HepCAP: Hepatitis C Allies f Philadelphia February 2012: Meeting Highlights On February 1, 2012 seventy-tw peple representing ver thirty agencies came tgether at the Philadelphia Department f Public Health (PDPH) fr the launch f a new hepatitis C calitin. The tw-hur meeting served t intrduce peple t the purpse f HepCAP by describing its frmatin and ffering an verview f hepatitis C in Philadelphia. A cnversatin with OraSure addressed the impact f PA State Bureau f Labratries classificatin (Level 3) n rllut f the HCV rapid test. The next HepCAP meeting will be held n Wednesday, April 4 th frm 4pm-6pm. Since the attendance fr the first meeting was s utstanding, PDPH is cnsidering mving the secnd meeting t a larger venue. Stay tuned fr an annuncement abut the lcatin f the 4/4 meeting! The ntes belw include meeting highlights. Please cntact Alex Shirreffs at 215-685-6462 r alexandra.shirreffs@phila.gv if yu have edits t these ntes r feedback abut HepCAP. WELCOME TO HEPCAP Dr. Carline Jhnsn, the Directr f Divisin f Disease Cntrl, welcmed the audience t the first HepCAP meeting, pledging the grup PDPH s full supprt. Dr. Jhnsn nted that a majr challenge fr hepatitis C is the lack f resurces available. This is different frm ther disease areas like STDs which have mre resurces fr testing/cunseling, case investigatin, and preventin activities. Even understanding the ppulatin affected by hepatitis C in Philadelphia is a challenge because the vlume f cases reprted t PDPH is s large that it des nt have the capacity t fllw-up and ask patients abut risk factrs r detailed demgraphic infrmatin (race, ethnicity, etc.) Dr. Jhnsn nted that this is nt just a Philadelphia prblem, but a natinal prblem and resurces frm the CDC are still limited, despite their grwing interest in addressing hepatitis. HepCAP can serve as way fr hepatitis stakehlders t advcate fr mre resurces and t share resurces between invlved agencies. The City has a lbbyist wh may be able t help HepCAP advcate fr mre funding r plicy/regulatry changes. PRESENTATIONS Why HepCAP?: Starting a hepatitis C calitin in Philadelphia Alex Shirreffs, MPH, Adult Viral Hepatitis Preventin Crdinatr (AVHPC) at PDPH described her rle at PDPH, explained the HepCAP planning prcess and described the reasns that the time is right t begin a hepatitis C calitin in Philadelphia. What is the Divisin f Disease Cntrl? PDPH s DDC, which includes hepatitis preventin and surveillance activities, is made up f the fllwing prgrams: Acute Cmmunicable Disease Epidemilgy Immunizatin STD Prgram Prgram Cllabratin & Service Integratin AACO, the AIDS Activities Crdinating Office, is a separate divisin f PDPH. Wh is the Adult Viral Hepatitis Preventin Crdinatr? The AVHPC is a CDC-funded psitin in all 50 states, Washingtn DC, and 5 cities; they are ften the nly staff at health departments slely dedicated t adult hepatitis B & C activities. Philadelphia AVHPC: Alex Shirreffs Alexandra.shirreffs@phila.gv r 215-685-6462 Pennsylvania AVHPC: Sameh Bktr Sbktr@pa.state.gv r 717-787-3350 1
Why? A natinal Viral Hepatitis Actin Plan was released in May 2011 t better crdinate the natinal hepatitis B and C effrts acrss federal agencies. As mre attentin is given t hepatitis C, it is imprtant that Philadelphia s hepatitis stakehlders cme tgether t: Raise the prfile f hepatitis C lcally; Prvide input t help PDPH priritize its hepatitis activities; Fster cllabratin between agencies t maximize lcal resurces; and Psitin Philadelphia t be a leader in the fight against hepatitis C. Planning Cmmittee: A HepCAP planning cmmittee began meeting in July 2011. The grup met regularly leading up t the 2/2/12 launch f HepCAP t lk at existing hepatitis C calitins (New Yrk City, Ls Angeles, Califrnia), plan Philadelphia s structure (missin, gals, etc), develp a HepCAP pririties survey, and cnduct utreach t invite agencies within ur netwrks t attend the first meeting. The fllwing agencies participated in the planning prcess: Hepatitis B Fundatin/Hep B Free Campaign Hepatitis Treatment, Research and Educatin Center (HepTREC) Office f Addictin Services (Department f Behaviral Health) Philadelphia Hepatitis Outreach Prject at PHMC Preventin Pint Philadelphia What will we d? HepCAP will bring a variety f agencies tgether t address the challenges f meeting the needs f peple living with hepatitis C and t prevent new cases in Philadelphia. Peple living with hepatitis C need t learn their status, be linked t care, and need t be supprted as they have their disease mnitred and/r treated. This includes activities frm raising awareness and prviding educatin (bth t the public and medical prviders) abut hepatitis C t strengthening the crdinatin f testing and medical care. New cases f hepatitis C need t be prevented. Since mst new hepatitis C cases ccur amng injectin drug users, this means supprting prjects and plicies address drug user health and develping resurces targeting this ppulatin. HepCAP members have the pprtunity t share their pinins abut hepatitis C pririties by cmpleting this shrt 10-questin survey: 2 http://www.surveymnkey.cm/s/hepcapsurvey Building ur HepCAP cmmunity. Ms. Shirreffs asked that peple cmmit t attend five mre meetings in 2012. Invite ther hepatitis C stakehlders. Build ur cmmunity s that tgether we can make nise abut hepatitis C and build a crdinated effrt t imprve hepatitis C services in Philadelphia. Fllwing Ms. Shirreffs, tw agencies invlved in the planning prcess ffered their perspective n HepCAP. Daniel Chen, MPH, the Prgram Manager fr the Hepatitis B Fundatin s Hep B Free campaign, spke frm the perspective f the hepatitis B cmmunity. Hep B Free cnsists f ver fifty partner agencies that stay engaged thrugh mnthly cnference calls and special events.
