Jurisdictional Approach to Curing Hepatitis C within the Ryan White HIV/AIDS Program (RWHAP) Highlights, tips and tools webinar January 22, 2020 Sara Woody Public Health Analyst Office of Training and Capacity Development (OTCD), Special Projects of National Significance (SPNS) HIV/AIDS Bureau (HAB)
Agenda • HIV/AIDS Bureau (HAB) Vision and Mission • Introductions • Presentations • Question and Answer 2
HIV/AIDS Bureau Vision and Mission Vision Optimal HIV/AIDS care and treatment for all Mission Provide leadership and resources to assure access to and retention in high quality, integrated care, and treatment services for vulnerable people living with HIV and their families 3
Introductions • Today’s Presenters Dana Higgins, Dept. of Public Health, City of Philadelphia, PA DeLita Rose-Daniels, City of Hartford, Health & Human Services Department Nirah Johnson, NYC Health Department Courtney Gidengil, RAND Corporation Dan Czajka, Debbie Isenberg, Phil Melemed, NASTAD • HRSA Project Officers Marean Duarte, Philadelphia Part A Project Officer Durkia Hudson, Hartford Part A Project Officer Sera Morgan, NYC Part A Project Officer Travis Brookes, NASTAD and North Carolina Part B Project Officer Sara Woody, RAND Corp. Project Officer 4
Saying C YA to Hep C in Philly How Close Did We Get to Ending Hep C in PLWH & What Will it Take to Get There? Dana Higgins, MPH Danica Kuncio, MPH
C Ya: Philly’s Plan to End HCV in PLWH Jurisdictional Approach to Curing HCV Among HIV/HCV Co-Infected People of Color • 3-year HRSA/SPNS cooperative agreement; September 2016 – September 2019 E Data & L • C Who is Co-Infected Evaluation I M Training & • C ross train staff on HCV I Capacity Building N A Re-Engagement • C onnect PLWH to Cure in Care T I Service O • C ontinuity & Sustainability Integration N
Snapshot of Philadelphia EMA* HIV • 19,199 people living with HIV • Ryan White Part A supports network of services • 21 adult HIV care & 23 adult case management providers Hepatitis C (HCV) • Over 55,000 people living with HCV • Limited funding for viral hepatitis services • Hep C Allies of Philadelphia (HepCAP) Coalition HepCAP Town Hall in North Philadelphia HIV/HCV Co-Infection • Estimated 3,086 co-infected PLWH at start of C Ya in 2016 * Disease data limited to Philadelphia County due to surveillance limitations in surrounding EMA counties
C YA Activity: Data-Driven Quality Improvement Challenge: HRSA’s one-time HCV screening measure gives limited snapshot of HCV in PLWH Solution: Set a new 2017 QI measure to drive improvements to RNA test outcomes Describe HCV testing Review care sites’ protocols to see where best practices were/were not applied process Is PHL11 performance Low performing sites do a root cause analysis for barriers below 90%? Ongoing feedback via C Ya team provided feedback to help sites improve outcomes quarterly reports
C Ya Interventions: Increased HCV Testing and Treatment Capacity All 21 RW adult care sites in the EMA have at least 1 HCV treater onsite • Increased HCV treatment capacity in the Philadelphia EMA from 14 sites in 2016 and trained 89 providers HCV reflex testing ( HCV antibody with reflex testing to HCV RNA ) availability results in better viral load completion among Ab+ patients • C Ya activities encouraged all 21 RW care sites to standardize HCV reflex testing o 2016: 9 sites (43%) 2019: 19 sites (90%) Identify Coinfected PLWH who are Out of HIV Care • Leverage existing data-to-care infrastructure to relink PLWH to care Use DIS • Incorporate HCV care into HIV care plan • Increase in RNA testing for PLWH with a positive HCV antibody test result • 1 year after implementation, 19 RW care sites reported PHL11 performance greater than 90%
HCV Care Continuum is Improving PLWH & HCV Diagnosis Baseline (Dec 31, 2016) Sept 30, 2019 Sept 30, 2019 (Includes new HIV/HCV diagnosis) 100% 93% 2,813 3,238 90% 2,813 82% 67% of HCV 77% 80% RNA+ PLWH 73% 70% 60% of HCV cured RNA+ PLWH 38% of HCV 55% 60% 52% cured RNA+ PLWH cured 40% 28% 20% 0% HCV AB Positive Confirmatory HCV RNA Positive HCV Resolved RNA Test Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office & Viral Hepatitis Program
