May 19 is Hepatitis Testing Day in the United States and provides an opportunity to raise awareness of the importance of screening for hepatitis B and C. It is estimated that up to 5 million Americans have viral hepatitis, but less than a third of people with chronic hepatitis B and just half of those with chronic hepatitis C (HCV) are aware of their status (see endnote). Local health departments are critical safety net providers for populations disproportionately affected by viral hepatitis, playing a critical role in identifying affected individuals and linking them to care, addressing health inequities, and reducing health disparities related to viral hepatitis outcomes.
In this interview, Fabienne Laraque, MD, MPH, Director of the Viral Hepatitis Program at the New York City Department of Health and Mental Hygiene, shares how her team is engaging key stakeholders and developing innovative strategies to address viral hepatitis in New York City.
What is New York City Department of Health and Mental Hygiene doing to identify viral hepatitis throughout the city?
All newly diagnosed cases of hepatitis B and C are reported to the Department of Health electronically. However, the difficulty in identifying persons with hepatitis rests in finding those that have few or no symptoms and are not yet diagnosed. To increase the proportion of persons who are aware of their infection, the Department is taking several steps to:
- Increase public awareness of the need for testing through awareness campaigns, social media and material dissemination, provide information on testing sites, and maintain a “NYC Liver Health” mobile app available on Android and iPhone that offers a screening questionnaire, search functionality for testing sites, and information on hepatitis;
- Increase provider awareness with our City Health Information publications (Hepatitis B; Hepatitis C), provider HCV screening toolkit, and the creation of an HCV Clinical Provider Network and website;
- Facilitate community engagement with the Hep Free NYC network, a professional community capacity building coalition comprised of the NYC Hep B Coalition and the NYC Hep C task Force; and
- Promote and directly work with clinicians and laboratories to increase RNA confirmation by stressing the importance of and providing technical assistance to implement reflex RNA testing.
What partners have been important in this work?
A number of internal and external partners are necessary for this work including clinical providers, hospitals, federally qualified health centers (FQHCs), community organizations, legislators, funders (private and governmental), patients, and advocates. Internal partners such as other department of health programs (Alcohol and Drug Use Prevention, HIV, STD, Primary Care, Communications, Inter-Governmental Affairs) and other government agencies (state, federal health agencies) are also critical.
What challenges have you encountered?
There is very limited funding and staffing to address viral hepatitis which is a challenge across the country. Patients, providers, and government agencies also face competing priorities. And despite the large burden of hepatitis, there continues to be a lack of awareness at all levels.
What successes have you experienced?
We were able to obtain a Centers for Medicaid and Medicare Services (CMS) Innovation Award to implement a demonstration project of HCV care coordination and tele-mentoring and develop a payment model. We also obtained funding from several drug companies to implement demonstration or research projects on linkage to care, patient navigation, and provider organizing and education. The viral hepatitis provider community has also successfully led local advocacy efforts that resulted in funding from the local legislature for hepatitis B and C patient navigation programs offering education, linkage to care, and care coordination services. These efforts and progress were followed by sustained funding from the government of the city of New York for almost a dozen staff lines ensuring the availability of a level of effort never seen before. We have a well-functioning and complete surveillance system and produce a detailed annual report with a profile of the epidemic as well as information on our programs.
Are you marking National Hepatitis Testing Day with any testing or awareness events?
Yes, there was a Hep Free NYC awareness event on the steps of New York City Hall, with representatives of a number of organizations, patients and advocates. We also developed a press release, internal department of health announcement, and social media postings for the month of May.
The Institute of Medicine (IOM) of the National Academies of Sciences, Engineering and Medicine recently released the report titled Eliminating the Public Health Problem of Hepatitis B and C in the United States. What role do you think local health departments play in eliminating viral hepatitis?
Local departments are likely in touch with their community and are in good position, given enough resources, to improve awareness both by providers and the public; facilitate linkage to care; and possibly educate providers on screening, linkage to care, and the success of the new treatments. They can also investigate barriers to testing and care and use this knowledge to reduce the barriers. Local departments of health can also create coalitions of providers (clinical and non-clinical), advocates, and patients to raise awareness and exchange ideas.
Do you have any advice for other local health departments looking to start or expand screening for hepatitis in their jurisdictions?
It is important to work with other programs that serve persons with or at-risk for viral hepatitis such as HIV programs and alcohol and drug use prevention. This will vary by department of health, so know your department and be open, creative and not shy about proposing collaboration. Forming a local coalition and inviting funders, both from industry and the non-profit sector, is a critical approach to addressing viral hepatitis.
I also recommend writing grants and starting small. One small grant might bring one staff and that may lead to another grant and so forth. Be creative when writing a grant: a project can be written as a demonstration project, program implementation, or research. Collecting and analyzing local data is also essential. This will help with advocacy and grant-writing. It is a good idea to present the data overall and by neighborhood—a simple map can tell an important story. If you don’t have epidemiologists, program planners or evaluators on board, contact universities in the area: MPH and PhD students can be a great help in getting projects done. Collaborate with academic providers and meet with relevant departments within universities.
- Institute of Medicine. (2016). Eliminating the Public Health Problem of Hepatitis B and C in the United States. Retrieved May 10, 2016 from http://nationalacademies.org/HMD/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx.