Georgia 2005 viral hepatitis strategic plan

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Division of Public Health Epidemiology Branch

Table of Contents
Letter of Introduction ............................................................................... 3 Acknowledgements ................................................................................. 5 Strategic Planning Process ......................................................................... 7 Participants ........................................................................................... 9 Mission, Vision, Key Focus Areas .............................................................. 15 Prioritization Criteria .............................................................................. 17 Background Hepatitis ............................................................................ 19 Background Hepatitis in Georgia .............................................................. 21 Strategic Planning Areas
Education .................................................................................. 31 Summary of Objectives ......................................................... 53
Primary & Secondary Prevention ...................................................... 57 Summary of Objectives ......................................................... 73
Clinical Management .................................................................... 75 Summary of Objectives ......................................................... 83
Surveillance & Related Research ....................................................... 85 Summary of Objectives ......................................................... 93
Glossary ............................................................................................. 95 Appendices .......................................................................................... 99
Appendix 1 House Resolution 701 ................................................. 101 Appendix 2 Strategic Planning Model ............................................. 105 Contact Information ..............................................................................106
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B. J. Walker, Commissioner Georgia Department of Human Resources Division of Public Health Stuart Brown, M.D., Acting Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715
Dear Colleague:
We are pleased to present the 2005 Georgia Viral Hepatitis Strategic Plan. This document is the result of many hours of hard work. The development of the Strategic Plan was a collaborative effort by groups and individuals, including public and private health care and service providers, from around the state.
The Strategic Plan is intended to be a "road map" for developing and implementing strategies to prevent and control viral hepatitis in Georgia. The priorities outlined in the Strategic Plan will assist the state in allocating existing resources and seeking out additional resources to implement the plan.
In recent years, Georgia's rates of acute hepatitis A and acute hepatitis B have exceeded national rates. Rates for hepatitis C have been more difficult to determine due to a number of factors, including incomplete surveillance data. While the Strategic Plan includes strategies for hepatitis A, B, and C, the plan draws attention to the growing problem of hepatitis C and prioritizes where resources should be devoted to address this problem.
While many Georgians are potentially at risk for viral hepatitis, certain individuals and population groups are at high risk of infection. The Strategic Plan not only includes strategies that focus on individuals at risk of infection, but also specific strategies that target high risk populations.
Even the most well developed plan has little value if it is never implemented. The challenge that now lies ahead is implementing the strategies and measuring the outcomes. The Georgia Division of Public Health is committed to being a key partner in the implementation of this plan. We encourage the participation of other public and private groups and individuals, as well as other State agencies, in this effort. Together we can work to prevent and control viral hepatitis in Georgia.
Sincerely,
Stuart Brown, MD Acting Director Georgia Division of Public Health

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Acknowledgements
The Georgia Viral Hepatitis Strategic Plan was made possible by a grant from the Council of State and Territorial Epidemiologists (CSTE). Many groups and individuals contributed to the development of this plan. Participants contributed a wide range of experience and expertise during the strategic planning process. Areas of expertise included: infection control, drug treatment, outreach, education and training, immunization, epidemiology, public health, sexually transmitted diseases (STDs), HIV/AIDS, laboratory, support groups, hepatitis, clinical medicine, mental health, corrections, pharmaceuticals, and media/communications (see Participant List on pages 6-10). Helen S. Whitlock of Mosaic Management Consulting, Inc. facilitated the strategic planning process. The Georgia Viral Hepatitis Strategic Planning Group would like to thank the following states that have already developed a statewide strategic plan: California, Colorado, Hawaii, Louisiana, Maryland, Massachusetts, New Mexico, Ohio, Texas, Washington, and Wisconsin. Plans from these states were used as reference documents throughout our strategic planning process.
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Strategic Planning Process
In January, 2004, the Georgia Division of Public Health (GDPH) was notified by the Council of State and Territorial Epidemiologists (CSTE) that Georgia was one of six states to be awarded funding to develop a statewide strategic plan to address viral hepatitis. During February and March, Advisory Committee members were identified, contacted, and recruited to participate in the strategic planning process. Other interested groups and individuals from around the state were invited to participate as Working Group members. While the Advisory Committee was limited in size, Working Groups were open to anyone who was interested.
In April, internal partners within GDPH met with the facilitator to finalize plans for the Kick-Off Meeting. On April 23, an all-day Kick-Off Meeting was held south of Atlanta. At the meeting, background information about viral hepatitis in Georgia was presented by GDPH. Information included current rates of viral hepatitis, hepatitis services provided by GDPH, hepatitis services offered by other groups and organizations, and gaps in viral hepatitis services (see Background Section on page 13-21).
At the Kick-Off Meeting, participants finalized vision and mission statements and chose four key focus areas for the Strategic Plan. The four areas are: Education, Primary & Secondary Prevention, Clinical Management, and Surveillance & Related Research. Working groups for each area were created and leaders were chosen for each group. The scope for each Working Group was finalized.
During the summer, each Working Group met for approximately 16-20 hours to develop objectives and strategies for their focus area. As a part of the process, participants reviewed Strategic Plans from other states. Working Group members also conducted additional interviews and research, as needed.
Once objectives and strategies were developed, each Working Group prioritized the strategies using standardized criteria. The prioritization criteria included two components: length of implementation and impact on target audience (see Prioritization Criteria Section on page 12). Each strategy was then placed into a prioritization matrix. The highlighted sections of the matrix designate high-priority strategies to be included in the first phase of implementation. Evaluation measures were developed for strategies that fell into the highlighted sections of the matrix.
The Recommendations Meeting was held on August 13, bringing all four Working Groups together again. Each Working Group presented the objectives, strategies, and evaluation measures they developed for their topic area. By the end of the meeting, consensus was achieved for the items presented.
After the Recommendations Meeting, Advisory Committee members reviewed the draft plan and gave additional feedback. Recommendations from the Advisory Committee were incorporated into the final Strategic Plan.
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Participants
Advisory Committee Members
Will Battles, MHA, MBA Manager of Special Projects, Administration Georgia Medical Care Foundation (replaced Jennifer Harrison)
Jodi H. Bazemore, MS District Epidemiologist South Central Health District Dublin Surveillance & Related Research Working
Group
James R. Cope, MPH District Epidemiologist North Georgia Health District Dalton Surveillance & Related Research Working
Group
Heidi A. Davidson, MPH District Epidemiologist East Metro Health District Lawrenceville Surveillance & Related Research Working
Group
Harsh Kapoor, MD, FRCP(C), FACP, FACG Atlanta Gastroenterology Associates & Clinical Assistant Professor, Emory University School of Medicine
Dee Lemmon HEALS of North Georgia Woodstock Education Working Group
George Lorenz District Sales Manager-Hepatology Schering Oncology Biotech (replaced Anne Raison)

Ricardo Mendiola HIV Prevention Manager Prevention Services Branch Georgia Division of Public Health
Pat Oaks, RN Georgia Infection Control Network & Director of Infection Control WellStar Health System Marietta Surveillance & Related Research Working
Group
Mahin (May) Park, Ph.D. Director, Clinical Microbiology Services Georgia Public Health Laboratory Surveillance & Related Research Working
Group
Russ Shoup Immunology Specialist Intermune Canton
R. Luke Shouse, MD, MPH Chief, HIV/STD Epidemiology Section Georgia Division of Public Health
Kenan Smith Regional Account Manager Roche Labs, Inc.
Jennifer Taussig, MPH Statewide Public Health Coordinator Office of Health Services Georgia Department of Corrections Primary & Secondary Prevention Working
Group
Charlotte Lovell Thompson Georgia Chapter Director American Liver Foundation Education Working Group

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Karen Waters Vice President Professional Services Georgia Hospital Association
Bobbi Woolwine, MSW Associate Director of Research Projects The Mind Body Program
Emory University Department of Psychiatry & Behavioral Sciences
Clinical Management Working Group

Georgia Immunization Program Georgia Division of Public Health
Notifiable Disease Section Epidemiology Branch Georgia Division of Public Health

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Working Group Members and Other Participants

Mona Bennett Atlanta Harm Reduction Center Atlanta Education Working Group
Sean Budacz Executive Vaccine Account Manager GlaxoSmithKline
Mike Chaney Program Manager Georgia Immunization Program Georgia Division of Public Health

Wayne Ford, MPH District Epidemiologist Clayton County Board of Health Morrow Surveillance & Related Research Working
Group
Julie Gabel, DVM, MPH Medical Epidemiologist Notifiable Disease Section Georgia Division of Public Health Surveillance & Related Research Working
Group

Vandella Conyers Hepatitis B Coordinator Georgia Immunization Program Georgia Division of Public Health Primary & Secondary Prevention Working
Group
Rosemary Donnelly, MSN, APRN-BC PHSO Nurse Consultant HIV Section Georgia Division of Public Health Clinical Management Working Group
Alan Eckles Epidemiologist East Health District Savannah Surveillance & Related Research Working
Group
Jennifer Edwards Public Health Liaison South Central Health District Dublin Surveillance & Related Research Working
Group
Sandy Fischer, RN Disease Surveillance Nurse Cobb/Douglas County Boards of Health Marietta Surveillance & Related Research Working
Group

William Gay Executive Producer Decatur
Ruth Gilmore Nurse Consultant Georgia Immunization Program Georgia Division of Public Health
Marie Hicks Public Health Advisor Georgia Immunization Program Georgia Division of Public Health
Kimberly Hosey Program Director GPA Treatment, Inc (Opioid Treatment Providers of Georgia) Doraville Primary & Secondary Prevention Working
Group
Wanda D. Jallow, RN Infectious Disease Nurse DeKalb County Board of Health Decatur Clinical Management Working Group
Kim Kennedy Public Health Liaison North Georgia Health District Dalton Surveillance & Related Research Working
Group

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Shamimul H. Khan, MBBS, MPH Epidemiologist Fulton County Dept of Health &
Wellness Office of Epidemiology Atlanta Surveillance & Related Research Working
Group
Pam Langford Vice President, HEALS of North Georgia Tallahassee, FL Education Working Group
Debbie Liby, RN Children 1st Coordinator Immunization Coordinator North Central Health District Macon Primary & Secondary Prevention Working
Group
Amie May, MPH District Epidemiologist Cobb/Douglas Boards of Health Marietta Surveillance & Related Research Working
Group
Phil McDevitt Communicable Disease Specialist North Central Health District Macon Primary & Secondary Prevention Working
Group
Terry Morris Interim Executive Director/Program
Director Atlanta Harm Reduction Center Atlanta Primary & Secondary Prevention Working
Group
Ruth Neeman, RN Study Coordinator Notifiable Disease Section Georgia Division of Public Health Education Working Group

Deborah E. Nolen Secretary/Treasurer HEALS of North Georgia Calhoun Clinical Management Working Group
Joe Norman Training Coordinator Prevention Services Branch Georgia Division of Public Health
Will Page Senior Vaccine Sales Representative GlaxoSmithKline Marietta Education Working Group
Stacey Pearce Opioid Treatment Providers of Georgia GPA Treatment of Macon, Inc Macon Clinical Management Working Group
Phillip Potter HEALS Support Group Leader Moultrie, GA Education Working Group
Monique Salter, MPH District Epidemiologist DHR Health District 2 Gainesville Surveillance & Related Research Working
Group
David Sammons Executive Area Immunization Manager GlaxoSmithKline Alpharetta Primary & Secondary Prevention Working
Group
Nomi Traub, MD Hepatitis C Clinic Grady Memorial Hospital Atlanta Clinical Management Working Group

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Eileen Usman, MSN District Epidemiologist West Central Health District Columbus Surveillance & Related Research Working
Group
Beth Ward, RN, MPH Epidemiologist Notifiable Disease Section Georgia Division of Public Health Surveillance & Related Research Working
Group
Sandra Watkins Georgia Public Health Laboratory Decatur Surveillance & Related Research Working
Group

Helen Whitlock Meeting Facilitator Mosaic Management Consulting Atlanta
Joy Wells, MPH Director for Health Assessment Cobb and Douglas Boards of Health Marietta Surveillance & Related Research Working
Group
E. Andra Whitworth Athens Banner-Herald Athens Education Working Group
Julie Wolthuis, MPH, MSW Hepatitis C Coordinator Notifiable Disease Section Georgia Division of Public Health Strategic Planning Project Coordinator

