CSTE Hepatitis Survey Results

1
CSTE Hepatitis Survey Results

• Frequencies and Percentages of Responses per
  Question

Steven Wiersma MD, MPH Steven Connor MPH
2
Background

• conceived as part of the cooperative agreement
  between CSTE and CDC
• baseline to determine activities of states with
  respect to Hepatitis Prevention and Control
  Issues
• information will be used to develop small grants
  for hepatitis planning
• developed by the CSTE Hepatitis Workgroup of the
  Infectious Disease Committee under the direction
  of Steven Wiersma MD, MPH
• external partners were asked to comment and a
  final survey was fielded as a web-based
  application

3
Summary Statistics

• Number of states and territories surveyed, N57
• Total number of states and/or territories who
  responded to the survey, N42
• Number of states and/or territories included in
  this analysis, N40 (denominator 40)
• Response rate of 70!
• States refers to both states and territories in
  this presentation

4
Does Your State Health Agency Feel There Is a
Need for a Written Hepatitis Prevention and
Control Plan Specific to Your Jurisdiction?
1) Percentages are of the 40 states who responded
to survey
5
Number of states who have started to develop a
written hepatitis prevention and control plan
(N40)
6
Stages of forming a written hepatitis prevention
and control plan (N21)
7
Breakdown of areas of hepatitis prevention and
control included in both draft and/or completed
plans
Percentages from states who responded (N40)
8
Which part of your state agency has been the lead
in the hepatitis prevention and control planning
process ?
n () Shared responsibility 11
(52.4) between departments Epidemiology 6
(28.6) No Response 4 (19.0)
N 21
9
Date of completion of states who have a written
hepatitis plan and prospective date of completion
for those in draft or discussion form
Once completed, would you be willing to share
your states document with CSTE/CDC?
10
Is (or will) your plan be a stand-alone plan, or
will it be incorporated as an annex into a
comprehensive disease control plan?

• n ()
• Hep plan will stand alone 10 (47.6)
• Hep plan incorporated 7 (33.3)
• Other 1 (4.8)1
• NR 3 (14.3)

N 21
1) Stated Hep plan will significantly integrate
with Epi, STDs, and HIV/AIDS programs
11
Where do your funds for hepatitis planning come
from?
n () Dedicated state funds 4
(19.0) Prevention block grants 0 --- CDC
cooperative agreement 6 (28.6) No hepatitis
planning support 7 (33.3) Other 5
(23.8)
N 21
12
What are the three most important barriers that
your state has faced in initiating the
development of a hepatitis plan?

• n ()
• 1) Lack of personnel resources 25 (62.5)
• 2) Lack of financial resources 23 (57.5)
• 3) Other competing demands 17 (42.5)
• Percentages total gt 100 because multi-answer
  question

13
What are the two most important resources/actions
needed by your state in order to complete a
hepatitis plan?

• n ()
• Securing funding and support 22 (55.0)
• Completion of national plan 17 (42.5)
• Legislative support 5 (12.5)
• Other 5 (12.5)
• N 40

14
Organization and Funding
15
Where is hepatitis prevention and control located
in your state organizational structure?
16
How many paid full-time equivalents (FTEs) are
involved in hepatitis prevention and control in
your state?

• n ()
• None 3 (7.5)
• Less than one 5 (12.5)
• 1-2 11 (27.5)
• 3-4 7 (17.5)
• 5-6 2 (5.0)
• 7-8 0
• Greater than 8 2 (5.0)

17
Is there a line item for Hepatitis Prevention and
Control in the state budget?

• YES NO NR
• n () n () n ()
• Hepatitis A 5 (12.5) 24 (60.0) 11 (27.5)
• Hepatitis B 6 (15.0) 22 (55.0) 12 (30.0)
• Hepatitis C 6 (15.0) 23 (57.5) 11 (27.5)

18
What is your combined hepatitis (A, B, C)
prevention and control annual budget?

• n ()
• ? 50K 7 (17.5)
• 51K 99K 3 (7.5)
• 100K 199K 4 (10.0)
• 200K 299K 2 (5.0)
• 300K 399K 0
• 400K 499K 1 (2.5)
• 500K 999K 4 (10.0)
• ? 1 million 4 (10.0)
• No Response 15 (37.5)

19
How much does your state currently spend per year
on hepatitis B vaccine for high-risk adults?

• n ()
• ? 50K 15 (37.5)
• 51K 199K 3 (7.5)
• ? 200K 6 (15)
• No Response 16 (40)

