1 / 23

Sandra W. Roush, MT, MPH National Immunization Conference Nashville 5/2004

Hepatitis A and Hepatitis B Vaccination in High Risk Adults: Florida’s Experience with Integrating Services Accountability, Series Completion, and Early Program Evaluation. Sandra W. Roush, MT, MPH National Immunization Conference Nashville 5/2004. Holmes. Jackson. Escambia. H. o. l.

shayna
Download Presentation

Sandra W. Roush, MT, MPH National Immunization Conference Nashville 5/2004

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hepatitis A and Hepatitis B Vaccination in High Risk Adults: Florida’s Experience with Integrating ServicesAccountability, Series Completion, and Early Program Evaluation Sandra W. Roush, MT, MPH National Immunization Conference Nashville 5/2004

  2. Holmes Jackson Escambia H o l m e s Santa Rosa J a c k s o n S a n t a R o s a Nassau W a l t o n Okaloosa Walton Washington Gadsden N a s s a u W a s h i n g o G a d s d e n Leon Hamilton Jefferson H a m i l t o n Madison Calhoun L e o n M a d i s o n J e f f e r s o n Duval B a k e r Baker D u v a l Liberty Suwannee Columbia Wakulla S u w a n n e e Taylor C o l u m b i a W a k u l l a Clay T a y l o r Bay Union Lafayette St. John’s U n i o n C l a y Gulf Bradford L a f a y e t t e Franklin S t J o h n s Florida: The Sunshine State B r a d f o r d F r a n k l i n Gilchrist i l c h r i s t Alachua A l a c h u a Putnam P u t n a m Dixie Flagler F l a g l e r Levy Marion M a r i o n Volusia V o l u s i a Citrus C i t r u s L a k e Sumter Lake Seminole S e m i n o l e u m t e r Hernando Orange O r a n g e B r e v a r d Pasco • 17+ million population • 67 counties ( 9 funded ) • Hepatitis A rates 5.89 (2001), 5.32 (2002), and 1.94 (2003) per 100,000 • Hepatitis B rates 3.45 (2001), 3.25 (2002), and 3.15 (2003) • Estimates indicate over 300,000 Floridians infected with hepatitis C Osceola Hillsborough i l l s b o r o u g h Polk Brevard O s c e o l a Pinellas P o l k Indian River I n d i a n R i v e r Manatee Okeechobee Hardee H a r d e e O k e e c h o b e e St. Lucie M a n a t e e S t L u c i e Highlands Desoto H i g h l a n d s D e S o t o Sarasota Martin r o t a Charlotte Glades C h a r l o t e t G l a d e s Hendry Palm Beach Lee P a l m B e a c h Broward Collier B r o w a r d Monroe Miami- Dade D a d e

  3. Florida’s Hepatitis (A, B, C) Program • Providing leadership, policy development, and technical assistance • Development of a comprehensive prevention plan • Counseling and testing services • Vaccination for adults • Patient care services • Prevention initiatives • Allocating state hepatitis resources

  4. Florida’s Statewide High Risk Adult Hepatitis Immunization Program • Initial purchase Dec. 2000 with carry over funds • 30,120 doses B ($ 700,290) • 946 doses A ($ 15,306) • Subsequent purchases: state and federal • Eligibility: adult high risk (STD, HIV, family planning, jail, outreach, epidemiology, immunization, hepatitis, etc.) • Statewide memos March 2001 and Dec. 2002 • NO CHARGE TO CHD OR CLIENT • Current monthly average for vaccine shipment : 1,175 hepatitis A; 2,163 hepatitis B

  5. Florida Adult Hepatitis Vaccine Management 2000 – 2003 $ 1,828,151 $ 812,289 79,492 46,470 Number of Doses 70,211 40,332 68,974 34,167 • * Combined vaccine was also purchased: 2,330 doses ($ 82,374)

  6. CY 2003 Adult Program Hepatitis A Vaccine Accountability* • 96 % hepatitis A vaccine accountability • 18,288 total doses required accountability • 5,526 doses in CHD refrigerators 1/1/03 • 12,901 doses distributed • 139 doses wasted • 17,746 total doses in accounting • 13,835 coded/used • 3,911 in CHD refrigerators 12/31/03 * 820 doses (4%) unaccounted

