Background: San Francisco (SF) is profoundly impacted by the hepatitis C virus
(HCV), with approximately 2.5% of the general population seropositive for HCV as of 2015,
and a chronic rate of hepatitis B virus (HBV) that is 3 times that of the statewide rate in CA.
Purpose: Our purpose in responding to RFA-PS21-2103 is to respond to our continuing
challenges with viral hepatitis in SF by 1) increasing analysis and reporting of chronic and
perinatal HCV and chronic HBV infection, undetectable HCV RNA, and HBV DNA laboratory
results; 2) improving our ability to analyze and publicly disseminate information about viral
hepatitis in SF on an annual basis; and 3) enhancing the effectiveness of existing viral hepatitis
prevention activities by leveraging our longstanding collaborations with community providers
and coalitions to increase access to HBV and HCV testing in high-impact settings.
Focus: As successful as SF has been in implementing cutting-edge, evidence-based
interventions to work toward elimination of HBV and HCV, SFDPH data reveals that
Blacks/African Americans, people who are unhoused, baby boomers, men who have sex with
men (MSM), trans women, and people who inject drugs (PWID) are likely to be infected with
HCV or HBV. For Components I and II of this proposal, our focus continues to be on these highprevalence
populations, utilizing a health equity approach to address identified health disparities
and their underlying social determinants, including homelessness and incarceration.
Staffing: The Principal Investigator for both components will be Tomás Aragón, MD,
DrPH, the Health Officer of SF. He will be accountable for overall planning, implementation,
monitoring, and reporting. Component I will be overseen by Juliet Stoltey, MD, Director of
Communicable Disease Control and Prevention (CDCP), with the support of Melissa Sanchez,
PhD, Director of Viral Hepatitis Surveillance, and a to-be-hired Epidemiologist II who will
coordinate the day-to-day activities. Component II will be overseen by Katie Burk, MPH, the
Viral Hepatitis Coordinator, who will be responsible for overseeing the planning and
implementation of HBV elimination activities within SFDPH, in partnership with Richard So,
MPH, the Executive Director of SF Hep B Free – Bay Area, and a to-be-hired End Hep C SF
Strategic Director, who oversee the planning and implementation of HCV elimination activities.
Component I Summary of Strategies and Activities: 1) Review existing outbreak plans in
other US jurisdictions and formalize a set of outbreak plans for HAV, HBV, and HCV in SF;
2) Begin to collect and analyze results of negative HCV RNA tests; and 3) Build a system for
regular, public reporting of our viral hepatitis data for HAV, HBV, and HCV: with these funds
we will start releasing annual public reports of HAV, HBV, and HCV in SF, similar to what is
currently done with other diseases in SF.
Component II Summary of Strategies and Activities: 1) Support viral hepatitis
elimination planning by hiring an End Hep C SF Strategic director to support existing HCV
elimination activities, therefore freeing up the city's Viral Hepatitis Coordinator to coordinate
with SF Hep B Free – Bay Area and engage in formal elimination planning for HBV in SF; 2)
Conduct a needs assessment for laboratories and major health systems in SF to increase routine
HCV and HBV testing in those settings (including reflex HCV testing); 3) Expand provider
capacity to treat HCV and/or HBV, including by enhancing existing training efforts, improving
guidance, and boosting dissemination of materials regarding evidence-based practices for access
to HCV treatment and prevention; 4) Partner with the UCSF DeLIVER Care van, SSPs, and
mobile Health Access Points in the Bayview/Hunters Point districts to increase access to HCV
and HBV testing and referral in high-impact settings, along with post-test counseling and referral
to treatment or prevention; and 5) Establish HAV and HBV vaccine delivery teams.