Confirmatory HCV RNA Testing Is Improving Data Snapshot: Individuals In HIV Care and Out of HIV Care P<.0001 P<.0001 P<.0001 In HIV Care: % Receiving HCV RNA Testing For those virally 95% 100% suppressed, having at 90% 88% 81% 80% least 1 viral load or CD4 73% 80% performed in the previous 365 days. For 60% those not virally 40% suppressed, having at least 2 viral load or 20% 613 1,474 270 391 1,776 742 CD4’s performed in the 0% previous 365 days. Ryan White Non-Ryan White Out of Care (RWHAP (Non- RWHAP) 2016 2019 Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office & Viral Hepatitis Program
HCV Cure Access Is Improving Data Snapshot: PLWH/HCV RNA+ In HIV Care and Out of HIV Care who Cured their HCV In HIV Care: For those virally suppressed, having P<.0001 P<.0001 P<.0001 100% at least 1 viral load or CD4 performed in 72% 80% % HCV Cured the previous 365 56% 60% days. For those not 47% 41% virally suppressed, 40% having at least 2 24% viral load or CD4’s 16% 20% performed in the 1,025 93 170 587 148 87 previous 365 days. 0% Ryan White Non-Ryan White Out of Care (RWHAP) (Non-RWHAP) 2016 2019 Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office & Viral Hepatitis Program
Key Successes • C Ya improved diagnosis and treatment of HCV in PLWH • 95% of HCV AB+ patients in the RW care system received confirmatory HCV RNA testing • 75% of HCV RNA+ patients in care in the RW care system were cured of their HCV HCV surveillance data is critical • Ability to assess scope of co-infection necessary to monitor progress towards micro- elimination Providers are open to integrating HCV into their practices • RW providers supported each other in building HCV capacity in our jurisdiction HRSA should continue to invest in HCV elimination – it is a feasible goal! • 12 of 21 RW HIV care sites are housed in community health centers or FQHC systems • Integrating HCV in Philadelphia has ripple effect benefitting high-need communities 13
Sustainability Philadelphia’s Sustainability Wish List for HRSA: • Promote reflex HCV testing as tool to improve HCV diagnosis • Recommend that all HIV care sites offer incorporate HCV treatment • Provide resources to encourage ongoing service integration of intersecting health issues • Our patients do not live in siloes so services to improve their care outcomes shouldn’t either! • Identify strategies to address drug user health and collaborate with other program areas: HEP, STD, Opioids, etc. 14
THANK YOU! Philadelphia Department of Public Health Viral Hepatitis Team AIDS Activities Coordinating Office C Ya & Data-to-Care Teams Community Partners HepCAP & the C Change Team MidAtlantic AETC Philadelphia Performance Site at Health Federation Philly’s HIV Service Providers Philadelphians living with HIV & Hep C National Partners HRSA Bureau of HIV/AIDS RAND
Project A t ACCE CCESS SS Ach chievi ving Comprehensive C Coverage E Early, Systematically, a and Sustainably Data t a to Car Care e
The Hartford TGA • Hartford, Middlesex and Tolland County • 16 Ryan White Part A Service Sites • 7 Hep- C Service Sites • 13 HRSA Defined Service categories • 3652 HIV positive individuals in the TGA • 631 Coinfected individuals in the TGA
HIV/ HCV CAREWare Screening Dependable Variable Hep C Free Community Link Retained Cured
Added ed HCV HCV Perfor ormance e Measures es
12 S 12 Service C Charges f for • HIV/HCV Patient Education track cking HCV c care a and • HIV/HCV Treatment Initiated outcom omes • HIV/HCV Adherence Assessment • HIV/HCV Adherence Support • HIV/HCV Adherence Advocacy • HIV/HCV Case Conference Cure Provider • HIV/HCV Referral to Supportive Service • HIV/HCV ID Service Face to Face • HIV/HCV Treated Complete Care Navigator • HIV/HCV Post Treatment Follow up 1 Team • HIV/HCV Post Treatment Follow up 2 • HIV/HCV Self Resolved without Treatment Nurse
Thank you Hartford CT TGA Project ACCESS DeLita Rose-Daniels rosed003@Hartford.gov
Project SUCCEED A Health Department Intervention to Eliminate Hepatitis C in People Living with HIV in NYC NYC Health Department Viral Hepatitis Program | HIV Care & Treatment Program
Hepatitis C (HCV) in People Living with HIV (PLWH), NYC 2015 NYC HIV/HCV Clinical Care Environment • Excellent health insurance access for PLWH • Few HCV medication coverage restrictions • Few clinical prescriber restrictions • Many experts in HIV/HCV care • Robust HIV and HCV surveillance systems 100% 79% 58% 27% 13% HIV/HCV coinfection Reported RNA Evaluated Initiated Cured HIV monoinfection with HCV positive for treatment ever treatment 15% of 81,664 PLWH HCV Care Continuum for HIV/HCV Co-infected Individuals, NYC 2015 ever had HCV
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