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Mission, Vision, and Key Focus Areas
Mission Statement
To protect, promote, and improve the health of Georgia's population by preventing transmission of viral hepatitis and limiting the complications of viral hepatitis-related liver disease.
Vision Statement
The vision for viral hepatitis prevention and control is a coordinated local and statewide effort supported by public and private partnerships providing comprehensive, science-based viral hepatitis services that assures: Reduction of new viral hepatitis infections and the related morbidity and mortality. Provision of affordable, accessible, and appropriate services and information. Implementation of National guidelines/recommendations regarding prevention, diagnosis and
care. Accurate identification and diagnosis of acute and chronic viral hepatitis. Implementation of a coordinated system for reporting, surveillance, analysis and
dissemination of data. Provision of evidence-based information to patients, providers, policy-makers, and the
public. Support of viral hepatitis research.
Key Focus Areas
Education Primary & Secondary Prevention Clinical Management Surveillance & Related Research
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Prioritization Criteria
Each Working Group used the following criteria to prioritize each strategy that was developed. Prioritization was a necessary (but difficult) step in the process. Since not every strategy can be implemented, it was necessary to prioritize those of greatest importance.
Length of Implementation
Short-Term: Up to 1 year Medium-Term: 1-2 years Long-Term: 3-5 years
Length of implementation refers to the length of time it will take to put a strategy into place, rather than how long a strategy will last.
Impact on Target Audience
Critical: Essential for preventing the primary transmission of viral hepatitis o What absolutely has to happen
Important: Useful for preventing the secondary transmission of viral hepatitis and limiting the complications of viral hepatitis liver disease
Nice To Have: Would enhance efforts to prevent the transmission of viral hepatitis and limit the complications of viral hepatitis liver disease o "Icing on the cake"
Goals/Evaluation Measures
Measures that evaluate whether the organization is successful in achieving its desired future state. Project Management Function One-time measurement to fully implement each work
plan. o Process measure
Quality Management Function On-going measurement to determine if each objective/strategy is delivering the target results. o Outcome measure
Performance Management Function On-going measurement to evaluate individual contribution. o People measure
The plan focuses on Quality Management targets and outcomes. Future Work Plans will include Project Management targets.
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Background Hepatitis
Hepatitis means inflammation of the liver. Viral hepatitis is an inflammation of the liver that is caused by a virus. Hepatitis A, hepatitis B, and hepatitis C are three forms of viral hepatitis caused by different viruses.
Common symptoms of viral hepatitis include: fever, fatigue, malaise, loss of appetite, nausea, abdominal pain, dark urine, and jaundice (yellowing of the skin and eyeballs). Adults generally have more severe symptoms, while children often are asymptomatic.
The primary mode of transmission of hepatitis A is by the fecal-oral route. The average incubation period is 28-30 days and the range is 15-50 days. There is no chronic form of hepatitis A infection.
Groups at risk of hepatitis A include: household or sexual contacts of an infected person, persons living in areas with high rates of hepatitis A, children in daycare, persons traveling to developing countries, persons engaging in anal/oral sex, men who have sex with men, and illegal drug users.
Two vaccines are available to protect against infection with hepatitis A. The vaccine is currently not licensed for children under 2 years of age.
Hepatitis B is usually transmitted by contact with the blood, semen, or vaginal secretions of an infected person. Transmission can also occur through transfusion of infected blood or blood products, needle sharing, hemodiaylsis, and needlesticks. The average incubation period for hepatitis B is 60-90 days and the range is 45-180 days.
Those at risk of hepatitis B infection include: infants born to infected mothers, household contacts of chronically infected persons, sexual contacts of infected persons, prisoners, injection drug users, health care workers and emergency responders, men who have sex with men, children of immigrants from areas with high rates of HBV infection, and hemodialysis patients.
A three-dose vaccine is available for infants, adolescents, and adults. Vaccination is recommended for all infants as a part of the routine childhood immunization schedule.
Hepatitis C, formerly known as non-A, non-B hepatitis, is spread primarily by exposure to blood from an infected person. The average incubation period is 6 to 9 weeks, with a range of 2 weeks to 6 months. Of those infected, up to 85% develop chronic infection and may develop cirrhosis. There is no vaccine available to prevent hepatitis C infection.
Those at greatest risk of infection are injection drug users (IDUs). Others at risk of infection may include: persons who received blood or blood products before 1992, hemodialysis patients, health care workers, sexual contacts of infected persons, persons with multiple sex partners, and infants born to infected women.
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Background Hepatitis in Georgia
To understand the strengths and weaknesses of the situation in Georgia, the following information was presented at the Kick-Off Meeting in April. This information represents the current "state of hepatitis" in Georgia and was used during the strategic planning process to identify gaps or areas where services and programs could be strengthened.
Viral Hepatitis in Georgia
Hepatitis A Georgia now considered a "high-incidence" state
o 2001: 11.4 cases per 100,000 persons o 2002: 6.0 cases per 100,000 persons o 2003: 9.1 cases per 100,000 persons National rates o 2001: 3.8 cases per 100,000 persons o 2002: 3.0 cases per 100,000 persons o 2003: 2.7 cases per 100,000 persons Ongoing outbreak among men who have sex with men (MSMs) o Rate increased in mid-90's and fluctuates up and down in this population Foodborne outbreak in the fall of 2003 o Approximately 348 cases o Attributed to contaminated green onions from Mexico distributed to several Georgia
restaurants
Hepatitis B Georgia incidence rate for acute HBV infection
o 2001: 5.2 cases per 100,000 persons o 2002: 5.9 cases per 100,000 persons o 2003: 7.7 cases per 100,000 persons National incidence rate for acute HBV infection o 2001: 2.7 cases per 100,000 persons o 2002: 2.9 cases per 100,000 persons o 2003: 2.6 cases per 100,000 persons
Hepatitis C Estimated number of chronic HCV infections in Georgia
o 2001: 151,302 estimated cases (1.8% of the population) o 2002: 153,114 estimated cases (1.8% of the population) o 2003: 156,324 estimated cases (1.8% of the population)
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Serologic Testing The following serologic tests are performed by the Georgia Public Health Laboratory
(GPHL): o Hepatitis A (IgM and total anti-HAV) o Hepatitis B (HBsAg, anti-HBs, and anti-HBc total antibody)
Hepatitis C testing is not currently available through GPHL
Hepatitis A Immunization Campaign for High-Risk Individuals HAV immunization offered to MSMs, bisexual males and female partners of bisexual males
o Administered through metro-Atlanta publicly funded HIV/STD clinics and the Fulton County mobile van
Pediatric HAV Immunization Campaign Immunization of 2-18 year olds in high-rate communities
o Fulton and DeKalb counties Universal hepatitis A vaccination for Georgia children is not recommended now
Hepatitis A Immunization State-supplied vaccine is available in all public health clinics for:
o Men who have sex with men (MSM) o Illegal drug users o HIV infected persons, or persons seeking HIV clinic services o American Indians / Alaska natives o Persons with chronic liver disease o Persons with clotting factor disorders
Hepatitis A Post Exposure Prophylaxis (Immune Globulin) Provided for:
o Sexual and household contacts of acute HAV cases o Day care staff and attendees as recommended by the District and State public health
staff o Coworkers of acutely infected foodhandlers o Restaurant/food exposures as defined by public health staff
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Hepatitis B Immunization State-supplied vaccine is available in all public health clinics for:
o Men who have sex with men (MSM) o Illegal drug users o Individuals with multiple sex partners o Persons seeking STD/HIV services o Homeless adults o Persons seeking family planning services o Sexual partners of persons with acute or chronic hepatitis B o Household contacts of persons with acute and chronic HBV infection o Hemodialysis and transplant patients
Perinatal Hepatitis B Program State coordinated program for the identification and follow up of HBsAg + pregnant women
and their infants. Multiple activities include, but are not limited to: o Site visits to prenatal care providers, birthing hospitals and labs to evaluate recording and reporting procedures o Assure completeness of HBsAg screening of pregnant women and treatment of perinatally-exposed newborns o Assure that providers complete the vaccination series of infants exposed perinatally to hepatitis B
Hepatitis B Post Exposure Prophylaxis (HBIG) Available for:
o Sexual partners of persons acutely infected with HBV o Percutaneous or mucous membrane exposure of household contacts of HBV infected
persons o Perinatal exposure as recommended by CDC and Georgia Perinatal Hepatitis B
Program
Public Health Personnel Involved in Viral Hepatitis Prevention State level:
o 2 epidemiologists (medical epidemiologist and Hepatitis C Coordinator) o Immunization Program staff District / Local level: o Immunization Coordinators o District Epidemiologists and Communicable Disease Coordinators o Nurses in PH clinics
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Special Public Health Projects Targeting High-Risk Groups
Hepatitis A and B Immunization Campaign for MSM Fulton County Department of Health and Wellness Vaccines are provided at low cost for men who have sex with men (MSM) at the following
venues: o Bars o Gyms o Ansley Mall o Annual Gay Pride Festivals o Gay Bookstores
GDPH "Protection from HBV Among U.S. Born Children of Asian Families" Study Objective:
o Assess effectiveness of HBV prevention programs among first generation southeast Asian immigrants and refugees in Georgia
Preliminary results: o HBV transmission appears to be ongoing among first generation Vietnamese o Prevalence of chronic HBV infection greatly reduced among first generation southeast Asians
Hepatitis B in Prisons HBV infection common among prisoners before and during incarceration
o GDPH receives approximately 50 reports per year CDC investigations evaluate methods of HBV transmission in the prison setting Department of Corrections (DOC) vaccine campaign in 2003-2004
o Limited number of doses of HBV vaccine provided to DOC for inmate immunizations
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Examples of Other Viral Hepatitis Programs and Services in Georgia
Education & Support Groups American Liver Foundation (ALF) HEALS of North Georgia (Hepatitis Education, Awareness, and Liver Support) Hepatitis social worker employed at a gastroenterologist's office in Athens
Outreach Services Risk reduction programs (for injection drug users)
o Atlanta Harm Reduction Center Services for prisoners and their families
o Southern Center for Human Rights
Hepatitis Screening: "Special Populations" Department of Corrections (DOC)
o Developed and implemented new hepatitis screening, evaluation, and treatment guidelines for inmates
State-funded Substance Abuse programs o Some programs/facilities provide hepatitis screening to their clients
Hepatitis Screening for Low Income/Uninsured Populations Center for Hepatitis C at Atlanta Medical Center Sheffield HealthCare Center, Atlanta
Treatment Options Patients with Insurance/Medicare/Medicaid
o Private Providers o Center for Hepatitis C at Atlanta Medical Center Patients without Insurance/Medicare/Medicaid o Hepatitis C Clinic at Grady Hospital o Grady Infectious Disease Program (HCV/HIV co-infected patients) o Sheffield Health Care Clinic, Atlanta
Treatment & Research Clinical trials for hepatitis treatment, when available Emory University Mind-Body Program
o Studies looking at the effects of interferon-alpha treatment for patients with hepatitis C
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Pharmaceutical Programs Patient Assistance Programs
o Available for patients unable to afford hepatitis C treatment Hope-C Program (Hepatitis C Outcomes through Patient Education & Care)
o Targeted to African Americans o Using a medical and case management model, identify people with HCV and provide
coordinated services o Provide HCV education, training, and counseling for medical providers, project
enrollees, and their families Other Hepatitis C Working Group
o Monthly meetings o Diverse membership o Networking o Developing a Hepatitis C Resource Directory
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Gaps & Weaknesses in Viral Hepatitis Prevention/Services in Georgia
Viral Hepatitis Case Follow-Up Performed by local public health staff
o Resources variable among Georgia's 19 Health Districts o In some jurisdictions follow-up is comprehensive, in others resources may preclude
some of these activities In general, acute cases of HAV and HBV are prioritized
Surveillance for Viral Hepatitis Better for acute HAV and acute and chronic HBV because of direct reporting by laboratories Poor reporting for HCV
o Confusion among health care providers regarding HCV reporting o Limited clinical information Quality of risk factor data variable
Testing Public Health Clinics
o Acute HBV testing is not available o Hepatitis B testing is not routinely provided in STD clinics o Not all pregnant women are screened for HBV o Hepatitis C testing is not routinely available Other o Limited options for free/low-cost testing for low-income and uninsured patients o Many private providers do not conduct risk-based testing
Immunizations Many "missed opportunities" to provide hepatitis immunizations to high-risk clients Many babies born to HBsAg+ women are not given HBIG and 1st dose of hepatitis B
vaccine within 12 hours after birth Many infants do not receive 2nd and 3rd doses of hepatitis B vaccine Populations not covered by state-funded hepatitis vaccine
o Refugees o Inmates o Public safety workers o Health care workers o Food handlers (hepatitis A)
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Treatment Limited options for low-income and uninsured patients
o Public Health is not able to provide treatment Patient Assistance Programs are usually limited to patients who have access to a medical
provider Information about clinical trials changes frequently
o Many clinical trials are located at National Institutes of Health (NIH) Limited options available for inmates whose parole/release is scheduled before treatment can
be completed
Hepatitis Awareness Lack of hepatitis awareness among many medical providers
o Risk Factors o Signs, symptoms of illness o Appropriate testing and interpretation o Knowledge of treatment options
Policies No statewide policy for hepatitis screening for mental health and substance abuse clients Jails and detention centers are not included in Department of Corrections' policies
Other Gaps Not enough hepatitis support groups throughout the state, particularly in areas outside metro-
Atlanta Lack of knowledge of existing hepatitis resources, services, programs in Georgia Lack of coordination of services among providers (medical and non-medical) Insufficient/limited prevention efforts among high-risk populations
o IV drug users o Men who have sex with men o Multiple sex partners Limited hepatitis information and resources available on GPDH website
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Strategic Planning Areas
Education Primary & Secondary Prevention
Clinical Management Surveillance & Related Research
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Education
Scope of Education
Control and prevention of viral hepatitis infection requires not only well-educated health care professionals but also a well-informed public.

