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You are Here: Home Page > Strategic Plan > Viral Hepatitis Strategic Plan  

Viral Hepatitis Strategic Plan

Appendix A

Organizational History

Currently three Centers at the New York State Department of Health (NYSDOH) conduct viral hepatitis activities: the Center for Community Health which includes the Bureau of Communicable Disease Control, the Bureau of Sexually Transmitted Disease (STD) Control and the Bureau of HIV/AIDS Epidemiology; the AIDS Institute; and the Wadsworth Center Laboratory.

Bureau of Communicable Disease Control (BCDC)

Two programs in the Bureau of Communicable Disease Control are responsible for hepatitis activities: the Regional Epidemiology Program's Hepatitis Unit and the Immunization Program.

• Regional Epidemiology Program-Hepatitis Unit

  The Regional Epidemiology Program's Hepatitis Unit has direct oversight of viral hepatitis surveillance activities. Viral hepatitis surveillance in New York State consists of surveillance for acute cases which helps in tracking incidence, monitoring patterns of transmission, evaluating prevention efforts, identifying missed opportunities for prevention, and ensuring those infected receive appropriate counseling. Hepatitis surveillance also includes identifying chronic hepatitis B and C cases. This allows for estimating the burden of disease, effectively allocating resources, and ensuring appropriate counseling.

  Since 2001, the NYSDOH has been involved in several initiatives to enhance the surveillance of chronic hepatitis B and C. The initiatives include:

  • Developing a provider letter that a county can use to follow-up on hepatitis C lab reports. This letter has proven to be an effective mechanism for local health departments (LHDs) to use when they receive a hepatitis C lab report and need to determine if it is an acute or chronic case,
  • Conducting a statewide hepatitis C physician mailing which included reporting information, case report forms, case definitions and educational brochures,
  • Developing viral hepatitis surveillance guidelines for LHDs,
  • Conducting statewide surveillance workshops to train the LHDs staff to use the surveillance guidelines, and
  • Building a chronic hepatitis disease registry.

  The hepatitis C coordination activities within the Regional Epidemiology Program are conducted by the state Hepatitis C Coordinator. The Coordinator is responsible for establishing a focus in the NYSDOH for hepatitis C activities, and ensuring internal and external support for NYSDOH viral hepatitis activities; coordinating the development, implementation, and evaluation of hepatitis C prevention activities that are integrated into existing prevention programs for HIV/AIDS, STD, drug treatment, and correctional facilities; and serving as a resource for information on HCV epidemiology, prevention and control. Additional coordinator activities include the maintenance of the viral hepatitis public Web site, the coordination of the Hepatitis C Workgroup which convenes quarterly to discuss issues such as surveillance, integration, education, treatment, testing and reimbursement, and the planning for the annual NYSDOH hepatitis C conference. The coordinator collaborates with various internal department of health agencies and external agencies, including the LHDs, DOCS, OASAS, and a number of community organizations.

• Immunization Program

  The Immunization Program at the NYSDOH takes the lead role in the prevention of hepatitis A and B through statewide vaccination initiatives. The state Hepatitis B Coordinator resides in the Immunization Program. The Immunization Program is directly responsible for the Perinatal Hepatitis B Prevention Program, which was established in 1991 when the NYSDOH Public Health Law (PHL) 2500-e was enacted. The goals of PHL 2500-e are to ensure 100% of pregnant women get screened for hepatitis B and 100% of infants born to HBsAg positive women get treated. In 1995, the STD Hepatitis Vaccination Program was started in which the Immunization Program provides hepatitis A, hepatitis B and Twinrix vaccine to LHDs for high-risk adolescents and adults seeking services through the LHD. Currently, 56 out of 57 upstate county-sponsored STD clinics participate in the program. Other Immunization Program initiatives include expanding the STD Hepatitis Vaccination Program to include HIV Counseling and Testing Sites (CTS) and county jails and renaming it as the Adult Hepatitis Vaccination Program, and providing hepatitis vaccine to birthing hospitals that have a universal birth dose policy in effect.

Bureau of STD Control

The Bureau of STD Control works in collaboration with the Immunization Program to encourage county STD clinics to take part in the Adult Hepatitis Vaccination Program. The bureau has also sponsored community forums focusing on sexually transmitted diseases and viral hepatitis. These forums were held in each region of the state. They were used to educate various community groups about the different types of STDs and hepatitis A, B and C, as well as the importance of integration of services.

