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Overview

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. Overview.

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Overview

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  1. Utilization of Integrated Hepatitis Services Among People with a History of Injection Drug Use in an STD Clinic2004 National STD Prevention ConferenceRobin R. HennessyKaren Schlanger, MPHIsaac Weisfuse, MD, MPHNew York City Department of Health and Mental Hygiene

  2. Overview Viral Hepatitis Integration Project (VHIP) in NYC Research Question Methods Study Population Results Conclusions

  3. VHIPProject Description Integrate viral hepatitis services in an STD/HIV clinic setting Evaluate the impact of integration Viral hepatitis services Include: Hepatitis A vaccine Hepatitis B vaccine (limited screening) Hepatitis C counseling, testing and referral

  4. Clinic and VHIP CensusMay 2000 – August 2003 Nearly 40,000 visits not unique patients 7,292 individual patients received a hepatitis service

  5. Vaccine Delivery Hepatitis A 2,223 doses given (1,674 1st doses) 35% completed 2 dose series Hepatitis B 10,860 doses given (5,829 1st doses) 53% returned for second dose 29% completed 3 dose series

  6. Screening Services Hepatitis B 4,641 patients screened 2% (92) chronic carriers 17% (799) immune (due to past exposure not prior vaccination) Hepatitis C 2,559 patients screened 8% (203) anti-HCV+ 1999 Clinic Seroprevalence Study: 2%

  7. Research Questions Does integrated hepatitis services bring new clients to the STD clinic – specifically injection drug users (IDU)? Do these “new” clients utilize traditional STD/HIV services?

  8. MethodsData Collection VHIP Database Hepatitis Services (vaccine, lab results) Risk Assessments Medical Record Review Reason for visit (symptoms, HIV, etc.) Have an STD exam IDU risk assessment STD/HIV (tests, results, diagnosis)

  9. Study PopulationMay 2000 – August 2003 3% (249/7,292) of patients receiving hepatitis services reported a history of IDU 19% (48/249) of these patients report current use

  10. Hepatitis Vaccine Among IDU (N=249) 29% (73) received the 1st dose of hepatitis A vaccine 71% (177) received the 1st dose of hepatitis B vaccine

  11. Hepatitis Screening Among IDU (N=249) 67% (166) tested for hepatitis B 45% (75/166) with evidence of past exposure Clinic wide: 19% past exposure 73% (181) tested for hepatitis C 57% (103/181) anti-HCV+ Clinic wide: 8% 1999 Clinic Seroprevalence Study: 2%

  12. STD Services Among IDU (N=249) 76% (188) were interviewed by a physician Physician documented a history of IDU for 44% (82/188) of these patients 55% (138) had an STD exam 40% (55/138) diagnosed with an STD 49% (122) were tested for HIV 5% (6/122) tested positive 8% (20/249) known to be HIV+

  13. ResultsReason for Visit Among IDU(N=249) 59% (147) of IDU are known to have visited the STD clinic specifically for hepatitis services 56 vaccine only 60 requested hepatitis services on intake (alone or in combination with other requested STD services) 31 referred from DTC for HCV testing

  14. Results After excluding IDU clients who came to the STD clinic for vaccine: 80% (73/91) received an STD service in addition to their hepatitis service 64% were tested for HIV 3.8% tested positive (all reported previous HIV- results) 53% had an STD exam 22% were diagnosed with an STD

  15. Limitations Small number of participants Based on self-report of IDU risk No baseline data on IDU utilization of the STD clinic

  16. Conclusions Integrated hepatitis services appear to be an incentive for IDU clients to visit the STD clinic Almost 60% of IDU came specifically for hepatitis services

  17. Conclusions Physicians do not consistently identify IDU risk Nearly half of IDU clients were NOT identified by the physician Implication … Only 29% of IDU received the recommended vaccine for hepatitis A

  18. Next Steps Staff (including physicians) recently received training from the Harm Reduction Coalition on strategies to elicit risk factors for drug use Re-emphasize to staff that anyone who is able to ascertain drug use should recommend ALL appropriate services (hepatitis A vaccine, etc.) Increase number of STD clinics where IDU clients can access hepatitis services Improve outreach and advertising of hepatitis services in DTC, SEP and CBO that provide support to IDU populations

  19. Acknowledgements Susan Blank, MD, MPH Assistant Commissioner Bureau of STD Control Alan Dunn, MD Physician in Charge Riverside STD Clinic Riverside STD Clinic Staff Centers for Disease Control & Prevention Division of Viral Hepatitis

  20. Contact Information Robin R. Hennessy NYC DOHMH Bureau of STD Control rhenness@health.nyc.gov New York City Department of Health and Mental Hygiene

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