Prioritization Matrix

Length of Implementation

Impact on Target
Audience

Critical Important
Nice To Have

Short-Term
E3, E4, E5, E25, E38 E1, E10, E13, E15, E22, E23, E24, E26, E28, E36, E37, E43, E54 E21, E27, E39

MediumTerm E9, E16, E17, E20, E48, E49 E6, E11, E18, E19, E29, E30, E31, E32, E33, E35, E53
E40, E41, E47, E52

Long-Term E51 E7, E50
E2, E8, E12, E34, E42, E44, E45, E46, E55

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Health Care Professionals Objective
Provide viral hepatitis education and training for health care professionals. Increase viral hepatitis knowledge and recognition by targeting general practitioners, obstetricians, pediatricians, internists, nurses, family nurse practitioners, physician assistants, dentists, oral surgeons, and pharmacists. Stress the importance of medical providers becoming more educated and educating others (train-the-trainer). Stress importance of pharmaceutical companies targeting not only specialists, but also general practitioners, with information about treatment options for hepatitis B and hepatitis C. Utilize available resources, including materials from the Centers for Disease Control and Prevention, where appropriate.
Health Care Professionals Strategies
E1: Obtain contact information for all physicians in Georgia and use information to develop a reliable list of physicians to invite to viral hepatitis conferences, seminars, and other educational sessions. Priority: Short-Term / Important
Evaluation Method: List of licensed physicians in Georgia from the Georgia Composite State Board of Medical Examiners Baseline: Unknown Target: Accurate information for at least 90% of licensed physicians in Georgia
E2: Design, produce, and distribute viral hepatitis educational videos for clinics and doctors' offices. Priority: Long-Term / Nice To Have
E3: Develop and provide educational materials to health care providers on viral hepatitis risk factors, clinical signs, symptoms, and appropriate tests to diagnose viral hepatitis: Design a checklist; Design a convenient pocket reference insert; and Design a poster for physician office use. Priority: Short-Term / Critical
Evaluation Method: Survey health care providers Baseline: Does not exist Target: 50% of health care providers use the materials to assist with diagnosis of viral hepatitis
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Health Care Professionals Strategies (continued)
E4: Educate health care providers on how to report potential and confirmed cases of viral hepatitis to local health departments and/or the Georgia Division of Public Health (GDPH). Priority: Short-Term / Critical
Evaluation Method: Survey health departments and GDPH to assess if there is an increase in reporting Baseline: Does not exist Target: At least 90% of health care providers report potential and confirmed cases of viral hepatitis to local health departments and/or GDPH
E5: Educate health care providers regarding treatment, referrals, and essential services for persons already diagnosed with viral hepatitis: Design a checklist; Design a convenient pocket reference insert; and Design a poster for physician office use. Priority: Short-Term / Critical
Evaluation Method: Survey health care providers Baseline: Unknown Target: 50% of health care providers use checklist, pocket reference insert, and poster
E6: Develop, maintain, and publicize a Georgia website for viral hepatitis information: Provide continuously updated viral hepatitis information; Provide up-to-date educational and informational resources; Advertise use of website as an educational tool; and Provide downloading capability of information to computers/Palm Pilots.
Priority: Medium-Term / Important
Evaluation Method: Survey health care providers; observe the number of hits to the website and monitor over time Baseline: Does not exist Target: 50% of health care providers in Georgia use viral hepatitis website
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Health Care Professionals Strategies (continued)
E7: Design, develop, and administer on-line viral hepatitis training courses: Provide access to the on-line training courses via the Georgia "Hepline" website; Offer continuing education credits for successful completion of the on-line training courses; and Consider partnering with an organization to administer on-line training on a regular and ongoing basis.
Priority: Long-Term / Important
E8: Collect and provide patient feedback from those who have gone through viral hepatitis treatment. Feedback will address emotional issues, psychological issues, long-term issues, and quality of life during and after treatment. Include this information in seminars and conferences; and Provide on website. Priority: Long-Term / Nice To Have
E9: Design and implement viral hepatitis curriculum taught in nursing schools, medical schools, and resident trainings. Priority: Medium-Term / Critical
Evaluation Method: Survey all nursing, medical schools, and resident programs in Georgia Baseline: Very little time spent on teaching viral hepatitis in nursing, medical schools and resident programs Target: 100% of all Georgia nursing, medical schools and resident programs will have a comprehensive viral hepatitis curriculum in their program
E10: Develop a viral hepatitis speaker series: Find/hire viral hepatitis "subject matter experts"; and Provide speakers for educational sessions and physician conferences.
Priority: Short-Term / Important
Evaluation Method: Evaluation form completed by physicians at end of session Baseline: Unknown Target: 25 physicians attend each session when offered
Evaluation Method: Evaluation form completed by physicians at end of session Baseline: Unknown Target: 80% of attending physicians rate the session worthwhile
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Health Care Professionals Strategies (continued)
E11: Provide continuing education credits (CEUs/CMEs) on viral hepatitis topics at conferences: Host a Georgia viral hepatitis consensus conference annually; Provide medical seminars more often in major cities in Georgia: Sponsor lunch/dinner educational sessions ("lunch and learn"); and Consider partnering with an organization to offer viral hepatitis training on a regular and ongoing basis. Priority: Medium-Term / Important
Evaluation Method: CEU/CME records from Georgia Composite State Board of Medical Examiners Baseline: Unknown Target: 50% of physicians have 2 CMEs focusing on viral hepatitis biannually
Evaluation Method: Count number of trainings provided, number of health care professionals that attend Baseline: Unknown Target: Provide quarterly viral hepatitis trainings for health care professionals
E12: Use seed grants to encourage interest in viral hepatitis research by medical students and researchers. Priority: Long-Term / Nice To Have
E13: Educate health care providers to test for viral hepatitis as part of immigration and refugee physicals. Priority: Short-Term / Important
Evaluation Method: Survey appropriate immigration and refugee agencies Baseline: Unknown Target: 90% of health care providers test all immigrants and refugees for viral hepatitis as part of the physical
E14: Educate health care providers to test for viral hepatitis for high-risk patients, especially kidney dialysis patients and hemophiliacs. Priority: Short-Term / Important
Evaluation Method: Survey health care providers, and dialysis centers Baseline: Unknown Target: 80% of health providers and dialysis centers test high-risk patients for viral hepatitis
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Health Care Professionals Strategies (continued) E15: Educate health care providers to test pregnant women for hepatitis B
Priority: Short-Term / Important Evaluation Method: Survey health care providers Baseline: Unknown Target: 80% of health care providers test pregnant women for hepatitis B E16: Collaborate with the Georgia Pharmacy Association and/or Georgia Society of Health System Pharmacists to develop educational materials and a course offering continuing education units (CEU) regarding viral hepatitis medications:
Educate pharmacists on the treatment of viral hepatitis so they can identify treatment errors; and
Education pharmacists on the importance of timely treatment for viral hepatitis. Priority: Medium-Term / Critical Evaluation Method: Document the number of licensed pharmacists who have completed a CEU course on viral hepatitis medications Baseline: Unknown Target: 80% of licensed pharmacists in Georgia will successfully complete the CEU course and utilize the educational materials appropriately.
Georgia Viral Hepatitis Strategic Plan 37

Policymakers Objective
Increase awareness among Georgia policymakers regarding viral hepatitis issues and enlist their help in leading, supporting and funding viral hepatitis prevention, diagnosis, treatment and education.
Note: State employees will not participate in lobbying or advocacy activities. State funds will not be used for lobbying or advocacy activities.
Policymakers Strategies
E17: "Match" each Member of the Health and Human Services Committees of the Georgia General Assembly (in both the House of Representatives and Senate) with a local constituent who is personally affected by viral hepatitis and encourage that constituent to develop a relationship with the Member: Identify Chair and Members of the Health and Human Services Committees of the Georgia General Assembly; Identify local constituents who have interest in and will support our goals; Draft and provide letter of introduction and educational materials for constituents to mail to Members to lay groundwork for need; Send periodic updates to Members to establish communication lines, particularly success stories; and Contact Members when critical legislation is being considered or to submit idea for needed legislation. Priority: Medium-Term / Critical
Evaluation Method: Advocate reports Baseline: Does not exist Target: 90% of Health and Human Services Committee members matched with liver advocates
Evaluation Method: Voting records on pertinent legislation Baseline: Does not exist Target: 50% of matches develop a working relationship; new viral hepatitis legislation passed
E18: Identify methods and language used in other states that have been successful in attaining viral hepatitis funding from the state legislature. Priority: Short-Term / Important
Evaluation Method: Assess amount of funding that becomes available for viral hepatitis Baseline: To be determined Target: Contact 50% of states with funding for viral hepatitis and identify methods and language utilized
Georgia Viral Hepatitis Strategic Plan
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Policymakers Strategies (continued)
E19: Prepare and submit verbiage outlining additional educational opportunities for inclusion into future House Resolutions. Priority: Medium-Term / Important
Evaluation Method: Pertinent verbiage included in legislation; Resolutions/bills passed Baseline: Unknown Target: Contact 90% of Health and Human Services Committee members
E20: Develop a centralized method of conducting legislative letter campaigns to address issues faced by people affected by viral hepatitis. Priority: Medium-Term / Critical
Evaluation Method: Legislative correspondence records Baseline: Unknown Target: 15% of people diagnosed with viral hepatitis participate in letter campaigns
E21: Identify public demonstration guidelines for specific public buildings and locations. Priority: Short-Term / Nice To Have
E22: Determine nomination procedure for identifying poster children/adults and establish viral hepatitis poster program. Priority: Short-Term / Important
Evaluation Method: Assess number of media releases using spokesperson(s) Baseline: Previous spokesperson(s) effectiveness Target: Viral hepatitis spokesperson(s) pictured in 10 media releases each year
E23: Determine procedure for and establish a Viral Hepatitis Day in Georgia. Priority: Short-Term / Important
Evaluation Method: List of participants (number of ribbons and/or T-shirts handed out) Baseline: Does not exist Target: 5000 participants attend Viral Hepatitis Day
E24: Meet with AIDS organizations to gain insight into their lobbying methods. Priority: Short-Term / Important
Evaluation Method: Survey programs/people that are interacting to find out if successful Baseline: Unknown Target: Meet with 50% of AIDS activist organizations in Georgia
Georgia Viral Hepatitis Strategic Plan
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Policymakers Strategies (continued) E25: Identify methods to finance additional HAV and HBV vaccinations.
Priority: Short-Term / Critical Evaluation Method: Monitor state and local funding for viral hepatitis Baseline: Current level of viral hepatitis funding to be determined Target: 10% increase in funding for HAV and HBV vaccinations E26: Provide reciprocal contact information for Georgia General Assembly members and pertinent viral hepatitis organizations for regular communication, i.e. newsletters. Priority: Short-Term / Important Evaluation Method: Survey to find out how many General Assembly members/organizations are aware of newsletters/websites/etc. Baseline: Existing newsletters/websites/etc. Target: 75% of Georgia General Assembly members/organizations are aware of newsletters/websites/etc. E27: Invite members of the Georgia General Assembly to pertinent viral hepatitis events and programs. Priority: Short-Term / Nice To Have E28: Challenge all Georgia General Assembly members to be tested for viral hepatitis and encourage any members testing positive to become public spokespersons. Priority: Short-Term / Important Evaluation Method: Survey General Assembly members to find out how many were tested and if willing to become spokesperson(s) Baseline: Unknown Target: 50% of Georgia General Assembly members tested for viral hepatitis
Georgia Viral Hepatitis Strategic Plan 40

