Hepatitis C in Iowa Ra Randy Mayer, MS, MPH Chief, Bureau of HIV, - PowerPoint PPT Presentation

Hepatitis C in Iowa Ra Randy Mayer, MS, MPH Chief, Bureau of HIV, STD, and Hepatitis Iowa Department of Public Health Bureau of HIV, STD, and Hepatitis

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Epidemiology of HCV in Iowa 23,588 Iowans ever reported to IDPH as diagnosed with HCV • 15,510 people with evidence of confirmatory result • 8,078 people with antibody only results (75% to 85% are likely chronically infected) CDC estimate: 45 to 85% of people with HCV are undiagnosed IDPH estimates there are 39,215 to 149,173 Iowans with HCV • 17,647 to 126,797 of these people are undiagnosed Bureau of HIV, STD, and Hepatitis

Iowans with HCV Number of Iowans Diagnosed with HCV: 2000 through 2016 2500 2,235 2,113 2,287 2000 2,080 1,922 Number of Persons 1,826 1500 1,503 1,431 1,311 1,031 1000 815 890 741 724 784 754 500 183 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Bureau of HIV, STD, and Hepatitis

Disease Burden Comparison 2016 Diagnoses of Chlamydia, Gonorrhea, HCV, and HIV in Iowa 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Chlamydia Gonorrhea HCV HIV Bureau of HIV, STD, and Hepatitis

Iowans with HCV: 30 and Younger Number of Iowans 30 and Under Diagnosed with HCV: 2000 through 2016 400 347 350 303 301 279 300 Number of Persons 236 250 195 200 150 103 100 73 66 55 40 50 26 25 22 9 5 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Bureau of HIV, STD, and Hepatitis

Evidence of HCV Chronic Infection in Iowans Number of Iowans Reported with Antibody-only or Confirmatory HCV Test Result 2500 Confirmatory Antibody only 2000 Number of Persons 1500 1000 500 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Bureau of HIV, STD, and Hepatitis

Race and Ethnicity of Iowans with HIV and HCV Race and Ethnicity of Iowans with HCV Race and Ethnicity of Iowans with HIV 1% 1% 3% 2% 4% 9% 9% 22% 63% 85% Hispanic: 3% Black, NH: 9% Hispanic: 9% Black, NH: 63% White, NH: 22% White, NH: 85% Asian, NH: 1% American Indian/AL Native: 1% Asian, NH: 2% Multi-race: 4% Bureau of HIV, STD, and Hepatitis

Sex and Age of Iowans with HCV: 2000 - 2016 70% 63% 62% 60% 50% Percentage of Persons 40% 36% 30% 26% 20% 10% 7% 4% 0% Male Female Born after 1985 Born between Born between Born before 1966 and 1985 1945 and 1965 1945 Bureau of HIV, STD, and Hepatitis

HCV in Iowans 30 and Under Diagnosed in 2016 Race and Ethnicity of Iowans 30 and Under with HCV Sex at Birth of Iowans 30 and Under with HCV 1% 3% 5% 48% 52% 88% Hispanic/Latino, All Races Not Hispanic, White Male Female Not Hispanic, Black/African American Not Hispanic, Asian, Native Haw./PI, Amer. Indian/AL Native, or Multi-race 90% of people 30 and under diagnosed with HCV are 20 years of age or older • 67% of people 30 and under reported injection drug use to their diagnosing provider • Bureau of HIV, STD, and Hepatitis

Distribution of HCV in Iowa Case numbers shown in counties; rates indicated by color.

Distribution of HCV in Iowans Under 30 Distribution of HCV in people under 30 is more heavily focused on the south-central and eastern parts of the state.

Co-Infection of HIV and HCV • 11% of Iowans living with HIV (as of Dec. 31, 2016) have been diagnosed with HCV • HCV treatment meds were added to the Iowa AIDS Drug Assistance Program (ADAP) formulary in 2014 (eligibility = 400% FPL). • The ADAP can pay for treatment of HCV for people who are co-infected with HIV and denied treatment by Medicaid. Bureau of HIV, STD, and Hepatitis

National Elimination Strategy – 90% reduction in HCV incidence by 2030 Bureau of HIV, STD, and Hepatitis

HCV Treatment Cascade: United States Yehia et al., 2014 Bureau of HIV, STD, and Hepatitis

Determination of Need • Under the Consolidated Appropriation Act of 2016, federal law permits use of funds from the Department of Health and Human Services (SAMHSA, HRSA, CDC) to support syringe service programs EXCEPT that funds may not be used to purchase needles or syringes. • To use HHS funds for this purpose, eligible state, local, tribal, and territorial health departments must first consult with CDC and provide evidence that their jurisdiction is experiencing or at risk for significant increases in hepatitis infections or an HIV outbreak due to injection drug use. IDPH will be submitting a Determination of Need to CDC this fall. Bureau of HIV, STD, and Hepatitis

Contact Information Randy Mayer, MS, MPH Chief, Bureau of HIV, STD, and Hepatitis Iowa Department of Public Health randall.mayer@idph.iowa.gov (515) 242-5150 Bureau of HIV, STD, and Hepatitis