Your SlideShare is downloading. ×
0
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
slides
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

slides

215

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
215
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Riverside STD Clinic, Manhattan Race/Ethnicity 36% Black 32% Hispanic 18% White 10% Mixed Race/Other/Unknown 2% Asian/Pacific Islander VHIP project coordinator on site
  • Be sure to emphasize that this number is not UNIQUE individuals but number of visits 7292 are unique individuals who have been served by the VHIP
  • VHIP Return rates are comparable and perhaps slightly better than in similar venues and urban areas
  • Not necessary: Prior to August of 2002, all patients receiving b vaccine were also screened for surface antigen and core antibody However, our overall percentage of exposure is 19% and the CDC recommendation for pre-vaccination screening is a baseline prevalence of 30%, we no longer offering routing screening but selected screening to IDU, MSM, HIV+, liver disease
  • In 2002 at the Riverside Clinic 7% (42/588) reported IDU history during hepatitis C pre-test 0.3% (14/4,085) reported IDU history during HIV pre-test
  • Information was collected for ALL 249 IDU patients Found 98% of charts, laboratory/HIV log book (6) FYI – no significant differences in service utilization or diagnosis between current and former users
  • Hepatitis is a large health burden for this population
  • Riverside: 2% of those testing are HIV+
  • 16% (39) Symptomatic: if patient complained of STD symptoms regardless of other reasons for visit 25% (63) Other reason: HIV test, asymptomatic check-up, etc.
  • Why? Remember there is still stigma attached to IDU. Also a physician is seen as an authority figure … someone you want to please. Finally, the physician in this clinic is the first person to see the patient and the first to ask the question. By the time they reach a counselor – they have had time to think about the question. Also, the counselor is probably seen as less official, more like a peer.
  • Transcript