High-risk Populations Objective Note: This section was moved to Primary & Secondary Prevention.
Patient and Family Objective Determine informational needs for people diagnosed with viral hepatitis; informational needs for people undergoing treatment; and post-treatment informational needs. Determine the informational needs of families so that they can better support a member who is chronically ill with viral hepatitis through treatment. Prepare educational materials including pamphlets, brochures, fact sheets, resource guides, and articles. Distribute educational materials to patients via doctors' offices, public health departments, hospitals, university health centers, support groups, health fairs, seminars, libraries, and websites.
Patient and Family Strategies Diagnosis and Pre-Treatment E29: Develop and distribute educational materials that define what a biopsy is, who needs
one, and how to interpret the results. Priority: Medium-Term / Important Evaluation Method: Survey physicians; include survey postcard in the educational materials sent to general practitioners Baseline: Does not exist Target: 50% of general practitioners use the educational materials sent to them Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year
Georgia Viral Hepatitis Strategic Plan 41

Patient and Family Strategies (continued) Diagnosis and Pre-Treatment (continued) E30: Educate patients about genotypes and response rates for each genotype.
Priority: Medium-Term / Important Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year E31: Outline points for patients to consider when deciding whether or not they begin treatment for hepatitis B or hepatitis C.
Provide lifestyle information that will help the patient prepare for treatment. Priority: Medium-Term / Important Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year
Georgia Viral Hepatitis Strategic Plan 42

Patient and Family Strategies (continued)
Diagnosis and Pre-Treatment (continued)
E32: Develop educational materials for patients on how to find a doctor and put together a health care team: Include sample questions that the patient should ask their doctor about their condition; and Discuss who should get psychological evaluations before starting treatment, and who might benefit from having a mental health provider as part of their team. Priority: Medium-Term / Important
Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state
Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year
E33: Develop educational materials for patients regarding viral hepatitis medications: Help patients understand the importance of taking the medication and staying on a schedule; and Discuss patient side-effects and possible effects post-treatment.
Priority: Medium-Term / Important
Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state
Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year
Georgia Viral Hepatitis Strategic Plan 43

Patient and Family Strategies (continued) Diagnosis and Pre-Treatment (continued) E34: Develop a legal resource guide for patients that will address their employment rights,
address whether or not they can be held legally responsible for giving the disease to someone, and list class action lawsuits or any kind of compensation program for viral hepatitis patients. Utilize HIV information as a model. Priority: Long-Term / Nice To Have E35: Develop an insurance/finance resource guide to help viral hepatitis patients and their families understand the intricacies of obtaining and using insurance and financing their treatment.
Include programs by pharmaceutical companies and listings of trials that patients can join;
Coordinate with the Georgia Partnership for Caring Foundation for referrals to physicians and/or pharmacies for low-income patients; and
Provide educational materials regarding Social Security Disability Insurance (SSDI) and COBRA.
Priority: Medium-Term / Important Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year
Georgia Viral Hepatitis Strategic Plan 44

Patient and Family Strategies (continued) Diagnosis and Pre-Treatment (continued) E36: Develop and update educational materials to identify currently available treatments,
briefly describe them, and provide data regarding their effectiveness and response rates. Priority: Short-Term / Important Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar to be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year E37: Develop and distribute materials that discuss alternative treatments and identify scam treatments. Priority: Short-Term / Important Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar to be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year
Georgia Viral Hepatitis Strategic Plan 45

Patient and Family Strategies (continued)
Diagnosis and Pre-Treatment (continued)
E38: Identify and provide support groups for viral hepatitis patients and for their family members. Priority: Short-Term / Critical
Evaluation Method: Survey newly diagnosed patients and count number of first-time attendees Baseline: Unknown Target: 50% of newly diagnosed patients aware of a support group in their area
Evaluation Method: American Liver Foundation list of new and/or current support groups Baseline: 9-11 support groups currently known in Georgia Target: Network of support groups established 100 miles apart throughout Georgia
E39: Develop patient and family seminars to provide viral hepatitis education on relevant topics and answer frequently asked questions for newly diagnosed patients and for patients finishing treatment. Priority: Short-Term / Nice To Have
During Treatment
E40: Identify community resources and food delivery sources where patients who are homebound or without a caregiver can get temporary and emergency support. Priority: Medium-Term / Nice To Have
E41: Select and provide viral hepatitis articles that discuss relevant issues, research studies, and clinical trials. Priority: Medium-Term / Nice To Have
E42: Develop a program to "recycle" unused viral hepatitis medications. (Current laws prohibit individuals from offering medication dispensed from them to anyone else for use. Current laws also prohibit taking medication that is prescribed, dispensed, and received back into a pharmacy for reuse). Priority: Long-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 46

Patient and Family Strategies (continued) During Treatment (continued) E43: Educate non-responders of other treatment options, such as re-treatment, alternative
medicine, and clinical trials. Priority: Short-Term / Important Evaluation Method: Seminar sign-in sheets and evaluations Baseline: Does not exist Target: 100 patients per year will attend Hepatitis Seminar. Seminars will be offered quarterly in different parts of the state Evaluation Method: Count the number of webpage hits; online survey for webpage visitors Baseline: Does not exist Target: 1000 webpage hits per year Post-Treatment E44: Encourage research among post-treatment patients to determine long-term effects and length of recovery. Priority: Long-Term / Nice To Have E45: Provide information to viral hepatitis patients regarding what to expect after treatment.
Collect and share personal stories of patients and their caregivers or family members and how they cope with chronic illness and treatment to document emotional and psychological repercussion; and
Provide lifestyle guidelines to protect the liver following treatment. Priority: Long-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 47

Patient and Family Strategies (continued) Families E46: Develop viral hepatitis educational materials on relevant family issues, such as:
Help family members to realize that they need to be prepared for some difficulties;
Inform family members and household contacts about the need for vaccination, as recommended by ACIP (Advisory Committee on Immunization Practices) and CDC guidelines;
Identify how some children may react to a parent on treatment or with a chronic illness;
Inform families of side-effects of viral hepatitis and how it affects attitude and depression;
Inform of high divorce rate for patients on treatment; Inform families how they can help their family member stick to their medication
routine, help support them in lifestyle changes, and help them through treatment; and Counsel families to whatever degree possible about where they may need to draw the line, don't let the sick person take advantage of them, and help them realize what they reasonably can and cannot do. Priority: Long-Term / Nice To Have E47: Identify community programs to relieve caregivers and provide marriage and/or family counseling. Priority: Medium-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 48

General Public Objective Provide education, training, and promote awareness of viral hepatitis for the general public.
General Public Strategies E48: Implement a viral hepatitis media campaign, including statistics to compare viral
hepatitis to other diseases (e.g., put viral hepatitis into perspective with West Nile virus and HIV). Personalize information to make it pertinent to the individual (e.g., the many faces of viral hepatitis). Venues to distribute the media campaign may include:
TV commercials/public service announcements; Radio ads; Newspaper ads; Magazine ads; Billboards; Public transportation; Internet ads and pop-ups; Newsletters; Mass mailings; and Movie theatre preview ads. Priority: Medium-Term / Critical Evaluation Method: Rates of hepatitis infection Baseline: TBD rates of acute hepatitis A, B, and C Target: Reduce rates of acute hepatitis A, B, and C by 50% Evaluation Method: Pre and post-survey 1000 Georgia residents regarding knowledge of viral hepatitis Baseline: Unknown Target: Increase number of Georgia residents knowledgeable about viral hepatitis by 50%
Georgia Viral Hepatitis Strategic Plan 49

General Public Strategies (continued) E49: Provide literature and information to the general population through the media and print
that includes: Information about the liver Information about vaccines Information about the differences between hepatitis A, B, and C Information about perinatal transmission Information about viral hepatitis prevention Risks associated with illegal drug use and viral hepatitis Risks associated with hepatitis A (hand washing, etc.) Risks associated with hepatitis B (sexual transmission, etc.) All hepatitis C risk factors (intravenous drug use, etc.)
Priority: Medium-Term / Critical Evaluation Method: Pre and post-survey 1000 Georgia residents regarding knowledge of viral hepatitis Baseline: Unknown Target: Increase number of Georgia residents knowledgeable of viral hepatitis by 50% E50: Prepare and produce a full-length feature or series suitable for TV (e.g., Frontline) or video explaining the complete viral hepatitis story. Priority: Long-Term / Important
Georgia Viral Hepatitis Strategic Plan 50

General Public Strategies (continued) E51: Develop a comprehensive viral hepatitis education plan for targeting youth:
Submit ads in high school/college playbills and sports programs; Develop lesson plans for health teachers and social workers and require inclusion
in curriculum and in the juvenile justice system; Stress the message of responsibility to protect yourself and others; and Respect the sophistication of today's youth by relating to them on a mature level. Priority: Long-Term / Critical Evaluation Method: Pre and post-survey 1000 Georgia high school and college students regarding knowledge of viral hepatitis Baseline: Unknown Target: Increase number of Georgia high school and college students knowledgeable about viral hepatitis by 50% Evaluation Method: Monitor public high school curriculum by State Board of Education to include one 6-week unit of hepatitis education Baseline: Does not exist Target: One 1 week unit of hepatitis education required in all public high schools Evaluation Method: Monitor rates of hepatitis infection among youth (ages 12-25) Baseline: TBD Target: Reduce rates of hepatitis infection among youth by 50% E52: Create a PowerPoint presentation about viral hepatitis available for downloading from the Georgia Division of Public Health website. Include links to other viral hepatitis resources. Priority: Medium-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 51

General Public Strategies (continued) E53: Provide free viral hepatitis educational classes to the general public through local health
departments and other pertinent organizations. Priority: Medium-Term / Important Evaluation Method: Georgia Division of Public Health will have lists and schedules of all viral hepatitis educational classes available in the state Baseline: Unknown (TBD) Target: Viral hepatitis classes will be available within a 100-mile radius of all Georgians on a quarterly basis Evaluation Method: Registration data Baseline: Unknown (TBD) Target: 5% of the population of the state of Georgia by district E54: Obtain the Governor's proclamation for Viral Hepatitis Awareness Month (May) and publicize it via media outlets and events. Priority: Short-Term / Important Evaluation Method: Monitor state legislation to determine when bill is passed Baseline: Bill does not exist Target: Bill proclaiming May as Hepatitis Awareness Month is passed and recognized Evaluation Method: List of participants (number of ribbons and/or T-shirts handed out) Baseline: Does not exist Target: 5000 participants attend activities during Viral Hepatitis Awareness Month E55: Prepare a viral hepatitis celebrity plan, actively seek out a spokesperson, and implement the plan. Priority: Long-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 52

