The District of Columbia continues to experience a severe epidemic of viral hepatitis with significant impact on the health and well-being of its residents. Between 2015 and 2019, 1,750 new cases of chronic hepatitis B (HBV) were reported. In 2019, the crude rate of chronic HBV was 42.9 cases per 100,000 population. With 98% of the cases among adults over the age of 20 years old, these cases were preventable by vaccine. Between 2015 and 2019, 15,811 cases of chronic hepatitis C (HCV) were reported, of which 6,671 (42.2%) represented new diagnoses. The crude rate of newly diagnosed chronic HCV within the District in 2019 was 156.5 cases per 100,000. While a slight increase has been observed in recent years, the rate of hepatitis A in the District of Columbia based on data reported to the Centers for Disease Control and Prevention (CDC) remains relatively low (1.6 cases per 100,000 population). The District maintained a high rate of hepatitis related deaths compared to the nation, significant of potential missed opportunities for preventing the adverse long-term sequelae associated with untreated infection.
The purpose of this application is to advance an end of the hepatitis epidemics in the District of Columbia through active surveillance, collaborations with clinical and community-based partners on testing and treatment, and innovative strategies to engage focus populations. Overall, the project will leverage epidemiological data to increase testing, accelerate linkage to care, and enhance treatment options for hepatitis and substance use disorder.
In five years, the District expects to achieve measurable progress to ending the hepatitis epidemics. Under surveillance, the District will increase reporting and completeness of data for adult and perinatal HBV and HCV, develop an outbreak response plan for applicable hepatitis viruses, and systematically monitor trends to inform program interventions. Under prevention, the District will increase testing (including automatic reflex testing), treatment prescribing and completion, and focus activities for people who use drugs, including use of SSPs, substance use treatment, vaccination, and integrated services. To achieve these outcomes, the District will engage community stakeholders, develop a hepatitis elimination plan, and address emerging conditions with flexibility and responsiveness.
The DC Department of Health (DC Health) will leverage its existing working partnerships across government, jurisdictions, academic/research, community providers, education, and consumer and stakeholder groups. DC Health maintains partnerships with an extensive network of culturally diverse community providers, including hospitals, medical practices, federally quality health centers (FQHCs), and non-clinical community-based organizations, including syringe service and substance use treatment providers. DC Health has strong connections with people who use drugs through its robust peer network programs. It has current and prospective highly expert, dedicated, and innovative team members. DC commits to a robust evaluation, specific metrics, and continuous quality improvement to ensure effective results and operations. HAHSTA will utilize its capacity building resources for community partners and staff.
The District has the foundational framework, robust collaborative partnerships, and willingness to promote innovative approaches to strengthen its surveillance, prevention, and program approaches for populations with the highest risk behavior for HBV and HCV. The District is committed to develop a plan leveraging the critical tools of testing, linkage to care, vaccination, and treatment to achieve an end to the hepatitis epidemics.