Bureau of HIV/AIDS Epidemology

The Bureau of HIV/AIDS Epidemiology has been involved with a number of hepatitis C seroprevalence studies. The studies include a prison study determining the seroprevalence of HCV in incoming inmates; a study of injecting drug users in NYC examining the incidence of HCV and HIV over time; and studies on the seroprevalence of HCV in other settings such as STD clinics, drug treatment programs, adolescent clinics and homeless shelters.

Because of the overlap in transmission of HIV and viral hepatitis, the NYSDOH AIDS Institute strongly supports the integration of viral hepatitis activities into many of their programs. Several programs have incorporated hepatitis screening, testing, and counseling into existing HIV protocols and guidelines.

Office of the Medical Director

The Office of the Medical Director has developed clinical guidelines for the management of HCV infection in HIV-infected patients. The HIV Education Unit, within the Office of the Medical Director, has successfully integrated viral hepatitis into existing training programs. Over the past years, the Education Unit distributed a Dear Colleague letter to all HIV providers offering information on hepatitis and HIV; developed and provided hepatitis A, B and C train-the-trainer programs that are delivered by the regional training centers throughout the state; developed and continue to deliver a half-day training on hepatitis A, B, and C through the regional training centers; and began to offer at syringe exchange programs (SEPs) 2-3 trainings per year on bloodborne infections including hepatitis B and C. In 2000, the Education Unit identified HCV as a training priority for Clinical Education Initiatives Sites. The AIDS Institute collaborated with OASAS on a statewide HCV videoconference for clinicians and offered regional HCV conferences for clinicians. The training initiatives continue with HCV training for SEPs and ongoing sessions for criminal justice Initiative Contractors.

Division of HIV Prevention

The Division of HIV Prevention has developed a hepatitis A and B workgroup which promotes awareness of the risks of hepatitis A and B among adult populations at high-risk for infections and determines effective and efficient ways to access hepatitis vaccine. In addition, HIV prevention providers are encouraged to play active roles in preventing hepatitis A and B by implementing efforts to increase awareness about hepatitis A and B, promote vaccination and provide referrals for vaccination. In addition, two bureaus within the Division of HIV Prevention, the Bureau of Direct Program Operations and the Bureau of Special populations, are involved in viral hepatitis activities.

• Bureau of Direct Program Operations

  The Bureau of Direct Program Operations, Anonymous HIV Counseling and Testing Program, has incorporated viral hepatitis messages into HIV counseling and testing settings and offers informational presentations on viral hepatitis to correctional settings and substance abuse treatment centers.

• Bureau of Special Populations

  The Bureau of Special Populations, which provides direct oversight to the state''s twelve syringe exchange programs, provides each SEP with viral hepatitis educational information. The bureau, which has campaigned successfully for the state's Expanded Syringe Access Programs (ESAP), has integrated viral hepatitis information into their educational materials for consumers.

Division of HIV Health Care

Two bureaus within the Division of HIV Health Care take part in viral hepatitis activities, the Bureau of HIV Ambulatory Care services and the Bureau of HIV Programs Review and Systems Development.

• Bureau of HIV Ambulatory Care Services

  The Bureau of HIV Ambulatory Care services funds various substance abuse treatment programs and requires these programs to adhere to state and federal regulations related to viral hepatitis. The bureau conducted a survey of drug treatment facilities to determine what types of HCV activities are currently being conducted. All but one program surveyed offered hepatitis C testing, all provided HCV counseling, and a majority of them provided access to treatment for HCV. The sur vey also found that the majority of programs of fered hepatitis vaccine and all programs offered educational materials pertaining to viral hepatitis.

• Bureau of HIV Programs Review and Systems Development

  The Bureau of HIV Programs Review and Systems Development has been instrumental in establishing and increasing the Medicaid reimbursement rates for hepatitis C testing including quantitative and qualitative PCR and genotype assays. Medicaid currently provides coverage for pegylated interferon treatment.

The Wadsworth Center Laboratory provides hepatitis C testing for NYSDOH seroprevalence studies and provides anti-HCV testing (EIA and RIBA) to patients on a limited basis such as pilot integration projects. The Wadsworth Center Laboratory has developed and validated a sequence-based HCV genotyping assay and is currently conducting a clinical research study to identify mutations in the HCV genome associated with progressive liver disease. Finally, the Center provides HBV testing for household and sexual contacts of pregnant women and follow-up blood work of the infant.