EDUCATION OBJECTIVES - Summary
Short-Term Critical
E3: Develop and provide educational materials to health care providers on viral hepatitis risk factors, clinical signs, symptoms, and appropriate tests to diagnose viral hepatitis.
E4: Educate health care providers on how to report potential and confirmed cases of viral hepatitis to local health departments and/or the Georgia Division of Public Health (GDPH).
E5: Education health care providers regarding treatment, referrals, and essential services for persons already diagnosed with viral hepatitis.
E25: Identify methods to finance additional HAV and HBV vaccinations. E38: Identify and provide support groups for viral hepatitis patients and for their family
members.
Medium-Term Critical
E9: Design and implement viral hepatitis curriculum taught in nursing schools, medical schools, and resident trainings.
E16: Develop educational materials for pharmacies that help them communicate better with the patient regarding viral hepatitis medications.
E17: "Match" each Member of the Health and Human Services Committees of the Georgia General Assembly (in both the House of Representatives and Senate) with a local constituent who is personally affected by viral hepatitis and encourage that constituent to develop a relationship with the Member.
E20: Develop a centralized method of conducting legislative letter campaigns to address issues faced by people affected by viral hepatitis.
E48: Implement a viral hepatitis media campaign, including statistics to compare viral hepatitis to other diseases (e.g., put viral hepatitis into perspective with West Nile virus and HIV). Personalize information to make it pertinent to the individual (e.g., the many faces of viral hepatitis).
E49: Provide literature and information to the general population through the media and print.
Long-Term Critical
E51: Develop a comprehensive viral hepatitis education plan for targeting youth.
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Short-Term Important
E1: Obtain contact information for all physicians in Georgia and use information to develop a reliable list of physicians to invite to viral hepatitis conferences, seminars, and other educational sessions.
E10: Develop a viral hepatitis speaker series.
Short-Term Important, continued
E13: Educate health care providers to test for viral hepatitis as part of immigration and refugee physicals.
E15: Educate health care providers to test pregnant women for hepatitis B. E22: Determine nomination procedure for identifying poster children/adults and establish
viral hepatitis poster program. E23: Determine procedure for and establish a Viral Hepatitis Day in Georgia. E24: Meet with AIDS organizations to gain insight into their lobbying methods. E26: Provide reciprocal contact information for Georgia General Assembly members and
pertinent viral hepatitis organizations for regular communication, i.e. newsletters. E28: Challenge all Georgia General Assembly members to be tested for viral hepatitis and
encourage any members testing positive to become public spokespersons. E36: Develop and update educational materials to identify currently available treatments,
briefly describe them, and provide data regarding their effectiveness and response rates. E37: Develop and distribute materials that discuss alternative treatments and identify scam
treatments. E43: Educate non-responders of other treatment options, such as re-treatment, alternative
medicine, and clinical trials. E54: Obtain the Governor's proclamation for Viral Hepatitis Awareness Month (May) and
publicize it via media outlets and events.
Medium-Term Important
E6: Develop, maintain, and publicize a Georgia website for viral hepatitis information E11: Provide continuing education credits (CEUs/CMEs) on viral hepatitis topics at
conferences. E18: Identify methods and language used in other states that have been successful in
attaining viral hepatitis funding from the state legislature. E19: Prepare and submit verbiage outlining additional educational opportunities for inclusion
into future House Resolutions. E31: Outline points for patients to consider when deciding whether or not they begin
treatment for hepatitis B or hepatitis C. E32: Develop educational materials for patients on how to find a doctor and put together a
health care team. E33: Develop educational materials for patients regarding viral hepatitis medications.
Georgia Viral Hepatitis Strategic Plan
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E35: Develop an insurance/finance resource guide to help viral hepatitis patients and their families understand the intricacies of obtaining and using insurance and financing their treatment.
E53: Provide free viral hepatitis educational classes to the general public through local health departments and other pertinent organizations.
Georgia Viral Hepatitis Strategic Plan 55

Georgia Viral Hepatitis Strategic Plan 56

Primary & Secondary Prevention
Scope of Primary Prevention
Primary prevention activities aim to reduce risks for contracting viral hepatitis infection. These activities focus on reducing or eliminating potential risk behaviors for transmission from an infected person to an uninfected person.
Scope of Secondary Prevention
Secondary prevention focuses on persons already infected with viral hepatitis. These activities aim to reduce risks for liver complications and other diseases and also prevent further transmission of viral hepatitis.

Prioritization Matrix

Length of Implementation

Impact on Target
Audience

Critical Important

Short-Term P1, P11, P24

MediumTerm P5, P6, P7, P9, P10, P12, P13, P14, P25, P30, P33, P34

Long-Term P26, P27, P32

P2, P8, P18, P4, P16, P17, P15

P19

P22, P31

Nice To Have P20

P3, P21, P23 P28, P29

Georgia Viral Hepatitis Strategic Plan 57

Georgia Viral Hepatitis Strategic Plan 58

High-Risk Populations Objective Provide education and training on viral hepatitis for high-risk populations. High-risk populations include Asians, Hispanics, and African Americans; as well as, the following: Injection drug users, past or present Intranasal drug users, past or present Recipients of any blood product prior to 1992 Veterans Infants born to HBsAg+ women Men having sex with men (MSM) Family members of infected persons Persons with piercings/tattoos Hemophiliacs Dialysis patients Health care providers Inmates of correctional systems Immigrants/refugees Community outreach workers and half-way house residents Emergency personnel and first responders (firemen, police, and emergency medical
technicians, etc.) Homeless individuals College students living in dorms Morticians
Georgia Viral Hepatitis Strategic Plan 59

High-Risk Populations Strategies
P1: Develop viral hepatitis educational materials targeting high-risk populations: Provide a script for word-of-mouth communication; Emphasize high-risk behavior(s)/past behaviors even once with IV drugs; and Make the message important/personal.
Priority: Short-Term / Critical
Evaluation Method: Count the types of materials and the number of each distributed Baseline: Unknown Target: High-risk individuals receive educational messages and materials and are aware of the risk factors of viral hepatitis
10% of injection drug users 10% of men having sex with men 50% of HbsAg positive pregnant women
P2: Develop viral hepatitis educational materials for people working with high-risk populations: Street out-reach workers; Speakers visiting inmates; Substance abuse and methadone clinic personnel; Community peer educators; and Forums where food is provided. Priority: Short-Term / Important
Evaluation Method: Survey people working with high-risk populations in Georgia Baseline: Unknown Target: 50% of people working with high-risk populations use the viral hepatitis educational material
P3: Develop viral hepatitis educational materials for use at Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA) meetings, websites, and clubhouses. Priority: Medium-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 60

Prevention Integration Objective Add and/or integrate viral hepatitis prevention messages, education, testing, and referrals into existing, relevant programs that serve high-risk populations. Such programs may include private and public providers, community based organizations (CBOs), substance abuse treatment, and community corrections. High-risk populations include African Americans, Asians, Hispanics, veterans, injection drug users and their sexual partners, men having sex with men, persons with non-sterile piercings/tattoos, intranasal drug users, STD/HIV clinic clients, incarcerated persons, parolees, probationers, homeless persons, college students, persons in half-way/recovery houses, immigrants/refugees, infants born to HBsAg positive women, transfusion recipients before 1992, and dialysis patients.
Prevention Integration Strategies P4: Provide public and private medical providers with web-based, CD-ROM, or other
training on how to counsel and educate their patients on viral hepatitis prevention. Priority: Medium-Term / Important Evaluation Method: Completed evaluation forms at end of training to obtain a baseline measure and then periodically survey medical providers to assess ongoing counseling and educating patients about viral hepatitis Baseline: Unknown Target: 30% of medical providers in Georgia have completed training (free continuing education credits provided) and 100% of participating medical providers complete an evaluation
Georgia Viral Hepatitis Strategic Plan 61

Prevention Integration Strategies (continued)
P5: Assist STD, HIV and AIDS service organizations in integrating hepatitis prevention messages into existing prevention activities using web-based, CD-ROM, or other training. Prevention messages should target high-risk populations and include information about coinfection (Provide free continuing education credits) Priority: Medium-Term / Critical
Evaluation Method: Completed evaluation forms at end of activities to obtain a baseline measure and then periodically survey program staff to assess ongoing integration of prevention messages Baseline: Unknown Target: 30% of STD, HIV and AIDS service organizations in Georgia have completed training and 100% of participating program staff complete an evaluation
Evaluation Method: Monitor number of viral hepatitis educational programs implemented with each STD/HIV organization in Georgia Baseline: Unknown Target: 50% of STD, HIV, and AIDS service organizations in Georgia provide clients with information about co-infection
P6: Integrate viral hepatitis prevention messages and services into publicly funded STD/HIV, family planning, and teen clinics. Priority: Medium-Term / Critical
Evaluation Method: Client surveys Baseline: Unknown Target: 25% of all clients receive viral hepatitis prevention messages and 50% of the appropriate clients are offered viral hepatitis services
Evaluation Method: Medical chart reviews Baseline: Unknown Target: 25% of all clients receive viral hepatitis prevention messages and 50% of the appropriate clients are offered viral hepatitis services
Evaluation Method: Count the number of doses of hepatitis A and hepatitis B vaccine distributed by the State Immunization Program to publicly funded health centers. Use GRITS to evaluate the number of doses administered. Baseline: 2002 and 2003 vaccine distribution. Baseline administration rates to be established through GRITS. Target: 25% increase in the number of viral hepatitis immunizations distributed to publicly funded health centers. After administration baseline is established, 25% increase in doses administered each year until 90% immunization rate is achieved.
Georgia Viral Hepatitis Strategic Plan
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Prevention Integration Strategies (continued)
P7: Train staff in publicly funded STD/HIV and family planning clinics to include screening for possible viral hepatitis infection according to standards of care and/or nurse protocols. Priority: Medium-Term / Critical
Evaluation Method: Medical chart reviews Baseline: Unknown Target: 90% of the appropriate clients are screened for viral hepatitis
P8: Collaborate with the State Board of Pardons and Paroles, the Georgia Department of Corrections, and community probation to provide health education seminars on viral hepatitis, HIV, and STDs to parolees and probationers. Priority: Short-Term / Important
Evaluation Method: Pre-test to determine baseline knowledge and post-test to determine improvement of knowledge of parolees and probationers Baseline: Unknown Target: 20% increase in knowledge of viral hepatitis, HIV, and STDs
P9: Develop a pilot project with health departments, parole, and probation to vaccinate their clients for viral hepatitis. Priority: Medium-Term / Critical
Evaluation Method: Medical chart reviews Baseline: Unknown Target: 30% of the appropriate clients are immunized against hepatitis A and hepatitis B
P10: Provide comprehensive, state-wide training for mental health counselors, substance abuse treatment and methadone providers on how to counsel, educate, and refer their clients on viral hepatitis. (Provide free continuing education credits through organizations such as NAADAC, The Association for Addiction Professionals) Priority: Medium-Term / Critical
Evaluation Method: Completed evaluation forms at end of activities to obtain a baseline measure and then periodically survey program staff to assess ongoing integration of prevention messages Baseline: Unknown Target: 30% of substance abuse treatment and methadone providers in Georgia have completed training and 100% of participating program staff completed an evaluation
Evaluation Method: Continuing Education Unit (CEU) records from state licensure board Baseline: Unknown Target: 50% of substance abuse and mental health counselors in Georgia have 2 CEUs focusing on viral hepatitis per year
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Prevention Integration Strategies (continued) P11: Provide substance abuse treatment centers with written and audio visual viral hepatitis
educational materials. Priority: Short-Term / Critical Evaluation Method: Survey substance abuse treatment center staff Baseline: Unknown Target: 50% of publicly funded treatment centers make viral hepatitis educational materials available to their clients P12: Pilot viral hepatitis vaccinations and testing in substance abuse treatment programs and methadone clinics. Priority: Medium-Term / Critical Evaluation Method: Medical chart reviews Baseline: Unknown Target: 10% of the appropriate clients are tested for viral hepatitis and/or immunized against hepatitis A and hepatitis B P13: Encourage birthing hospitals to provide the first dose of hepatitis B vaccine to all newborn infants prior to discharge. Priority: Medium Term / Critical Evaluation Method: Number and percent of birthing hospitals routinely administering the first dose of hepatitis B vaccine to newborn infants in the hospital as measured by a hospital policy survey Baseline: In a 2003 survey, 66 of 100 birthing hospitals routinely provided the birth dose of hepatitis B vaccine Target: 95% of birthing hospitals will routinely provide the birth dose of hepatitis B vaccine
Georgia Viral Hepatitis Strategic Plan 64

Prevention Integration Strategies (continued)
P14: Ensure completeness of HBsAg screening of pregnant women and treatment of perinatally-exposed infants. Priority: Medium Term / Critical
Evaluation Method: Assess appropriate records and conduct case management activities in order to ensure timely administration of HBIG and hepatitis B vaccine in the hospital, completion of the three-dose hepatitis B vaccine series and post-vaccination serologic testing of infants born to women with positive HBsAg results. Baseline: From July through December 2003, 138 infants born to HBsAg-positive women were identified. Of these, 100 percent received HBIG and one dose of hepatitis B vaccine within 12 hours of birth; 70 percent (96 of 138) received the second dose of hepatitis B vaccine; 37 percent (51 of 138) received the third dose of hepatitis B vaccine; and 17 percent (23 of 138) received post-vaccination testing. Target: At least 90% of all infants born to HBsAg-positive and unknown status mothers receive HBIG and hepatitis B vaccine in the hospital within 12 hours of birth and receive three doses of hepatitis B vaccine by 12 months of age. At least 80% of these infants receive serologic testing.
Evaluation Method: Conduct sample surveys of hospital delivery records to assess completeness of HBsAg screening of pregnant women, documentation of maternal status and timely administration of HBIG and hepatitis B vaccine in the hospital to infants born to women with positive or unknown HBsAg results Baseline: Unknown Target: At least 90% of pregnant women have documented HBsAg status in maternal records. At least 90% of all infants born to HBsAg-positive and unknown status mothers receive HBIG and hepatitis B vaccine in the hospital within 12 hours of birth
P15: Pilot a chronic hepatitis B and hepatitis C treatment program in substance abuse treatment programs and methadone clinics. Priority: Long-Term / Important
P16: Distribute viral hepatitis educational materials, web-based materials, and videos that can be used by community based organizations, parole, and probation. Priority: Medium-Term / Important
Evaluation Method: Survey community based organizations, parole, and probation staff Baseline: Unknown Target: 15% of community based organizations, parole, and probation centers make viral hepatitis educational materials available to their clients
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Prevention Integration Strategies (continued) P17: Distribute viral hepatitis educational materials to public and private medical providers
to give to patients. Priority: Medium-Term / Important Evaluation Method: Survey medical providers and staff Baseline: Unknown Target: 30% of medical providers and staff make viral hepatitis educational materials available to their patients
Georgia Viral Hepatitis Strategic Plan 66

