MMWR News Synopsis for May 8, 2014

Expanding Primary-Care Capacity to Treat Hepatitis C Virus Infection through an Evidence-Based Care Model — Arizona and Utah, 2012–2014

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
404-639-8895
NCHHSTPMediaTeam@cdc.gov

Innovative efforts to build the capacity of providers to care for patients with hepatitis C virus (HCV) infection can enhance patient management and careat a time of tremendous progress in curative therapies. Lack of provider expertise in HCV treatment and limited access to specialists are significant barriers to achieving the substantial public health benefits of HCV testing, care, and treatment. To overcome these challenges, CDC funded programs in Arizona and Utah (Project ECHO) to build primary care capacity to treat patients with HCV. These providers serve populations at increased risk for infection (including persons born during 1945-1965 and racial/ethnic minorities) in areas with a shortage of HCV specialists. Using videoconferencing software, primary care providers collaborated with specialists in weekly sessions, receiving advice and mentoring to help inform HCV diagnosis and patient management practices. Sixty-six primary care clinicians, predominantly from rural settings, were trained through this program. Nearly all (94 percent) of the clinicians had no prior experience in the care and treatment of HCV infection. Approximately 46 percent of all presented patients received antiviral treatment. These findings show ECHO is an effective model that can expand primary care capacity to treat HCV infection, especially among underserved populations.

Early Identification and Linkage to Care of Persons with Chronic Hepatitis B Virus Infection — Three U.S. Sites, 2012–2014

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
404-639-8895
NCHHSTPMediaTeam@cdc.gov

Hepatitis B virus (HBV) testing initiatives in community-based settings and refugee clinics can identify substantial numbers of persons living with chronic HBV infection and promote linkage to medical care. Of the estimated 800,000 to 1.4 million persons living with chronic HBV in the U.S., as many as 70 percent were born in global regions with intermediate or higher HBV prevalence (≥2 percent). CDC recommends HBV testing for all persons born in these areas and linkage to medical care and preventive services for those who are infected. In 2012, CDC funded nine sites to implement HBV testing initiatives among foreign-born persons. This article summarizes the results from three sites (Minneapolis-St. Paul, MN; New York City, NY; and San Diego, CA) where 4,727 persons were tested, of whom 310 (6.5 percent) were positive. New York City and San Diego used community-based outreach to educate and test, while the Minnesota program tested newly arriving refugees at their first scheduled visit. Cultural and linguistic-specific approaches were necessary at all sites. A majority of those testing positive were informed of their results, counseled, and medically referred. Attendance at a follow-up visit was higher for those referred from the refugee program (91 percent) than from community-based sites (33 and 56 percent). Outreach and patient navigation activities require intensive effort but can effectively help to identify, counsel and refer infected persons. Strategies to improve linkage from community-based testing to medical care are needed.

Primary and Secondary Syphilis — United States, 2005–2013

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
404-639-8895
NCHHSTPMediaTeam@cdc.gov

Once nearly eliminated in the U.S., syphilis is increasing among gay and bisexual men. New surveillance data on reported primary and secondary syphilis cases – the most infectious stages of the disease – show the rate of syphilis in the U.S. (5.3 cases per 100,000 population in 2013) is now more than double the all-time low of 2.1 cases per 100,000 in 2000. Men account for most cases of syphilis (91 percent in 2013), with the vast majority of those cases occurring among men who have sex with men (MSM). In 2012, MSM accounted for 84 percent of cases among men in the 35 areas for which sex of sex partner data was available. From 2009 to 2012, cases among MSM increased overall and among MSM of all ages and races/ethnicities from all four U.S. regions. Despite the increases among MSM, syphilis has declined among women in recent years, driven by declines among black women. However, disparities in syphilis by race/ethnicity persist among both men and women, with communities of color most affected. The authors note that these findings point to the need for intensified efforts to prevent, screen, and treat syphilis among MSM.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES