Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach.
BACKGROUND
New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration.


METHODS
HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development.


RESULTS
IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain.


CONCLUSIONS
A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.
Birkhead
Guthrie S
GS
AIDS Institute, New York State Department of Health, Albany, NY 12237, United States. gsb02@health.state.ny.us <gsb02@health.state.ny.us>
Klein
Susan J
SJ
Candelas
Alma R
AR
O'Connell
Daniel A
DA
Rothman
Jeffrey R
JR
Feldman
Ira S
IS
Tsui
Dennis S
DS
Cotroneo
Richard A
RA
Flanigan
Colleen A
CA
D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003157:Community Pharmacy Services / Q000458:organization & administration; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy* / Q000635:transmission; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006526:Hepatitis C / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy* / Q000635:transmission; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008484:Medicaid; D017744:Medical Waste Disposal; D017057:Medically Uninsured; D017146:Models, Organizational; D018671:Needle-Exchange Programs / Q000458:organization & administration; D009518:New York / Q000453:epidemiology; D010353:Patient Education as Topic; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011329:Prisoners; D016730:Program Development; D011787:Quality of Health Care; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology / Q000628:therapy*
D017744:Medical Waste Disposal