Referral System Objective Develop a referral system for use by client providers serving high-risk individuals and/or those infected with viral hepatitis. Providers may include methadone clinics, abstinence-based treatment programs, drug/mental health help lines, emergency rooms, public health providers, community-based organizations, law enforcement, infection control practitioners, and private medical providers.
Referral System Strategies P18: Distribute HCV Resource Directory to community based organizations, public health
educators, infection control practitioners, substance abuse treatment providers, methadone clinics, parole, probation, prisons, and jails. Priority: Short-Term / Important Evaluation Method: Count the number of directories requested Baseline: Unknown Target: 20% additional directories requested P19: Make HCV Resource Directory web-based. Priority: Short-Term / Important Evaluation Method: Count the number of web site hits and directory downloads Baseline: Unknown Target: 20% additional web site hits and directory downloads P20 Develop and distribute "Dear Provider" letter with HCV Resource Directory. Priority: Short-Term / Nice To Have P21: Develop a referral algorithm and distribute with HCV Resource Directory. Priority: Medium-Term / Nice To Have
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Referral System Strategies (continued) P22: Create HAV and HBV referral materials for private providers to use with their clients,
including pregnant women. Utilize public health liaisons to help disseminate materials and provide training. Priority: Medium-Term / Important Evaluation Method: Survey providers to assess whether they refer eligible patients to public health for hepatitis immunizations Baseline: Unknown Target: 30% of providers refer eligible patients to public health for hepatitis immunizations when it is not possible for patients to receive their immunization(s) at the provider's office P23: Collaborate with and train law enforcement and other first responders on how to use the referral network. Priority: Medium-Term / Nice To Have P24: Foster memoranda of understanding among providers working with populations at high-risk for viral hepatitis in order to provide for continuity of care. Priority: Short-Term / Critical Evaluation Method: Count the number of memoranda of understanding Baseline: Unknown Target: 10 new memorandums of understanding
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Existing Policy Objective
Advocate for the modification of policies/regulations and address gaps in existing services that limit or restrict the prevention of viral hepatitis. Policies and service gaps that may be addressed include laws and regulations restricting access to and possession of sterile injection equipment, limited viral hepatitis prevention education curriculum for students, and school board policies restricting classroom discussion of science-based prevention strategies, such as condom use.
Existing Policy Strategies
P25: Collaborate with Nurse Protocol Committee and QA/QI team to develop strategies and tools to improve screening, vaccination, and education for viral hepatitis by public health nurses. Priority: Medium-Term / Critical
Evaluation Method: Minutes of Nurse Protocol Committee and QA/QI team meetings Baseline: Unknown Target: Strategies and tools are developed and incorporated into nursing practice standards and 90% of public health nurses follow the viral hepatitis protocols
P26: Collaborate with Georgia State Board of Pharmacy and Georgia Pharmacy Association and other relevant state medical associations to modify state laws and regulations that restrict access to and possession of sterile injection equipment. Priority: Long-Term / Critical
Evaluation Method: Legislation amended Baseline: Illegal to sell or distribute non-prescription sterile injection equipment for illicit purposes Target: Legal to sell or distribute non-prescription sterile injection equipment
P27: Collaborate with city and/or state governmental officials and other organizations to develop mechanisms to allow syringe exchange programs to legally operate state-wide. Priority: Long-Term / Critical
Evaluation Method: Legislation amended Baseline: Paraphernalia law currently includes syringes Target: Paraphernalia law excludes syringes
P28: Collaborate with the state and local boards of education to develop and implement standardized, science-based viral hepatitis educational curriculum. Priority: Long-Term / Nice To Have
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New Policy Objective
Advocate for the creation of new policies, regulations, and fiscal resource allocation that promote the prevention of viral hepatitis. New policies and regulations may include legal access to and possession of sterile injection equipment and expanded access to drug treatment, viral hepatitis testing, and vaccinations.
New Policy Strategies
P29: Collaborate with methadone clinics and abstinence based programs to develop viral hepatitis referral protocols for clients who were released from programs as a result of drug use or face challenges abstaining from street drugs. Priority: Long-Term / Nice To Have
P30: Lobby for allocation of state funds to vaccinate high-risk and incarcerated populations against viral hepatitis. Priority: Medium-Term / Critical
Evaluation Method: Review state legislative budget Baseline: None Target: State funds allocated for viral hepatitis vaccinations for high-risk and incarcerated populations
Evaluation Method: Immunization program records / private provider records (number of doses distributed and administered) Baseline: Unknown Target: 10% increase in the number of viral hepatitis vaccines distributed to adult populations
P31: Collaborate with hospitals, public health clinics, and community based organizations to develop and implement a protocol for referrals to viral hepatitis prevention services and care. Priority: Medium-Term / Important
Evaluation Method: Medical chart review Baseline: Unknown Target: 25% of staff utilizes the referral protocols
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New Policy Strategies (continued) P32: Collaborate with Georgia State Board of Pharmacy and Georgia Pharmacy Association
and other relevant state medical associations to develop and implement new state laws and regulations permitting legal access to and possession of sterile injection equipment. Priority: Long-Term / Critical Evaluation Method: New legislation passed Baseline: Illegal to sell or distribute non-prescription sterile injection equipment for illicit purposes Target: Legal to sell or distribute non-prescription sterile injection equipment
Georgia Viral Hepatitis Strategic Plan 71

Community Outreach Objective Reach high-risk individuals in their communities through culturally appropriate viral hepatitis interventions including health fairs, screenings, faith-based outreach, street outreach, individual and group level interventions, health presentations, and media campaigns.
Community Outreach Strategies P33: Encourage the incorporation of research-based or CDC recommended viral hepatitis
interventions by community outreach programs when working with high-risk populations. Priority: Medium-Term / Critical Evaluation Method: Survey organizations providing community outreach Baseline: Unknown Target: 10% increase in number of organizations using research-based or CDC recommended interventions P34: Collaborate with community based and public health HIV/STD programs to increase the number of culturally appropriate programs to decrease the risk of viral hepatitis infection among high-risk populations. Priority: Medium-Term / Critical Evaluation Method: Survey program participants about pre-program risk perception and post-program risk knowledge Baseline: Unknown Target: 10% decrease in number of program participants who participate in high-risk behaviors
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PRIMARY & SECONDARY PREVENTION OBJECTIVES Summary
Short-Term Critical
P1: Develop viral hepatitis educational materials targeting high-risk populations. P11: Provide substance abuse treatment centers with written and audio-visual viral hepatitis
educational materials. P24: Foster memoranda of understanding among providers working with populations at
high-risk for viral hepatitis in order to provide for continuity of care.
Medium-Term Critical
P5: Assist STD, HIV and AIDS service organizations in integrating hepatitis prevention messages into existing prevention activities using web-based, CD-ROM, or other training. Prevention messages should target high-risk populations and include information about coinfection (Provide free continuing education credits).
P6: Integrate viral hepatitis prevention messages and services into publicly funded STD/HIV, family planning, and teen clinics.
P7: Train staff in publicly funded STD/HIV and family planning clinics to include screening for possible viral hepatitis infection in patient care protocols.
P9: Develop a pilot project with health departments, parole, and probation to vaccinate their clients for viral hepatitis.
P10: Provide comprehensive, state-wide training for mental health counselors, substance abuse treatment and methadone providers on how to counsel, educate, and refer their clients on viral hepatitis. (Provide free continuing education credits through organizations such as NAADAC, The Association for Addiction Professionals).
P12: Pilot viral hepatitis vaccinations and testing in substance abuse treatment programs and methadone clinics.
P13: Encourage birthing hospitals to provide the first dose of hepatitis B vaccine to all newborn infants prior to discharge.
P14: Ensure completeness of HBsAg screening of pregnant women and treatment of perinatally-exposed infants.
P25: Expand protocols for public health nurses to include screening, vaccinations, and education for viral hepatitis.
P30: Lobby for allocation of state funds to vaccinate high-risk and incarcerated populations against viral hepatitis.
P33: Encourage the incorporation of research-based or CDC recommended viral hepatitis interventions by community outreach programs when working with high-risk populations.
P34: Collaborate with community based and public health HIV/STD programs to increase the number of culturally appropriate programs to decrease the risk of viral hepatitis infection among high-risk populations.
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Long-Term Critical
P26: Collaborate with Georgia State Board of Pharmacy and Georgia Pharmacy Association and other relevant state medical associations to modify state laws and regulations that restrict access to and possession of sterile injection equipment.
P27: Collaborate with city and/or state governmental officials and other organizations to develop mechanisms to allow syringe exchange programs to legally operate state-wide.
Short-Term Important
P2: Develop viral hepatitis educational materials for people working with high risk populations.
P8: Collaborate with the State Board of Pardons and Paroles, the Georgia Department of Corrections, and community probation to provide health education seminars on viral hepatitis, HIV, and STDs to parolees and probationers.
P18: Distribute HCV Resource Directory to community based organizations, public health educators, infection control practitioners, substance abuse treatment providers, methadone clinics, parole, probation, prisons, and jails.
P19: Make HCV Resource Directory web-based.
Medium-Term Important
P4: Provide public and private medical providers with web-based, CD-ROM, or other training on how to counsel and educate their patients on viral hepatitis prevention.
P16: Distribute viral hepatitis educational materials, web-based materials, and videos that can be used by community based organizations, parole, and probation.
P17: Distribute viral hepatitis educational materials to public and private medical providers to give to patients.
P22: Create HAV and HBV referral materials for private providers to use with their clients, including pregnant women. Utilize public health liaisons to help disseminate materials and provide training.
P31: Collaborate with hospitals, public health clinics, and community based organizations to develop and implement a protocol for referrals to viral hepatitis prevention services and care.
Georgia Viral Hepatitis Strategic Plan 74

Clinical Management
Scope of Clinical Management
Clinical management is a system in which a professional works with a client or patient to assure the receipt of diagnosis, treatment, support services, monitoring, and referral, as needed.

Prioritization Matrix

Length of Implementation

Impact on Target
Audience

Short-Term

Critical

C1

Important C15

Nice To Have

MediumTerm C2 C3, C6, C8, C12, C13, C19 C10, C14

Long-Term
C4, C7, C16 C9, C17, C18, C20 C11, C21

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Georgia Viral Hepatitis Strategic Plan 76

