Los Angeles (LA) County has a population of 10.1 million, making it more populous than 40 states in the United States. LA County has a high absolute burden of chronic hepatitis C virus (HCV) infection that is concentrated in specific identifiable populations – adults born during 1946–1964, persons who inject drugs (PWIDs), persons experiencing homelessness (PEH), and persons incarcerated in County jail system. Many of the populations at risk for having chronic HCV infection are also at risk for outbreaks of hepatitis A virus (HAV) infection. LA County has a large burden of chronic hepatitis B virus (HBV) infection because many residents were born in countries where HBV is endemic, including 1.2 million residents who were born in Asia.
The LA County Department of Public Health (DPH) currently maintains and implements protocols to rapidly detect and respond to acute HAV, HBV, and HCV outbreaks. The purpose of the projects proposed in this grant are to:
1) Improve data collection, management, and analysis of electronic laboratory reported (ELR) surveillance data for chronic HBV and HCV. (Component 1)
2) Advance viral hepatitis elimination through improved coordination and collaboration among stakeholders along the continuum of chronic viral HBV and HCV care from prevention, screening, linkage to care, and treatment. (Component 2)
3) Improve access to services for PWIDs by improving linkage to viral hepatitis care from syringe service providers (SSPs). (Component 3)
It is expected that implementation of the activities proposed in this grant proposal will allow LA County DPH to achieve the following outcomes:
1) Reduced incidence of acute viral hepatitis cases through improved detection and response to viral hepatitis outbreaks.
2) Improved monitoring of trends in chronic HBV, chronic HCV, and perinatal HCV infections through improved data management and analysis of ELR reported data.
3) Develop and implement in collaboration with community stakeholders a 5-year viral hepatitis elimination plan that will result in an increase in the number of persons who receive all services along the viral hepatitis continuum of care.
4) Reduction in the incidence and prevalence of acute and chronic viral hepatitis among PWIDs through improved linkage of services between standalone SSPs and traditional health clinics that are capable of providing vaccination and treatment.
LA County DPH is well positioned to successfully implement this grant proposal through it demonstrated organizational capacity and established relationships with community stakeholders. Within DPH, the project will be led by a medical director with 8+ years of clinical, research, and applied public health experience in viral hepatitis; the viral hepatitis unit is housed within the communicable disease program that is led by a director 15+ years in viral hepatitis, including standing up the viral hepatitis program at NYC Health. Pre-COVID-19, DPH held quarterly interdepartmental viral hepatitis workgroup meetings, which will resume next year. Represented in the workgroup were the substance abuse prevention and control program, the County public hospital system, and physicians from the County jail system. DPH has also been represented in many key community-based organizations that work to eliminate viral hepatitis including the Hep B Free LA coalition, Hep C Taskforce, Project ECHO, and the MediCal managed care health plans in LA County.