HCV Update 04

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HCV Update 04 Powered By Docstoc
					                                         HCV INITIATIVE SNAPSHOT 02.15.08
Brief Background
In June 2002 District 3 (Region 5 as of July 2005) met with staff from the Public Health Division Infectious Disease Bureau to
plan possible cooperative efforts for hepatitis C. In February 2003 the District Director made his first contact with Dr. Sanjeev
Arora of the University of New Mexico Health Sciences Center to discuss ways to collaborate on expanding HCV treatment
services in the southern section of the state. In June 2003 District 3 participated in the first telehealth hepatitis C session as a
member of the Hepatitis C Education and Treatment Network (later to be called Project ECHO). In November 2003 the
Community Wellness Program (CWP) in District 3 was formed to address chronic diseases and conditions. In January 2004
the Public Health Resource Center in the District 3 Office opened to house the Special Projects Unit of the CWP. In July 2004
hepatitis C was designated as a priority of Governor Bill Richardson and was added to the NM Comprehensive Strategic Health
Plan. In July 2005 Region 5 was formally recognized as the only public health pilot site in the DOH-UNM Hepatitis C
collaboration regarding a legislative appropriation of $1.6M for FY06. In October 2005 the Southwest Pathways Program in
Las Cruces, which was one of three state sites in the federal Access to Recovery (ATR) grant for a voucher-based central
intake unit for substance abuse treatment, opened at the Region 5 Office. In July 2007 Region 5 began offering opiate
replacement therapy with buprenorphine / Suboxone in conjunction with Project ECHO. The Region 5 HCV initiative is based
on a multi-disciplinary, inter-agency approach to service delivery, which is documented in the Region 5 Intranet at
http://intranet/phd3/hepatitsc.htm .

Present Players & Places and Plans
The notifiable condition reporting and field follow-up process for suspected (probable) and confirmed cases of chronic
hepatitis C (CHC) has gathered surveillance momentum. The Epidemiology Office in Santa Fe enters cases in the central
database that are received at the state level. As of January 2006 lab results received at the local level are being entered into
NMEDSS (NM Electronic Disease Surveillance System) by Patty Frank, Infectious Disease Nurse Epidemiologist, and her
work unit. The Hepatitis B Nurse Coordinator, Cindy Lyell, and the Emergency Preparedness Health Educator (Vacant)
contact persons who have had antibody, viral load or genotype tests for HCV to offer them education, counseling, support,
and referral. In an average month they typically process 100-125 case reports for hepatitis C.

Treatment services for CHC as part of Project ECHO with the University of New Mexico Health Sciences Center (UNMHSC)
are now available with the MMC Family Practice Residency Program (Dr. Kathleen Hales) and La Clinica de Familia Internal
Medicine Group (Dr. Prasad Kannaeganti) in Las Cruces, the Ben Archer Health Center in TorC (Dr. Julio Rivera) and with
Hidalgo Medical Services (Nellie Gallegos, PA-C) in Silver City. The Public Health Resource Center in Las Cruces with the
Community Wellness Program has approximately 100 - 120 visits per month for persons with chronic hepatitis C receiving
nursing services from Dorothy Portillo, Lucia Carrera, Romi Means, Sandra Gonzales, and Beatriz Vela; a member of the
same nursing group also goes to MMC FPRP and LCDF each week to work with staff there giving HCV clinical services.
Elizabeth Kuchler, FNP and Janie Coker, PA-C perform histories and physicals for HCV patients and participate in ECHO
telehealth clinics. Lydia Marquez, Community Wellness Program Manager, coordinates all program aspects around HCV
issues. Two clerks provide administrative support for hepatitis C functions.

Patrick Stafford, LPCC/MA and Meribeth Hauenstein, APRN/MSN lead the behavioral health service component for HCV
patients. Both are working to coordinate opiate replacement therapy with buprenorphine/Suboxone in Las Cruces. Meribeth
also provides medication management and individual therapy to persons with depression and other mental health disorders.
Patrick has been certified to offer a one-day DOH course for Hepatitis C counseling, testing & referral (CTR) so that we can
ensure that each local health office has a person trained to provide this service on site. Michael Lucero and the whole
Disease Prevention crew are making great strides to expand harm reduction services with Narcan and needle exchange in all
Public Health Offices throughout our ten counties. Dr. Eugene Marciniak continues to represent us in the weekly telehealth
conferences for Project ECHO and make excellent case presentations to the ECHO Treatment Review Committee. Dr.
Marciniak and Dr. Carlos Pastrana have completed training and licensure requirements to become two of a handful of
physicians in Las Cruces capable of providing opiate replacement therapy.

In mid May of 2007 the Doña Ana County Detention Center under Director Chris Barela completed the remodeling of a
modular unit on the premises so that a local public health office could be fully established in the jail facility in October. The
R5 Public Health cross-program team provides comprehensive educational and preventive services and some clinical care
for infectious and chronic diseases along with behavioral disorders to targeted priority incarcerated populations, with a
special emphasis on discharge/release planning and care coordination. Region 5 has an agreement with the Dona Ana
County Detention Center for funding the county to hire a contract nurse for outreach services with viral hepatitis in the facility.

Presently during any given month 20-25 patients in the greater Las Cruces area are in treatment for chronic hepatitis C with
others awaiting delivery of free medications from pharmaceutical companies. The obvious operational challenge is to export
hepatitis C preventive health, early intervention and medical treatment services to other areas in Region 5. Dolores
Coronado, PHN in the Luna Co. Public Health Office, has attended a Train the Trainer Hepatitis C workshop and the HCV
counseling & testing course so that she will be part of Project ECHO expansion for this border county to Deming in the near
future. For more information about what we are doing with the hepatitis C initiative, including UNMHSC winning an
international competition for Changemakers Disruptive Innovations from the Robert Woods Johnson Foundation in
September 2007, you may click on the Internet link that follows and then look in the Quick Links section: .

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