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

Fi Find th these docume ments ts at: t: http tps:/ ://idph.iowa.gov/hivstdhep ep/hep ep

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

754 815 183 741 1,311 784 890 1,031 1,431 724 1,503 1,826 1,922 2,113 2,080 2,235 2,287 500 1000 1500 2000 2500 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Number of Persons

Number of Iowans Diagnosed with HCV: 2000 through 2016

Bureau of HIV, STD, and Hepatitis

Disease Burden Comparison

2,000 4,000 6,000 8,000 10,000 12,000 14,000 Chlamydia Gonorrhea HCV HIV

2016 Diagnoses of Chlamydia, Gonorrhea, HCV, and HIV in Iowa

Bureau of HIV, STD, and Hepatitis

Iowans with HCV: 30 and Younger

5 9 1 22 26 25 40 55 66 73 103 195 236 301 279 303 347

50 100 150 200 250 300 350 400 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Number of Persons

Number of Iowans 30 and Under Diagnosed with HCV: 2000 through 2016

Bureau of HIV, STD, and Hepatitis

Evidence of HCV Chronic Infection in Iowans

500 1000 1500 2000 2500 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Number of Persons

Number of Iowans Reported with Antibody-only or Confirmatory HCV Test Result

Confirmatory Antibody only

Bureau of HIV, STD, and Hepatitis

Race and Ethnicity of Iowans with HIV and HCV

Bureau of HIV, STD, and Hepatitis

9% 22% 63% 2% 4%

Race and Ethnicity of Iowans with HIV

Hispanic: 9% Black, NH: 63% White, NH: 22% Asian, NH: 2% Multi-race: 4%

3% 9% 85% 1% 1%

Race and Ethnicity of Iowans with HCV

Hispanic: 3% Black, NH: 9% White, NH: 85% Asian, NH: 1% American Indian/AL Native: 1%

Sex and Age of Iowans with HCV: 2000 - 2016

62% 36% 7% 26% 63% 4%

0% 10% 20% 30% 40% 50% 60% 70%

Male Female Born after 1985 Born between 1966 and 1985 Born between 1945 and 1965 Born before 1945

Percentage of Persons

Bureau of HIV, STD, and Hepatitis

HCV in Iowans 30 and Under Diagnosed in 2016

3% 88% 5% 1%

Race and Ethnicity of Iowans 30 and Under with HCV

Hispanic/Latino, All Races Not Hispanic, White Not Hispanic, Black/African American Not Hispanic, Asian, Native Haw./PI, Amer. Indian/AL Native, or Multi-race

52% 48%

Sex at Birth of Iowans 30 and Under with HCV

Male Female

• 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

Bureau of HIV, STD, and Hepatitis

Yehia et al., 2014

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