Viral Hepatitis Testing Initiative - Sharing Results - nastad

Viral Hepatitis Testing Initiative Sharing Results March 11, 2014

Who is NASTAD? Mission NASTAD strengthens state and territory-based leadership, expertise and advocacy and brings them to bear on reducing the incidence of HIV and viral hepatitis infections and on providing care and support to all who live with HIV/AIDS and viral hepatitis.

Vision NASTAD’s vision is a world free of HIV/AIDS and viral hepatitis.

Table of Contents  Testing Initiative Overview  Presentations by Grantees – Denver Health and Hospital Authority, Denver, CO – Alia Al-Tayyib – MedStar Research Institute, Washington, DC – Dawn Fishbein – Ohio Asian American Health Coalition, Columbus, OH – Manju Sankarappa

Viral Hepatitis PPHF Testing Initiative  Established in FY2012, out of the Prevention and Public Health Fund  $6.7 million to 32 grantees in the following categories: – HBV identification and linkage to care among foreignborn persons (9) – HCV identification and linkage to care among people who inject drugs (10) – HCV testing and linkage to care at community health centers (7) – Project ECHO sites (2) – HCV testing and linkage to care in other settings (7)  Continued in FY2013 through Secretary Transfer

PCSI in Practice: Fully Integrated Screening for HCV in an STI Clinic Alia Al-Tayyib, PhD and Laura Ginnett, MNM Viral Hepatitis Testing Initiative Webinar

March 11, 2014

Testing Site

 Denver Metro Health Clinic  Largest STI clinic and HIV testing facility in Rocky Mountain region with approximately 18,000 visits annually  Free and confidential STI, HIV, and HCV testing, counseling, and treatment (sliding fee scale implemented January 2014)  Family planning services (Title X clinic)  Immunization services (HPV, HBV, HAV)  Established HIV Linkage to Care program (LTC)  Electronic medical record system (HealthDoc®)  Operates using a physician extender model: employs an 12-person clinical staff and a 3-person clerical staff, supervised by a nurse manager and clinic administrator, with daily medical activities supervised by one of 7 attending physicians

 Clinic housed within Denver Public Health, part of Denver Health and Hospital Authority

Testing Protocol 1. During triage, all patients are asked a standard set of questions related to HCV risk 2. If a patient has any risk factors, they are offered a free HCV rapid antibody test 3. If the patient agrees to testing, two purple top tubes of blood are drawn (similar to HIV protocol) 4. The patient then sees a provider for their clinic visit. During the visit, the provider discusses the patient’s risk factors and delivers the HCV rapid test results to the patient 5. If the patient has a non-reactive rapid result, their visit concludes 6. If the patient has a reactive rapid result:  

A Linkage to Care counselor is paged to meet with the patient A blood specimen is processed for quantitative RNA testing at the Denver Health Microbiology Lab

HCV Screening Questions

Screening Tracking

Testing Outcomes

Denver Metro Health Clinic, January 1 - December 31, 2013 # of persons with HCV antibody result

2,857

# of persons with documented risk factor

2,491 (87%)

# of persons with documented counseling

1,326 (46%)

# of persons with positive HCV antibody

58 (2%)

# of persons with HCV RNA result

54 (93%)

# of persons with positive HCV RNA

32 (59%)

Demographics by HCV antibody status Total n (%)

HCV Antin (%)

HCV Anti+ n (%)

X2 p-value

2,068 (72)

2,041 (73)

27 (47)