritize venues where drug users are likely to receive services Support adoption of multi-component prevention programs, especially targeting adolescents and young adults Work with state Medicaid and other insurers to assure that insurance products are response to the needs of people atrisk for/living with HCV infection
What can health departments do - 4 Program strategies Cross-train staff at funded programs to provide HCV screening, prevention counseling and linkage to care Utilize existing webinars, educational materials Work with PTCs, AETC, and medical associations Work with PCAs and CHCs to promote screening and treatment as a component of primary care Support capacity for clinical management and peer support Facilitate collaboration between non-medical and medical community providers
Acknowledgements MDPH Bureau of Infectious Disease Kevin Cranston Alfred DeMaria MDPH BID Office of HIV/AIDS Tom Barker Barry Callis Ralph Chartier Dawn Fukuda Linda Goldman Sophie Lewis Maura Miminos Liisa Randall MDPH BID Division of Epidemiology and Immunization Kerri Barton Jessica Hagewood Pat Kludt Shauna Onofrey MDPH BID Office of Integrated Surveillance and Informatics Services Gillian Haney Susan Soliva
Questions? Dan Church, MPH William A Hinton State Laboratory 305 South St. Jamaica Plain, MA 02130 617-983-6830 Daniel.church@state.ma.us 17