Diagnosis Objective
Implement appropriate, accessible, and affordable testing for viral hepatitis diagnosis. Diagnosis should include laboratory testing and clinical information.
Diagnosis Strategies
C1: Inform high-risk individuals about the advantages and disadvantages of HCV screening by providing educational materials at substance abuse treatment facilities. (Note: Long-term plan will include targeting other at-risk/high-risk groups.) Priority: Short-Term / Critical
Evaluation Method: Types of educational materials distributed, number of educational materials of each type, number of substance abuse treatment facilities existing and reached Baseline: Unknown Target: Reach 50% of the substance abuse treatment facilities; distribute at least 1000 copies of each type of educational material available
C2: Integrate HBV and HCV services education, counseling, testing, HAV and HBV vaccinations (as recommended by ACIP and CDC), and referrals into existing relevant programs (in public or private facilities). Priority: Medium-Term / Critical
Evaluation Method: Conduct chart reviews and staff interviews at top 10 publicly funded STD clinics to assess the number of tests vs. number of clients seen Baseline: Unknown Target: 10% increase in number of clients who receive appropriate education and/or counseling about viral hepatitis
Evaluation Method: Conduct chart reviews at top 10 publicly funded STD clinics to assess the immunization rates of clients Baseline: Unknown Target: 10% increase in adult hepatitis A and hepatitis B immunization rates
C3: Promote HCV testing among providers who serve at-risk individuals in public and private health care settings. Priority: Medium-Term / Important
Evaluation Method: Compare number of HCV test results from year to year Baseline: Unknown Target: 25% increase in HCV testing for at-risk individuals
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Diagnosis Strategies (continued) C4: Make HCV screening (and confirmatory testing) in public health settings financially
accessible to individuals at-risk. Priority: Long-Term / Critical Evaluation Method: Count number of HCV EIA antibody tests performed by Georgia Public Health Laboratory Baseline: Low-cost testing not available on a routine basis Target: 500 low-cost HCV EIA antibody tests performed each year (by GPHL) C5: Increase accurate diagnosis of HCV through completion of RIBA or PCR (confirmatory) testing when HCV EIA antibody tests are positive:
Establish a policy requiring physicians/labs confirmatory testing for a positive HCV antibody test
Priority: Long-Term / Important C6: Increase the number of people who are aware that they are infected with viral hepatitis
(acute and chronic) by increasing testing, accurate diagnosis, and patient return rate: Individuals need to know; and Testing needs to be affordable and available.
Priority: Medium-Term / Important Evaluation Method: Assess the number of viral hepatitis tests ordered by medical staff at the top 10 publicly funded STD clinics (largest volume or highest incidence rates) Baseline: Unknown Target: 10% increase in the number of viral hepatitis tests ordered Evaluation Method: Assess the number of clients who received viral hepatitis test results at the top 10 publicly funded STD clinics (largest volume or highest incidence rates) Baseline: Unknown Target: 10% increase in the number of clients who receive viral hepatitis test results and counseling
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Diagnosis Strategies (continued) C7: Encourage prenatal care providers to maintain and use a written protocol for testing,
documenting, and informing birthing hospitals of the HBsAg status of pregnant women during each pregnancy. Priority: Long Term / Critical Evaluation Method: Number and percent or prenatal care providers with written protocols for HBsAg testing, documenting and informing birthing hospitals as measured through a survey of OB-GYN practices Baseline: Unknown Target: 75% of prenatal care providers maintain and use written protocols for HBsAg testing, documenting and informing birthing hospitals C8: Increase the number of laboratories that follow CDC guidelines for HCV testing (i.e. using signal to cut-off ratios) and reporting. Priority: Medium-Term / Important Evaluation Method: Survey laboratories and hospitals to find out if signal to cut-off ratios are used and reported Baseline: 2002 and 2003 laboratory reports Target: 25% increase in labs that use and report signal to cut-off ratios for HCV antibody testing
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Case Management Objective
Establish and implement a comprehensive care structure for the management of viral hepatitis. This structure should include disease management, patient education, and referrals.
Case Management Strategies Note: Collaborate with the following groups during implementation: Georgia Division of Public Health (GDPH), American Association for the Study of Liver Diseases (AASLD), American Psychiatric Association (APA) and other professional organizations.
C9: Advocate for changes to the ACIP and CDC guidelines to include recommendations for HBV vaccine for persons infected with HCV. Priority: Long-Term / Important
C10: Develop a multidisciplinary, team approach to care: Examples: Kaiser Permanente Hepatitis C Clinic, Dr. Smith in Athens, Dr. Pearlman at the Sheffield Clinic; Improves overall quality of care for the patient; Continuous monitoring of patient throughout care; and Frees up doctor's time to concentrate on what the doctor does best (medical management).
Priority: Medium-Term / Nice To Have
C11: Advocate expanding Medicare policy to include viral hepatitis treatment and prescription drug costs. Priority: Long-Term / Nice To Have
C12: Establish a statewide telephone "800 helpline (Hepline)" and/or webpage for patients and providers. These resources would provide access to viral hepatitis disease information and referrals to appropriate resources. Priority: Medium-Term / Important
Evaluation Method: Count hits to webpage; online survey of webpage users Baseline: No webpage currently exists Target: 1000 webpage hits per year
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Case Management Strategies (continued)
C13: Develop a viral hepatitis referral system for use at local drug treatment and needle exchange programs, HIV/AIDS/STD programs, local health departments, correctional settings, veteran services, community mental health centers, and other relevant agencies. Priority: Medium-Term / Important
Evaluation Method: Survey 10 health districts to determine if staff are utilizing the referral system Baseline: No formal referral system exists Target: Establishment of a formal referral system in 10 of the 19 health districts
C14: Incorporate psychiatric evaluations, as indicated, for HBV and HCV patients. (Note: There is an increased incidence of depression associated with medical illness and interferon treatment.) Priority: Medium-Term / Nice To Have
C15: Increase knowledge of and utilization of state-funded hepatitis vaccine currently available at health centers. Priority: Short-Term / Important
Evaluation Method: Count the number of doses distributed by the State Immunization Program to publicly funded health centers. Evaluate doses administered through GRITS. Baseline: 2002 and 2003 vaccine distribution rates. Baseline administration rates to be established through GRITS. Target: Increase number of doses administered by 25%. After the administration baseline is established, increase the number of doses administered by 25% each year until 90% immunization rate is achieved.
C16: Increase the number of HCV+ individuals who receive HAV and HBV vaccinations, as recommended by ACIP and CDC guidelines. Priority: Long-Term / Critical
Evaluation Method: Count the number of doses provided Baseline: 2002 and 2003 vaccine utilization rates Target: Increase number of doses by 10%
C17: Increase the number of chronic HBV+ individuals who receive HAV vaccinations. Priority: Long-Term / Important
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Treatment Services Objective Ensure appropriate, accessible, and affordable treatment options for patients with HBV and HCV. Treatment Services Strategies C18: Advocate for changes to the psychiatric exclusion criteria for HCV treatment as
recommended by the American Association for the Study of Liver Diseases (AASLD) (e.g., change recommendations so that Bipolar disorder, irritability, and history of violence are not considered exclusion criteria) Priority: Long-Term / Important C19: Standardize medical and psychosocial intake assessments to maximize access to quality care. Priority: Medium-Term / Important Evaluation Method: Survey all physician offices in HCV resource directory Baseline: No standardized system exists within Georgia Target: Develop written guidelines and disseminate to all physicians offices listed in HCV resource directory C20: Increase access to affordable HCV treatment, including liver biopsies, genotype testing, viral load testing, medical care, medications, and case management services. Priority: Long-Term / Important C21: Obtain state and/or federal funding to ensure comprehensive continuity of care for uninsured and underinsured HCV+ individuals:
Similar to Ryan White Title II funding. Priority: Long-Term / Nice To Have
Georgia Viral Hepatitis Strategic Plan 82

CLINICAL MANAGEMENT OBJECTIVES Summary
Short-Term Critical
C1: Inform high-risk individuals about the advantages and disadvantages of HCV screening by providing educational materials at substance abuse treatment facilities. (Note: Long-term plan will include targeting other at-risk/high-risk groups.)
Medium-Term Critical
C2: Integrate HBV and HCV services education, counseling, testing, HAV and HBV vaccinations (as recommended by ACIP and CDC), and referrals into existing relevant programs (in public or private facilities).
Long-Term Critical
C4: Make HCV screening (and confirmatory testing) in public health settings financially accessible to individuals at-risk.
C7: Encourage prenatal care providers to maintain and use a written protocol for testing, documenting, and informing birthing hospitals of the HBsAg status of pregnant women during each pregnancy.
C16: Increase the number of HCV+ individuals who receive HAV and HBV vaccinations, as recommended by ACIP and CDC guidelines.
Short-Term Important
C15: Increase knowledge of and utilization of state-funded hepatitis vaccine currently available at health centers.
Medium-Term Important
C3: Promote HCV testing among providers who serve at risk individuals in public and private health care settings.
C6: Increase the number of people who are aware that they are infected with viral hepatitis (acute and chronic) by increasing testing, accurate diagnosis, and patient return rate:
C8: Increase the number of laboratories that follow CDC guidelines for HCV testing (i.e. using signal to cut-off ratios) and reporting.
C12: Establish a statewide telephone "800 helpline (Hepline)" and/or webpage for patients and providers. These resources would provide access to viral hepatitis disease information and referrals to appropriate resources.
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C13: Develop a viral hepatitis referral system for use at local drug treatment and needle exchange programs, HIV/AIDS/STD programs, local health departments, correctional settings, veteran services, community mental health centers, and other relevant agencies.
C19: Standardize medical and psychosocial intake assessments to maximize access to quality care.
Georgia Viral Hepatitis Strategic Plan 84

Surveillance & Related Research
Scope of Surveillance & Related Research
Surveillance and related research are procedures used by public health and the health care community to monitor disease incidence, prevalence and trends, and to target and assess the effectiveness of prevention strategies.

Prioritization Matrix

Length of Implementation

Impact on Target
Audience

Short-Term

Critical

S1, S7

Important S5, S6

Nice To Have

MediumTerm S8, S9 S2 S3

Long-Term S4

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Georgia Viral Hepatitis Strategic Plan 86

Provider Awareness and Timely Reporting Objective Increase knowledge and awareness among health professionals on reporting requirements for viral hepatitis. Reporting requirements include: what to report, how to report, when to report, and why to report. Health professionals may include: doctors, nurses, laboratory personnel, infection control practitioners, employee health professionals, occupational health professionals, blood banks, tissue banks, and correctional facilities.
Provider Awareness and Timely Reporting Strategies District level public health will: S1: Compile and distribute current viral hepatitis reporting materials to all health care
providers and laboratory staff and review submission procedures. Materials may include: Georgia Notifiable Disease poster; CDC case definitions and state reporting criteria; CDC testing guidelines; and District and county contact information.
Priority: Short-Term / Critical Evaluation Method: Analysis of confirmed HCV cases in SENDSS (State Electronic Notifiable Disease Surveillance System) Baseline: To be determined from SENDSS Target: 10% increase state-wide in the number of HCV positive antibody tests with a confirmatory test Evaluation Method: Analysis of confirmed viral hepatitis cases in SENDSS Baseline: To be determined from SENDSS Target: 10% decrease state-wide in the number of viral hepatitis cases reported that are not notifiable by case definition
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Provider Awareness and Timely Reporting Strategies (continued) S2: Create and distribute materials (e.g., algorithms and worksheets) to assist health care
providers with viral hepatitis diagnosis including: What tests to order; and How to interpret tests.
Priority: Medium-Term / Important Evaluation Method: Analysis of confirmed HCV cases in SENDSS Baseline: To be determined from SENDSS Target: 10% increase state-wide in the number of HCV positive antibody tests with a confirmatory test Evaluation Method: Analysis of confirmed viral hepatitis cases in SENDSS Baseline: To be determined from SENDSS Target: 10% decrease state-wide in the number of viral hepatitis cases reported that are not notifiable by case definition
Georgia Viral Hepatitis Strategic Plan 88

SENDSS/Data Feedback Objective Utilize and expand SENDSS (State Electronic Notifiable Disease Surveillance System) to capture viral hepatitis data to be used for analysis. Routinely disseminate appropriate viral hepatitis information to public health partners, the health care community, and the general public in order to increase awareness of viral hepatitis.
SENDSS/Data Feedback Strategies S3: Continue development, implementation, and utilization of the electronic viral hepatitis
case report form in SENDSS. Note: Add immunization history. Priority: Medium-Term / Nice To Have S4: Merge viral hepatitis registries with SENDSS. Priority: Long-Term / Important S5: Collaborate with the SENDSS programmers to implement alerts (pop-up boxes) when incomplete or inaccurate data is entered. Priority: Short-Term / Important Evaluation Method: Incomplete patient information Baseline: To be determined from SENDSS Target: 10% increase in the number of reports that contain complete patient information, including pregnancy status of women ages 15-45 Evaluation Method: Incomplete or missing laboratory, reporter, and/or physician/provider information Baseline: To be determined from SENDSS Target: 10% increase in the number of reports that contain complete laboratory, reporter, and/or physician/provider information Evaluation Method: Analysis of viral hepatitis cases in SENDSS Baseline: To be determined from SENDSS Target: 10% decrease state-wide in the number of viral hepatitis cases reported that are not notifiable by case definition
Georgia Viral Hepatitis Strategic Plan 89

SENDSS/Data Feedback Strategies (continued) S6: Provide training to SENDSS users (primarily in the private sector) on entering hepatitis
reports including: Develop a data entry checklist/job aide to help reduce data entry errors Provide feedback to users on quality of data entry Establish mandatory data fields
Priority: Short-Term / Important Evaluation Method: SENDSS query of number of new private providers Baseline: Current number of private providers signed-up for SENDSS Target: 10% increase in the number of private provider offices using SENDSS to report notifiable diseases Evaluation Method: Call log Baseline: Unknown Target: 10% decrease in number of public health follow-up phone calls to notifiable disease reporters S7: Analyze and disseminate viral hepatitis statistical data through a variety of media to reach target audiences. Some examples include:
Article in Georgia Epidemiology Report (GER) Quarterly viral hepatitis newsletter prepared by the Georgia Division of Public
Health Priority: Short-Term / Important Evaluation Method: Survey GER subscribers regarding viral hepatitis awareness Baseline: Does not exist Target: 10% increase of viral hepatitis awareness by GER subscribers
Georgia Viral Hepatitis Strategic Plan 90