Hep B Free s gals are t 1) Raise awareness abut hepatitis B, 2) Increase hepatitis B screening and vaccinatin and 3) Imprve safety net services fr vaccinatin and treatment. Mr. Chen talked abut sme f the innvative ideas Hep B Free has used t engage cmmunity partners, raise awareness, and prvide services like hepatitis B testing t the cmmunity. A current prject is a cntest that challenges peple t make their wn hepatitis B PSA! This perspective gave a glimpse f what HepCAP may als be able t accmplish! Yu can find ut mre abut Hep B Free at: http://bfreephilly.rg/ Like them n Facebk: http://www.facebk.cm/hepbfreephilly Mary-Kate McGinty, the Directr f External Relatins fr University f the Sciences and HepTREC, explained that HepTREC was initially funded as a cmmunity-based nt-fr-prfit rganizatin in 2002 and mved int the University in 2009. In a university hme, HepTREC benefits frm the university's infrastructure and the enthusiasm and participatin f USP's students, faculty and staff. HepTREC is interested in the ptential that HepCAP might have t link students t interdisciplinary hepatitis prjects in the cmmunity thus fstering a new generatin f hepatitis C advcates. Ms. McGinty als nted that HepCAP has the ptential t d great things fr hepatitis C care and HepTREC is excited t be invlved. Yu can find ut mre abut HepTREC at: http://www.heptrec.rg/default.asp Epidemilgy f Hep C in Philadelphia: What we knw and dn t knw Ms. Shirreffs intrduced PDPH staff wh presented n the epidemilgy f hepatitis C in Philadelphia: Rbbie Madera, MPH; Epidemilgist Kathryn Gevitz; Data Manager Shadia BelHamdunia, Yung Hepatitis C Surveillance Crdinatr Seth Sheffler-Cllins, MPH; PCSI Epidemilgist Ms. Madera and Ms. Gevitz pened this presentatin by nting the limitatins f ur hepatitis C data infrmatin cllected by PDPH thrugh electrnic lab reprting mainly cnsists f name, address, and birthday. Because f the vlumes f HCV case reprts, PDPH des nt d any further HCV surveillance r case investigatin (unless it is an acute case, althugh very few are reprted each year). In additin t an verview f hw hepatitis C data is cllected by PDPH, Ms. Gevitz prvided a breakdwn f HCV case reprts. Ms. BelHamdunia discussed an enhanced surveillance prject that will enable PDPH t fllw-up n hepatitis C cases in peple under 30 years ld. Philadelphia was ne f seven sites and the nly city t receive CDC funding fr this prject. Ms. BelHamdunia asked prviders t help spread the wrd abut this prject. Anyne interested in learning mre abut this can cntact her at: Shadia.BelHamdunia@phila.gv Mr. Sheffler-Cllins is the Epidemilgist fr the Prgram Cllabratin and Service Integratin Prgram (PCSI) at PDPH. Philadelphia is ne f six natinal CDC-funded PCSI pilt sites. This prgram aims t encurage mre cllabratin between HIV, Hepatitis, STD, and TB prgrams at health departments, in rder t better serve ppulatins that may be at risk fr multiple diseases. In his rle, Mr. Sheffler-Cllins matches data between each prgram s disease registries. Since risk factr and demgraphic data is s limited fr hepatitis C, these matches may help PDPH develp a 3
better understanding f what specific ppulatins r cmmunities are mst impacted by hepatitis C as well as c-infectins with ther diseases like HIV. Slides cntaining data frm these presentatins will be prvided t HepCAP members sn! DISCUSSION HCV Rapid Test & PA State Level 3 Classificatin OraSure representatives were present t describe current challenges with rlling ut their new hepatitis C rapid test in Pennsylvania. Rebekah Parsns, MS; Public Health Accunt Manager, Infectius Disease Testing Reggie Carr, MBA; Directr f Glbal Marketing, HCV Christine Lgan; Accunt Manager, Hspital Divisin The HCV rapid test is FDA apprved fr whle bld and fingerstick. In Nvember the test was CLIA waived. It is exactly the same platfrm as the HIV rapid test. Ms. Parsns passed arund a sample test and distributed flders cntaining mre detailed infrmatin abut the rapid test. The test detects HCV antibdies, the results are ready within 20 minutes. The PA Bureau f Labratries requires sites ffering the HIV r HCV rapid test t fulfill specific lab classificatins. Each test has a different classificatin frm the Bureau f Labs. HIV Rapid Test Level 2 Classificatin: Fr a site in PA t ffer the HIV rapid test, their lab/physicians ffice must meet the Level 2 lab classificatin standards which include: apply fr a state lab license; designate a lab directr and lab supervisrs; dcument training and cmpetency evaluatins; develp