20
How much does your state currently spend per year
on hepatitis C?

• n ()
• ? 100K 4 (10.0)
• 101K 500K 3 (7.5)
• ? 501K 2 (5.0)
• NR 31 (77.0)

21
Does your state have a hepatitis B coordinator?
27.5
62.5
10.0
(n25)
N 40
22
Who oversees the work of the hepatitis B
coordinator?
N 25
23
Does your state have a hepatitis C coordinator?
(n15)
N 40
24
Who oversees the work of the hepatitis C
coordinator?
N 15
25
SURVEILLANCE ACTIVITIES
26
Does your state have statutes that specifically
require reporting of each of the following
disease conditions?

• n ()
• Hep A, acute 28 (70.0)
• Hep B, acute 28 (70.0)
• Hep B, perinatal infection 24 (60.0)
• Hep B, HBsAg pregnancy 24 (60.0)
• Hep B, chronic 15 (37.5)
• Hep C, acute 27 (67.5)
• Hep C, chronic 14 (35.0)

27
Does your state have statutes that specifically
require reporting of each of the following
disease conditions? (cont.)

• n ()
• Hep unspecified/other, acute 18 (45.0)
• Hep Delta, acute 15 (37.5)
• Hep E, acute 10 (25.0)
• Hep non-A, non-B, acute 16 (40.0)
• Hep non-A, non-B, non-C, acute 11 (27.5)
• Registry for all markers of hepatitis 3 (7.5)

28
What tests are states labs performing?

• n ()
• IgM antibody to hep A virus 21 (52.5)
• Hep B surface antigen 23 (57.5)
• Antibody to Hep C virus 17 (42.5)
• HCV RNA (PCR) 11 (27.5)
• HCV RIBA 8 (20.0)
• Molecular testing of Hep A 1 (2.5)
• Molecular testing of Hep B 0 ---

29
Does your state have a database for monitoring

• YES NO NR
• n () n () n ()
• Chronic hep B? 14(35) 13(32.5) 13(32.5)
• Chronic hep C? 13(32.5) 14(35) 13(32.5)

N 40
30
Policy Development
31
Are there currently any legislative bills in your
state system specifically addressing viral
hepatitis?

• n ()
• Yes 4 (10.0)
• No 25 (62.5)

Has your state developed any statewide policies
for hepatitis prevention and control?
n () Yes 20 (50.0) No 9 (22.5)
N 40
32
Outreach
33
What type of hepatitis outreach does your state
conduct?

• n ()
• None 3 (7.5)
• Partner notification 17 (42.5)
• Community education 21 (52.5)
• Counseling and testing 14 (35.0)
• Partner referral 18 (45.0)
• Referral of Hep C partners 8 (20.0)

N 40
34
Counseling, Testing, and Referral
35
Is hepatitis C counseling and testing available
in publicly-funded sites in your state?

• n ()
• Yes 10 (25.0)
• No 19 (47.5)
• NR 11 (27.5)

N 40
36
Adult Vaccinations
37
How is hepatitis vaccine for adults purchased and
administered in your state?

• n ()
• State purchase, Local administration 11 (27.5)
• State Local purchase, Local administration 5 (12
  .5)
• State Local purchase and administration 1 (2.5)
• Vaccine not purchased nor administered 4 (10.0)
• Other 8 (20.0)
• NR 11 (27.5)

N 40
38
Does your state use the federal contract to
purchase vaccine?

• n ()
• Yes 26 (65.0)
• No 3 (7.5)
• NR 11 (27.5)

N 40
39
Treatment
40
Does your state have a mechanism for referring
persons with chronic hepatitis (B or C) for
medical evaluation and potential treatment?

• n ()
• Yes 14 (35.0)
• No 15 (37.5)
• NR 11 (27.5)

N 40
41
Prevalence Studies
42
Has your state done hepatitis C prevalence
estimates statewide?

• n ()
• Yes 12 (30.0)
• No 16 (40.0)
• Unknown 0 ---
• NR 12 (30.0)

N 40
43
Strengths and Weaknesses

• Strength
• Response rate of 70
• Pilot tested

• Weakness
• Several states indicated that questions found on
  survey were difficult to answer
• People stated that survey was very political,
  possibly creating bias

44
Next Steps

• SSurvey results will be utilized to develop RFP
  to states
• SSteering committee will review submitted
  proposals and select awardees
• SElected states will receive funding to advance
  planning activities
• FFunded States will meet to share information
  regarding the planning process