APPLICANT: The Wisconsin Department of Health Services (DHS) Communicable Disease Harm Reduction Section (CDHRS) is applying to CDC for funds to accomplish the outcomes identified in Components 1, 2 and 3.
NEED: As injection drug use has increased in Wisconsin, new hepatitis C virus (HCV) infections have increased dramatically, particularly among people who are American Indian and living in rural areas. However, most prevalent HCV cases reside in urban areas (such as Milwaukee County) and rates are highest among Black people. Trends in HBV and HAV are not as well understood because of limited testing among people who inject drugs (PWID) and passive identification and reporting of acute cases. Syringe services programs (SSPs) exist in Wisconsin, but mapping assessments reveal gaps in SSP services in rural areas. HAV and HBV vaccination rates are suboptimal among PWID in Wisconsin. Despite all Wisconsin Medicaid barriers being removed, few HCV treatment providers practice in rural areas and most people with HCV have not received treatment.
PURPOSE: Component 1 (C1): Improve viral hepatitis outbreak detection, surveillance, case reporting, and analyze and disseminate data to characterize trends and implement public health interventions. Component 2 (C2): Support viral hepatitis elimination planning and increase viral hepatitis testing, referral to care, vaccination, and prevention in high-impact settings such as SSPs that serve the target populations. Component 3 (C3): Improve access to services for PWID in high-impact settings that serve target populations.
TARGET POPULATION: C1 and C2: Many of the activities will have statewide impacts, however C2 specifically focuses on improving access to viral hepatitis prevention, vaccination, testing, and treatment among American Indian people through collaborations with Tribal Health Clinics with SSPs and among people living in Milwaukee through an FQHC with an SSP. For C3, the target population includes a largely rural 12-county area that includes several areas of concern with high rates of HCV or overdose identified through a recent mapping assessment.
OUTCOMES: During the 5-year project period, CDHRS will show progress toward all of the outcomes included in Notice of Funding Opportunity (NFOA) including improving viral hepatitis surveillance and outbreak detection (Outcomes 1.1.1-1.3.3), supporting elimination planning and improving access to testing, referral to care, and access to SSPs (Outcomes 2.1.1-2.3.3), and improving access to services for PWID (Outcomes 3.1.1-3.1.7).
APPROACH: C1: CDHRS will collaborate with internal DHS and external partners to improve viral hepatitis surveillance, outbreak detection and case reporting. C2: CDHRS will partner with multiple stakeholders to organize and begin elimination planning. CDHRS will partner with high-impact settings (Tribal Health Clinics with SSPs and FQHCs with SSPs) to improve testing, vaccination, prevention and treatment. C3: CDHRS will partner with a local health department with an SSP to develop and expand a PWID service bundle for a 12-county area.
EVALUATION: The project will be evaluated using DHS surveillance and immunization registry data, and service data collected by SSPs in Wisconsin and the selected partners.
COLLABORATION: CDHRS will continue to partner with state partners including the Division of Medicaid Services, Division of Care and Treatment Services, Department of Corrections, State Laboratory of Hygiene, as well as with local health departments, community collaborators, SSPs, Tribal Health Centers and Federally Qualified Health Centers.