a prcedure manual; develp and adhere t quality cntrl; participate in a prficiency test; and ntify the bureau f labs f changes. Mre details abut each f these requirements can be fund in these dcuments: http://www.prtal.state.pa.us/prtal/server.pt/dcument/693771/rapid_hiv _antibdy_test_guidance_pdf http://www.prtal.state.pa.us/prtal/server.pt/dcument/693772/rapid_hiv _test_systems_reg_cmpliance_pdf HCV Rapid Test Level 3 Classificatin: In additin t all f the standards required fr the HIV test, the HCV test als requires a Medical Directr t be nsite and the facilities must be inspected by the state befre they begin testing. In Philadelphia, HIV testing is able t be dne n a citywide scale because AACO serves as the lab directr fr all f their funded test sites and versees the assciated training, prcedures, and prficiency testing. If the HCV test als had Level 2 classificatin, it culd be incrprated at AACO s testing sites fairly easily. The Level 3 classificatin pses many barriers: many sites d nt have a medical directr nsite at all times and the Bureau f Labs has a waiting list f sites that need t be inspected, which means that even if a site did fill the Level 3 requirements it wuld have t wait befre smene frm the state came t inspect the facility. Sites that use the rapid test withut fulfilling the certificatin requirements culd get shut dwn if the State fund ut. 4
While testing cannt be dne at cmmunity-based sites right nw, sites that are interested in being trained n the new test can cntact Rebekah Parsns: rparsns@rasure.cm What can be dne t reverse the State s decisin? Since there is n fficial prcess t appeal the Bureau f Labratries decisin, OraSure is invlved in discussins with the PA Department f Health t advcate fr the classificatin t be dwngraded t at least a Level 2. Since Philadelphia wuld ptentially be ding a lt f hepatitis C testing as the State s largest city, pressure n the State needs t cme ut f Philadelphia. OraSure suggested writing letters t the PA Secretary f Health and State Senatr Vincent Hughes. UPDATE: As these meeting highlights were being prepared, OraSure met with the PA Secretary f Health. He has cmmitted t reslving this prblem ver the next few weeks. If there is n change t the classificatin, we will let HepCAP members knw what specific actins they can take t mve the prcess alng. Thank yu fr cming t the meeting t vice yur supprt fr an accessible hepatitis C rapid test! ANNOUNCEMENTS Viral Hepatitis Resurce Guide: Since ne f the challenges f expanding HCV testing is that many prviders d nt knw where t refer patients wh test psitive, PDPH is updating the Hepatitis Resurce Guide fr the first time since 2008. Jasn Bell, a Drexel MPH student, has develped a cmprehensive survey t cllect infrmatin abut agencies that prvide hepatitis B and/r C preventin, treatment, and/r supprt services. If yur agency has nt yet cmpleted the survey, it is still pen here: http://www.surveymnkey.cm/s/hnmkkdd Hep C Supprt Grup: A grup is starting at the PHMC Care Clinic It will be held n the third Wednesday f each mnth. Fr flyers r mre infrmatin cntact Dejenaba Grdn at the Philadelphia Hepatitis Outreach Prject dgrdn@phmc.rg Liver Life Walk: Spnsred by the American Liver Fundatin n May 12 th http://www.liverfundatin.rg/chapters/midatlantic/events/789/ Fr mre infrmatin cntact Ivry Allisn at iallisn@liverfundatin.rg Natinal Hepatitis Testing Day: Saturday, May 19 th There was a recmmendatin t add this as a discussin item at the April HepCAP meeting. 5
NEXT STEPS Ms. Shirreffs will send ut the meeting minutes. At the April 4 th meeting, the fllwing tpics will be discussed: Amend and apprve the missin, gals, and lg fr HepCAP Prpsed missin, gals and lg were distributed n the meeting s agenda. They will als be included in the meeting minutes t be distributed via email. Nminate HepCAP cmmunity c-chair A cmmunity c-chair wuld serve t supprt the gvernmental c-chair (Alex Shirreffs) in the duties f leading HepCAP. Amng the expectatins wuld be that the cmmunity c-chair: C-facilitate meetings Prvide a cmmunity perspective n agenda items and HepCAP prjects Take n additinal supprt and leadership duties as the grup evlves Brainstrming activity based n HepCAP pririties survey results The next HepCAP meeting will be held n Wednesday, April 4th frm 4pm-6pm. Lcatin TBA s please check yur email fr updates and an RSVP link!! 2012 HepCAP Meetings First Wednesday f every ther mnth, 4pm-6pm April 4 June 6 August 1 Octber 3 December 5 Mark yur calendars nw! 6