Most cases were tested at their PCP or at a drug treatment facility. â¡ Most knew the risk factors for HCV and how they
Hepatitis C Virus Infection Among Young Drug Users What is Happening and What Can 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 7,000 to 10,000 newly diagnosed cases of HCV infection annually
55% of reported cases are among people born between 1945-1965
Approximately 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
HCV data may serve as a marker for where the epidemic may be moving towards in the future
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 cases of HCV infection by age and gender in Massachusetts, 2011
Suspect perinatal cases
Enhanced data collection - 1
In 2012, MDPH attempted to follow-up all people ages 18-25 years reported to MDPH with HCV infection between 8/2011 and 2/2012 Supported by one-time only CDC funds via ELC grant Supported the hiring of a contractor to conduct interviews using an instrument developed with CDC and other funded jurisdictions
Enhanced data collection - 2
63 interviews were completed (23% of confirmed cases in that age group)
567 phone calls conducted
Most cases were tested at their PCP or at a drug treatment facility Most knew the risk factors for HCV and how they were infected 87% reported any drug use
65% reported injection drug use Commonly injecting heroin by itself
Drug initiation age from enhanced surveillance among young HCV cases in Massachusetts 53 (87%) reported any kind of drug use
No. of interviewed cases
14 12 10 8 6 4 2 0 7
8
9
10
11
12
13
14
15
16
Age at first time of drug use, in years
17
18
19
20
21
22
Needle and injection equipment sharing practices from enhanced surveillance in Massachusetts Of the 41 who reported any injection drug use ever: n
%
Ever used syringe previously used by another injector
29
71
Ever divided up drugs using a needle (back loading)
24
59
Ever used cooker, bottle cap, or spoon after someone else used it
29
71
Ever used cotton after someone else used it
28
68
Ever used rinse water after someone else used it
25
61
Knew where they could access clean needles
31
76
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)
Of clients testing for HIV, 7,972 (12%) reported past IDU
7,065 HCV tests were conducted (28% antibody positive)
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 at least 688 clients received some level of service at the 5 HCV case management programs
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
Continue to analyze for shifts (e.g. pediatric cases)
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
Use interns to process data that have not been entered or analyzed Service utilization data from CBOs serving people who use drugs Drug treatment admission 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
What can health departments do - 3
Policy Strategies
Fully integrate HCV with other communicable disease prevention and care efforts
Harmonize practice standards, performance measures, practice guidelines and data collection across programs Address drug user health via multi-component prevention programs, especially targeting adolescents and young adults
Prioritize venues where drug users are likely to receive services
Support and encourage syringe access with a range of options
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
Work with PCAs and CHCs to promote screening and treatment as a component of primary care
Utilize existing webinars, educational materials Work with PTCs, AETC, and medical associations
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 Division of Epidemiology and Immunization
MDPH BID Office of HIV/AIDS
Tom Barker Barry Callis Ralph Chartier Dawn Fukuda Linda Goldman Sophie Lewis Maura Miminos Liisa Randall
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
[email protected]
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