    • 1. Utilization of Integrated Hepatitis Services Among People with a History of Injection Drug Use in an STD Clinic 2004 National STD Prevention Conference Robin R. Hennessy Karen Schlanger, MPH Isaac Weisfuse, MD, MPH New York City Department of Health and Mental Hygiene
    • 2. Overview <ul><li>Viral Hepatitis Integration Project (VHIP) in NYC </li></ul><ul><li>Research Question </li></ul><ul><li>Methods </li></ul><ul><li>Study Population </li></ul><ul><li>Results </li></ul><ul><li>Conclusions </li></ul>
    • 3. VHIP Project Description <ul><li>Integrate viral hepatitis services in an STD/HIV clinic setting </li></ul><ul><li>Evaluate the impact of integration </li></ul><ul><li>Viral hepatitis services Include: </li></ul><ul><ul><li>Hepatitis A vaccine </li></ul></ul><ul><ul><li>Hepatitis B vaccine (limited screening) </li></ul></ul><ul><ul><li>Hepatitis C counseling, testing and referral </li></ul></ul>
    • 4. Clinic and VHIP Census May 2000 – August 2003 <ul><li>Nearly 40,000 visits </li></ul><ul><ul><li>not unique patients </li></ul></ul><ul><li>7,292 individual patients received a hepatitis service </li></ul>
    • 5. Vaccine Delivery <ul><li>Hepatitis A </li></ul><ul><ul><li>2,223 doses given (1,674 1 st doses) </li></ul></ul><ul><ul><li>35% completed 2 dose series </li></ul></ul><ul><li>Hepatitis B </li></ul><ul><ul><li>10,860 doses given (5,829 1 st doses) </li></ul></ul><ul><ul><li>53% returned for second dose </li></ul></ul><ul><ul><li>29% completed 3 dose series </li></ul></ul>
    • 6. Screening Services <ul><li>Hepatitis B </li></ul><ul><ul><li>4,641 patients screened </li></ul></ul><ul><ul><li>2% (92) chronic carriers </li></ul></ul><ul><ul><li>17% (799) immune (due to past exposure not prior vaccination) </li></ul></ul><ul><li>Hepatitis C </li></ul><ul><ul><li>2,559 patients screened </li></ul></ul><ul><ul><li>8% (203) anti-HCV+ </li></ul></ul><ul><ul><li>1999 Clinic Seroprevalence Study: 2% </li></ul></ul>
    • 7. Research Questions <ul><li>Does integrated hepatitis services bring new clients to the STD clinic – specifically injection drug users (IDU)? </li></ul><ul><li>Do these “new” clients utilize traditional STD/HIV services? </li></ul>
    • 8. Methods Data Collection <ul><li>VHIP Database </li></ul><ul><ul><li>Hepatitis Services (vaccine, lab results) </li></ul></ul><ul><ul><li>Risk Assessments </li></ul></ul><ul><li>Medical Record Review </li></ul><ul><ul><li>Reason for visit (symptoms, HIV, etc.) </li></ul></ul><ul><ul><li>Have an STD exam </li></ul></ul><ul><ul><li>IDU risk assessment </li></ul></ul><ul><ul><li>STD/HIV (tests, results, diagnosis) </li></ul></ul>
    • 9. Study Population May 2000 – August 2003 <ul><li>3% (249/7,292) of patients receiving hepatitis services reported a history of IDU </li></ul><ul><ul><li>19% (48/249) of these patients report current use </li></ul></ul>
    • 10. Hepatitis Vaccine Among IDU (N=249) <ul><ul><li>29% (73) received the 1 st dose of hepatitis A vaccine </li></ul></ul><ul><ul><li>71% (177) received the 1 st dose of hepatitis B vaccine </li></ul></ul>
    • 11. Hepatitis Screening Among IDU (N=249) <ul><ul><li>67% (166) tested for hepatitis B </li></ul></ul><ul><ul><ul><li>45% (75/166) with evidence of past exposure </li></ul></ul></ul><ul><ul><ul><ul><li>Clinic wide: 19% past exposure </li></ul></ul></ul></ul><ul><ul><li>73% (181) tested for hepatitis C </li></ul></ul><ul><ul><ul><li>57% (103/181) anti-HCV+ </li></ul></ul></ul><ul><ul><ul><ul><li>Clinic wide: 8% </li></ul></ul></ul></ul><ul><ul><ul><ul><li>1999 Clinic Seroprevalence Study: 2% </li></ul></ul></ul></ul>
    • 12. STD Services Among IDU (N=249) <ul><ul><li>76% (188) were interviewed by a physician </li></ul></ul><ul><ul><ul><li>Physician documented a history of IDU for 44% (82/188) of these patients </li></ul></ul></ul><ul><ul><li>55% (138) had an STD exam </li></ul></ul><ul><ul><ul><li>40% (55/138) diagnosed with an STD </li></ul></ul></ul><ul><ul><li>49% (122) were tested for HIV </li></ul></ul><ul><ul><ul><li>5% (6/122) tested positive </li></ul></ul></ul><ul><ul><ul><li>8% (20/249) known to be HIV+ </li></ul></ul></ul>
    • 13. Results Reason for Visit Among IDU (N=249) <ul><ul><li>59% (147) of IDU are known to have visited the STD clinic specifically for hepatitis services </li></ul></ul><ul><ul><ul><li>56 vaccine only </li></ul></ul></ul><ul><ul><ul><li>60 requested hepatitis services on intake (alone or in combination with other requested STD services) </li></ul></ul></ul><ul><ul><ul><li>31 referred from DTC for HCV testing </li></ul></ul></ul>
    • 14. <ul><ul><li>After excluding IDU clients who came to the STD clinic for vaccine: </li></ul></ul><ul><ul><ul><li>80% (73/91) received an STD service in addition to their hepatitis service </li></ul></ul></ul><ul><ul><ul><ul><li>64% were tested for HIV </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>3.8% tested positive </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>(all reported previous HIV- results) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>53% had an STD exam </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>22% were diagnosed with an STD </li></ul></ul></ul></ul></ul><ul><ul><li>Results </li></ul></ul>
    • 15. <ul><ul><li>Small number of participants </li></ul></ul><ul><ul><li>Based on self-report of IDU risk </li></ul></ul><ul><ul><li>No baseline data on IDU utilization of the STD clinic </li></ul></ul><ul><ul><li>Limitations </li></ul></ul>
    • 16. <ul><ul><li>Integrated hepatitis services appear to be an incentive for IDU clients to visit the STD clinic </li></ul></ul><ul><ul><ul><li>Almost 60% of IDU came specifically for hepatitis services </li></ul></ul></ul><ul><ul><li>Conclusions </li></ul></ul>
    • 17. <ul><li>Physicians do not consistently identify IDU risk </li></ul><ul><ul><ul><li>Nearly half of IDU clients were NOT identified by the physician </li></ul></ul></ul><ul><ul><ul><li>Implication … </li></ul></ul></ul><ul><ul><ul><li>Only 29% of IDU received the recommended vaccine for hepatitis A </li></ul></ul></ul>Conclusions
    • 18. <ul><ul><li>Staff (including physicians) recently received training from the Harm Reduction Coalition on strategies to elicit risk factors for drug use </li></ul></ul><ul><ul><li>Re-emphasize to staff that anyone who is able to ascertain drug use should recommend ALL appropriate services (hepatitis A vaccine, etc.) </li></ul></ul><ul><ul><li>Increase number of STD clinics where IDU clients can access hepatitis services </li></ul></ul><ul><ul><li>Improve outreach and advertising of hepatitis services in DTC, SEP and CBO that provide support to IDU populations </li></ul></ul><ul><ul><li>Next Steps </li></ul></ul>
    • 19. Acknowledgements <ul><ul><li>Susan Blank, MD, MPH </li></ul></ul><ul><ul><li>Assistant Commissioner </li></ul></ul><ul><ul><li>Bureau of STD Control </li></ul></ul><ul><ul><li>Alan Dunn, MD </li></ul></ul><ul><ul><li>Physician in Charge </li></ul></ul><ul><ul><li>Riverside STD Clinic </li></ul></ul><ul><ul><li>Riverside STD Clinic Staff </li></ul></ul><ul><ul><li>Centers for Disease Control &amp; Prevention </li></ul></ul><ul><ul><li>Division of Viral Hepatitis </li></ul></ul>
    • 20. Contact Information <ul><ul><li>Robin R. Hennessy </li></ul></ul><ul><ul><li>NYC DOHMH </li></ul></ul><ul><ul><li>Bureau of STD Control </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>New York City Department of Health and Mental Hygiene </li></ul>

    ×