Integrating HIV Prevention with Hepatitis C Co‐Infection Programs

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Integrating HIV Prevention with Hepatitis C Co‐Infection Programs

  1. 1. AIDS Community Research Initiative of AmericaIntegrating HIV Prevention with Hepatitis C Co‐ Infection Programs  HIV Health Literacy Program 230 West 38th Street 17th Floor 230 West 38 Street, 17 New York, NY 10018 
  2. 2. Issues Treatment and prevention programs focus on HIV While HIV and HCV co‐morbidity continues to increase y MSM sexual transmission is emerging as a common risk  factor, while sexual transmission in other populations,  factor while sexual transmission in other populations remains low Understanding unique circumstances for clients and  Understanding unique circumstances for clients and providers in different settings
  3. 3. Project and Setting National Program completed in 15 cities nationwide All 5 boroughs in NYC g 3 year CDC‐funded, NYSDOH and ACRIA initiated Targeting both clients and staff at ASOs, LGBT  T ti b th li t d t ff t ASO LGBT organizations, agencies and programs within criminal  justice system, substance use centers
  4. 4. BackgroundA national advisory panel guided the development of this training between 2003‐2006 CDC and experts from service delivery settings that provide care to people living with or at risk for HCVInput was gained from six focus groups that were held throughout the United States  Combination of administrators, supervisor and direct client  staff representing different settings
  5. 5. Training Format  Training materials are comprehensive  Design is flexible and modular in format Design is flexible and modular in format Tailored content for special settings Focus on integration Skills‐based Skills based
  6. 6. O i fM d lOverview of Modules epa s Hepatitis C Overview of the Liver and Disease Prevalence Transmission/Non‐Transmission Spectrum of Illness and Common Symptoms Prevention Diagnosis and Testing Diagnosis and Testing Treatment Risk Assessment and Tailored Harm Reduction Messages g Risk Assessment Cultural Awareness and Values Clarification Harm Reduction Messages Safer Injection Practices
  7. 7. Hepatitis = Inflammation of the liver Hepato liver itis inflammation 
  8. 8. Causes of HepatitisImmunologic  InfectionsDamage ‐ Vi Viruses ‐ Bacteria Inflammation Toxic Damage Toxic Damage ‐ Alcohol ‐ Drugs ‐ Poisons/Chemicals
  9. 9. Chronic HCV Monoinfection ~ 80% develop chronic infection 80% develop chronic infection Of those with chronic infection: ~ 35% remain stable ~ 20% will develop cirrhosis and serious illness 20% will develop cirrhosis and serious illness Of those with cirrhosis: ~ 25% will develop liver cancer, need a transplant,  25% will develop liver cancer, need a transplant, and/or die as a result of liver disease
  10. 10. Chronic HCV Monoinfection Another way to look at HCV disease  progression …
  11. 11. Progression of HCV Infection over 10‐25 Years 100% (100 people) Acute Infection 20% (20) 80% (80) Resolved Chronic 35% (28) 65% (52) Slowly Progressive Disease y g Stable S bl (some symptoms) 70% (36) 30% (16) Some liver damage, Some liver damage Cirrhosis no cirrhosis 75% (12) ( ) 25% (4) ( ) Slowly progressive Liver failure, cancer, cirrhosis transplant, death
  12. 12. Setting‐Specific Modules Integrating Hepatitis C Rationale and Opportunities for Integration pp g Brainstorm: Barriers to Integration Model Programs for Integration Strategies for Integration Implementing a Successful Plan for Integration
  13. 13. HIV/AIDS Programs:HIV/AIDS Programs:Rationale for Addressing HCVCo‐existing epidemics 25‐30% of HIV‐positive people are co‐infected with  25 30% f HIV iti l i f t d ith HCV In some studies, up to 90% of IDUs with HIV are co In some studies up to 90% of IDUs with HIV are co‐ infected with HCV
  14. 14. HIV/AIDS Programs:HIV/AIDS Programs:Overlapping Risk Factors Behaviors associated with the transmission of HIV are  also associated with transmission of HCV: 50‐90% of IDUs are infected with HCV – most users become  infected with HCV during first five years of injecting Sharing injection equipment is a highly efficient means of  spreading HCV
  15. 15. Integration of HIV and HCV services will be beneficial to clients Meets more needs of the clients Convenient for clients  Convenient for clients Reduces barriers to service May help reduce costs May help reduce costs Uses existing, trusted infrastructure Complements services that target the same population Complements services that target the same population Provides additional services that may bring in more  clients