  7. CY 2003 Adult Program Hepatitis B Vaccine Accountability* • 96 % hepatitis B vaccine accountability • 35,033 total doses required accountability • 5,573 doses in CHD refrigerators 1/1/03 • 29,823 doses distributed • 363 doses wasted • 34,536 total doses in accounting • 29,567 coded/used • 4,969 in CHD refrigerators 12/31/03 * 1,499 doses (4%) unaccounted

  8. Adult Hepatitis A Vaccine Used/Coded November 1, 2000 to December 31, 2003

  9. Hepatitis A Vaccine Doses and Series Completion in High Risk Adults: 67 Counties 25% 15% Number of Doses 20%

  10. Hepatitis A Number of Doses and Series Completion in High Risk Adults: Selected Counties CY 2001 CY 2002 CY 2003 Number of Doses

  11. Adult Hepatitis B Vaccine Used/Coded November 1, 2000 to December 31, 2003 *Funded Counties 31% hepatitis B series completion during this time period **Unfunded Counties 25% hepatitis B series completion during this time period

  12. Hepatitis B Vaccine Doses and Series Completion* in High Risk Adults: 67 counties 53% 57% 51% 52% Number of Doses 50% 48% *Series Completion: 2001 (24%); 2002 (27%); 2003 (30%)

  13. Hepatitis B Vaccine Doses and Series Completion in High Risk Adults:Selected Counties CY 2002 CY 2001 CY 2003 Number of Doses

  14. Adult Hepatitis Vaccine and Testing Program: Early Program Evaluation • Chart review process similar to quality improvement • Clients seen Nov 1, 2001- Oct 31, 2002 • Demographics, doses received/dates, test results, results received, risk factors, medical/social referral • As of 11/6/2003, 1,541 charts reviewed in 11 counties • 9 site types (family planning, general, hepatitis, HIV, immunization, outreach, primary care, TB, STD) • Randomly selected charts within clinic type • Number of charts selected is based on county population contribution

  15. Clients’ Use of Hepatitis A Vaccine November 1, 2001 – October 31, 2002 • Dose 1 • 54 % of lab eligible (228/419) • 26 % of risk assessment eligible (341/1309) • 72 % of HCV positive (52/72) • Dose 2 • 30 % of lab eligible (125/419) • 13 % of risk assessment eligible (175/1309) • 49 % of HCV positive (35/72)

  16. Clients’ Use of Hepatitis B VaccineNovember 1, 2001 – October 31, 2002 • Dose 1 • 58 % of lab eligible (288/501) • 35 % of risk assessment eligible (451/1309) • 72 % of HCV positive (52/72) • Dose 2 • 42 % of lab eligible (210/501) • 24 % of risk assessment eligible (309/1309) • 57 % of HCV positive (41/72) • Dose 3 • 25 % of lab eligible (126/501) • 14 % of risk assessment eligible (184/1309) • 39% of HCV positive (28/72)

  17. Date Appropriate Hepatitis Vaccination* November 1, 2001 – October 31, 2002 • Hepatitis A • 25 % of lab eligible (103/419) • 12 % of risk assessment eligible (160/1309) • 35 % of HCV positive (25/72) • Hepatitis B • 25 % of lab eligible (123/501) • 16 % of risk assessment eligible (205/1309) • 31 % of HCV positive (22/72) * Among those starting vaccine

  18. Date-Appropriate Adult Hepatitis A Vaccination by Clinic Site

  19. Date-Appropriate Adult Hepatitis B Vaccination by Clinic Site

  20. Hepatitis Testing for Florida Adults at Risk • Statewide ABC panel (“chronic panel”) • Hepatitis A (anti-HAV total) added 2/9/04 • Hepatitis B (HBsAg, HBsAb, HBcAb) • HCV • Anti-HCV with signal-to-cut-off ratio • Polymerase chain reaction (PCR) and/or recombinant immunoassay (RIBA™) • Pricing considerations • Medicaid • Signal-to-cut-off ratio

  21. Florida Chronic Hepatitis Testing Program: Results Summary* • Number (percent) based on n=26,241 “chronic panels” Jan. 2001 – Dec. 2003

  22. Hepatitis Integration Guidance

  23. Next Steps: Florida’s Adult Hepatitis A and B Immunization Program • Vaccine accountability mechanisms • Coverage assessment • Evaluation • Feasibility • Cost effectiveness/efficiency • Expand to additional clinics and other sites • Ensure a reliable vaccine supply

More Related