Follow-Up Objective
Assure the appropriate and timely follow-up of newly reported viral hepatitis cases. Follow-up is defined as a comprehensive plan to evaluate individual risk factors and other necessary clinical information so that disease control and prevention activities can be implemented.
Follow-Up Strategies
S8: Develop a procedures manual to standardize the investigation of viral hepatitis cases across public health districts. Components of the manual will include, but not be limited to, the following: Conducting timely case investigation on all suspect or confirmed reports of acute viral hepatitis based on priority list and available resources; Ensuring timely SENDSS data entry for acute viral hepatitis cases; Communicating with health care providers to request additional testing, if needed, as recommended in the CDC testing guidelines for viral hepatitis; Completing standardized forms for each investigation and submit to the state either on paper or electronically through SENDSS; Documenting cases that are lost to follow-up; Providing appropriate prophylaxis to susceptible contacts of acute hepatitis A and B cases based on district policies and resources; and Notifying the state office immediately of suspected case clusters of acute hepatitis A in order to facilitate the possible identification of an outbreak. Priority: Medium-Term / Critical
Evaluation Method: Survey district public health notifiable disease staff to determine manual utilization Baseline: Unknown Target: 100% of public health notifiable disease staff utilize the manual
Evaluation Method: Assess number of CDC viral hepatitis case report forms submitted to the state office Baseline: Current number of CDC viral hepatitis case report forms submitted to the state office Target: 100% of viral hepatitis cases have CDC viral hepatitis case report forms submitted to the state office
Evaluation Method: Assess new form with checkbox to determine whether or not appropriate prophylaxis was offered Baseline: Unknown Target: 100% of susceptible contacts to acute hepatitis A and B cases are offered appropriate prophylaxis based on district policies and resources
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Follow-Up Strategies (continued) S9: Ensure that all local health departments perform case investigations on all HBsAg
positive pregnant women reported to their jurisdiction according to Georgia Immunization Program Perinatal Hepatitis B Prevention Program Guidelines. Priority: Medium-Term / Critical Evaluation Method: Survey district public health staff to determine utilization of guidelines. Baseline: Unknown. Target: 100% of HBsAg positive pregnant women are followed up according to Perinatal Hepatitis B Prevention Program Guidelines.
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SURVEILLANCE & RELATED RESEARCH OBJECTIVES Summary
Short-Term Critical District level public health will: S1: Compile and distribute current viral hepatitis reporting materials to all health care
providers and laboratory staff and review submission procedures. S7: Analyze and disseminate viral hepatitis statistical data through a variety of media to
reach target audiences.
Medium-Term Critical
S8: Develop a procedures manual to standardize the investigation of viral hepatitis cases across public health districts.
S9: Ensure that all local health departments perform case investigations on all HBsAg positive pregnant women reported to their jurisdiction according to Georgia Immunization Program Perinatal Hepatitis B Prevention Program Guidelines.
Long-Term Critical None listed
Short-Term Important S5: Collaborate with the SENDSS programmers to implement alerts (pop-up boxes) when
incomplete or inaccurate data is entered. S6: Provide training to SENDSS users (primarily in the private sector) on entering hepatitis
reports including:
Medium-Term Important S2: Create and distribute materials (e.g., algorithms and worksheets) to assist health care
providers with viral hepatitis diagnosis.
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Georgia Viral Hepatitis Strategic Plan 94

Glossary
Commonly used terms and acronyms
AASLD: American Association for the Study of Liver Diseases
ACIP: Advisory Committee on Immunization Practices A committee of 15 experts in fields associated with immunization who have been selected by the Secretary of the U.S. Department of Health and Human Services to provide advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention on the most effective means to prevent vaccine-preventable diseases.
AIDS: Acquired Immune Deficiency Syndrome
ALF: American Liver Foundation
APA: American Psychological Association
ASO: AIDS Service Organization
CBO: community-based organization
CDC: Centers for Disease Control & Prevention
CEU: Continuing Education Unit
CME: Continuing Medical Education
COBRA: Consolidated Omnibus Budget Reconciliation Act - Gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances.
CSTE: Council of State and Territorial Epidemiologists An organization for state-based and other epidemiologists that promotes the effective use of epidemiologic data to guide public health practice and improve health.
DOC: Georgia Department of Corrections
GDPH: Georgia Division of Public Health - the lead agency entrusted by the people of the State of Georgia with the ultimate responsibility for the health of communities and the entire population. At the state level, GDPH is divided into numerous branches, sections, programs and offices, and at the local level, GDPH functions via 19 health districts and 159 county health departments. GDPH is part of a larger state agency, the Georgia Department of Human Resources (DHR).
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GER: Georgia Epidemiology Report a monthly publication of the Epidemiology Branch, Georgia Division of Public Health. The GER is distributed monthly to over 22,000 physicians, nurses, laboratories, and public health officials throughout the State of Georgia. The GER's focus is on public health issues in Georgia, but it may also report on national health issues.
GPHL: Georgia Public Health Laboratory - The mission of the Georgia Public Health Laboratory is to provide screening, diagnostic and reference laboratory services to citizens of the Georgia through county health departments, public health clinics, physicians, hospitals and state agencies.
EIA: enzyme immunoassay An antibody/screening test for HCV
HAV: hepatitis A virus
HBIG: hepatitis B immune globulin
HBsAg+: hepatitis B surface antigen positive
HBV: hepatitis B virus
HCV: hepatitis C virus
HEALS: Hepatitis Education and Liver Support a non-profit group in Georgia that seeks to expand awareness about liver health through educational programs, literature, and public speaking
HIPAA: Health Insurance Portability and Accountability Act - Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. The Administrative Simplification provisions (Title II) require the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.
HIV: human immunodeficiency virus
IDU: injection drug user
ICP: infection control practitioner
Incidence: The number of new cases of infection that occur in a given population over a period of time.
IV: intravenous (drug use)
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Medicaid: a Federal/State program that pays for medical assistance for certain individuals and families with low incomes and resources. Medicaid is the largest source of funding for medical and health-related services for people with limited income
Medicare: the national health insurance program for: 1) People age 65 or older; 2) Some people under age 65 with disabilities; 3) People with End-State Renal Disease (ESRD), a permanent kidney failure requiring dialysis or a kidney transplant
MSM: men who have sex with men
NIH: National Institutes of Health
PCR: Polymerase Chain Reaction A common method of creating copies of specific fragments of DNA. A type of laboratory test used to confirm HCV infection
Perinatal: The time just before, during and immediately after birth (e.g., 5 months before and 1 month after).
Prevalence: The number of infected individuals in a population at a given point in time
RIBA: Recombinant Immunoblot Assay a laboratory test used to confirm HCV infection.
Ryan White Title CARE Act: The Ryan White CARE (Comprehensive AIDS Resource Emergency) Act is a federal program designed to improve the quality and availability of care for persons with HIV/AIDS and their families. Grants are given to states for health care and support services for persons with HIV/AIDS. Allocation decisions are by states.
Ryan White Title II funding: Major services funded under Title II are 1) Home and community-based health care and support services; 2) Pharmacy support through ADAP (AIDS Drug Assistance Program); 3) Local consortia to assess needs and organize a regional plan for delivery of HIV/AIDS services; 4) Medical care and support services
SENDSS: State Electronic Notifiable Disease Surveillance System
SSI: Supplemental Security Income A program financed through general tax revenues. SSI disability benefits are payable to adults or children who are disabled or blind, who have limited income and resources, who meet the living arrangement requirements, and are otherwise eligible.
SSDI: Social Security Disability Insurance A program financed with Social Security taxes paid by workers, employers and self-employed persons. In order to be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work. Disability benefits are payable to disabled workers, disabled widow(er)'s or adults disabled since childhood, who are otherwise eligible.
STD: sexually transmitted disease
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TBD: to be determined VFC: Vaccines for Children Program - provides free vaccines to doctors who serve eligible children. States and eligible U.S. projects enroll physicians who serve eligible patients up to and including age 18 years, providing routine immunizations with little to no out-of-pocket costs.
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Appendices
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Appendix 1
04 LC 25 3515S
The House Committee on Health & Human Services offers the following substitute to HR 701:
A RESOLUTION Recognizing Hepatitis C Awareness and Education Month and urging the Division of Public Health of the Department of Human Resources to undertake certain related studies; and for other purposes. WHEREAS, Hepatitis C is a "silent epidemic" and is the most common chronic bloodborne viral infection in the United States; and WHEREAS, Hepatitis C virus infection is a life-threatening disease that the Centers of Disease Control and Prevention conservatively estimate affects 4,000,000 persons in the United States; and WHEREAS, there are approximately 41,000 newly infected Hepatitis C patients per year as of 2002; and WHEREAS, Hepatitis C infections accounted for approximately 25,000 deaths per year in 2002 and is predicted to cause 30,000 annual deaths within ten years; and WHEREAS, Hepatitis C infection is three to four times more prevalent in the United States than HIV/AIDS, and approximately one third of all HIV infected persons are coinfected with HCV; and WHEREAS, 85 percent of Hepatitis C virus-infected persons are chronically infected; and WHEREAS, infected individuals serve as a source of transmission to others; and WHEREAS, very few of those infected with Hepatitis C virus are aware that they are infected,
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since symptoms often do not develop until ten to 20 years after the infection is contracted; and
WHEREAS, infected individuals who are unaware that they are infected are unlikely to take precautions to prevent the spread or exacerbation of their infection; and
WHEREAS, no vaccine is available for Hepatitis C virus; and
WHEREAS, Hepatitis C is now a leading cause of liver disease, placing infected individuals at elevated risk for chronic liver disease, liver cancer, and other Hepatitis C virus related illnesses; and
WHEREAS, Hepatitis C affects rural populations disproportionately and Georgia has 117 counties which are medically underserved; and
WHEREAS, detection is possible through blood screenings and treatment is effective in 10 to 40 percent of infected persons; and
WHEREAS, Hepatitis C should be treated as the public health crisis it has become, and government should take a proactive role in prevention education and making treatment available for those already infected with Hepatitis C; and
WHEREAS, the House of Representatives is concerned with preserving and protecting the health of the citizens of Georgia.
NOW, THEREFORE, BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES that the members of this body recognize the month of October as Hepatitis C Awareness and Education Month.
BE IT FURTHER RESOLVED that the Division of Public Health of the Department of Human Resources is urged to undertake a study of the public health impact of Hepatitis C in the State of Georgia and the need for programs or policies to enhance education, awareness, detection, and prevention of the disease in the general population.
BE IT FURTHER RESOLVED that the Division of Public Health of the Department of Human Resources is urged to undertake a study of the conditions, needs, issues, and problems mentioned above or related thereto and recommend any actions or legislation as necessary or appropriate.
BE IT FURTHER RESOLVED that the Clerk of the House of Representatives is authorized and directed to transmit an appropriate copy of this resolution to the Division of Public Health of the Department of Human Resources.
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Appendix 2
Strategic Planning Model

Feedback

Define Current
State
(Kick-Off)

Benchmark Current State
(Kick-Off)

Analyze Gaps
(Kick-Off)

Define Mission
(Kick-Off)

Define Vision
(Kick-Off)

Identify Key Focus
Areas
(Kick-Off)

Brainstorm & Prioritize Objectives
(WG Day 1)

Determine Goals
(WG Day 1)

Brainstorm & Prioritize Strategies
(WG Days 1-2)

Determine Metrics
(WG Day 2)

Conduct Research (Between Meeting Assignments)

Build Work Plans (WG Day 2*)
Sequence & Implement Work Plans (WG Day 2*)
Allocate Resources (Out-Of-
Scope)

Measure & Evaluate Work Plan
Implementation
(Out-Of-Scope)
Record Lessons Learned & Revise Plan, As Necessary
(Follow-Up)
Measure & Evaluate
Strategic Plan Success
(Out-Of-Scope)

STRATEGY FORMULATION

Feedback

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STRATEGY IMPLEMENTATION

STRATEGY EVALUATION

*Example Only

For more information or additional copies of this report, contact: Julie S. Wolthuis, MPH, MSW Hepatitis C Coordinator Viral Hepatitis Program Notifiable Disease Section
Georgia Division of Public Health 2 Peachtree Street, NW 14-264 Atlanta, GA 30303 Phone: 404-463-0849 Fax: 404-657-2608
email: jlschuitema@dhr.state.ga.us
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