  16. 16. Promoting Wellness for PWHIV/AIDS Educating clients and providing access to viral hepatitis  screening and vaccination is a critical component of  wellness for PWHIV/AIDS wellness for PWHIV/AIDS HIV providers need to be well versed in viral hepatitis  in order to serve clients who are co infected with viral  in order to serve clients who are co‐infected with viral hepatitis
  17. 17. LGBT Organizations:LGBT Organizations:Rationale for Addressing HCVSexual Stigma & Discrimination Create High Levels of Lifelong Stress GLB individuals suffer from more mental health problems  including substance use disorders, depression, and  suicide Gay men use substances and alcohol at higher rates than  y g heterosexual men LBT women smoke almost 200% more than heterosexual  LBT women smoke almost 200% more than heterosexual women
  18. 18. lCorrectional Settings: g pRationale for Addressing Viral Hepatitis High risk group  Higher rates of HCV, STIs, HIV and TB 12‐39% of all Americans with chronic HBV or HCV  were released from correctional facilities during the  previous year Adult prison inmates: 16‐41% have evidence of HCV  infection; 12‐35% have chronic infection
  19. 19. lCorrectional Settings:Rationale 83% of state and 73% of federal prisoners report past  p p p IDU 57% of state and 45% of federal prisoners report drug  use in the month before their offence 60‐90% of IDUs are infected with HCV  14‐42% of incarcerated people are infected with HCV
  20. 20. lCorrectional Settings:Rationale Benefits the general community Reduces disease transmission and medical costs Inmates who participate in health programs have lower  recidivism rates and are more likely to maintain health‐ conscious behaviors
  21. 21. Integration Benefits Inmates and Entire Community Opportunity to provide critical health services to those  at highest risk Vaccination helps prevent future infection/illness for  inmates Screening helps identify cases and prevent further  transmission to family members and the general  community i Translates into overall cost savings for the community
  22. 22. Integration eg a o ac es ca be de e ed ou Integration activities can be delivered without  significant cost or need for new resources Integrating screening for HCV in non‐traditional  Integrating screening for HCV in non‐traditional settings can be an important step in expanding access  to these services for those at highest risk Include questions about viral hepatitis screening,  vaccination and history of disease during the initial  y g client intake and/or health history
  23. 23. Integration Providing an integrated prevention message about viral  Providing an integrated prevention message about viral hepatitis, HIV, and STIs is a benefit to clients because it  treats them as a “whole person” Integration is most effective when it has become a  routine part of services offered p 1) All relevant forms (intake, medical history, reassessment,  etc) address viral hepatitis,  ) p , 2) Agency standards, policies and procedures outline  specific tasks to be performed by staff, and  3) Agency quality assurance activities monitor progress  toward meeting these standards
  24. 24. Integration There is no one size fits all approach to integration How and when integration is accomplished in your  How and when integration is accomplished in your agency depends on how your program is organized and  run Innovative programs across the country have reviewed all  aspects of their program’s operation and found many new  and creative ways to integrate viral hepatitis services
  25. 25. Lessons Learned Development of HIV/HCV co‐infection curriculum is  essential to meeting needs people living with both HIV  and HCV and HCV Programs specializing in HIV treatment and prevention  education can enhance their services and better meet the  needs of co‐infected clients through the adoption and  integration of a co‐infection curriculum integration of a co infection curriculum
  26. 26. Next StepsCreating HIV programs that are inclusive of hepatitis as well as other STIs  Providing easy‐to‐understand information helping non‐medical service providers to become part of the prevention/treatment/care continuum

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