Interagency Implementation Progress Report 

for the 

Action Plan for the Prevention, Care & 

Treatment of Viral Hepatitis
 
 

 

 

This report was prepared under the direction of the Office of HIV/AIDS and Infectious Disease Policy 

(OHAIDP), Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services 

(HHS). Information contained in the report was provided by the Viral Hepatitis Leads from various HHS 

agencies, the Department of Veterans Affairs and the Bureau of Prisons, Department of Justice. Ms. 

Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy Advisor in OHAIDP coordinated development of this 

report. Ms. Antigone Dempsey, M.Ed., Ms. Kelly Stevens, and Ms. Deborah Finette of Altarum Institute 

and Mr. Steve Holman, M.B.A., all working under contract to OHAIDP, assisted OHAIDP staff in 

compiling and formatting the report. 

Howard K. Koh, M.D., M.P.H ............Assistant Secretary for Health, HHS
 

Ronald O. Valdiserri, M.D., M.P.H.....Deputy Assistant Secretary for Health, 

Infectious Diseases, HHS 

September 2013 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preface 

September 2013 

It is my honor to share this second report highlighting our progress in implementing Combating the 

Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care, & Treatment of Viral 

Hepatitis (Action Plan). Released in May 2011, the Action Plan articulated robust and dynamic 

steps for improving viral hepatitis prevention and the care and treatment provided to infected 

persons. During 2012, implementation of the Action Plan continued in earnest with significant 

activities undertaken by offices and agencies within the U.S. Department of Health and Human 

Services and by our colleagues at the Department of Justice’s Federal Bureau of Prisons and the 

Department of Veterans Affairs’ Veterans Health Administration. We are also very pleased that 

recently the Department of Housing and Urban Development has joined in our cross-government 

efforts to improve the Nation’s response to viral hepatitis. 

Once again, I want to acknowledge and thank my colleagues from across the participating 

Federal agencies who are actively pursuing the Action Plan’s ambitious call to action for 

improved awareness, prevention, testing, treatment, and research. In particular, I want to 

express gratitude to the members of the Viral Hepatitis Action Plan Implementation Group, 

the representatives of 18 agencies and offices who have been collaborating on a regular 

basis since the Plan’s release to guide and advance implementation of the Action Plan, 

serving as champions for the Action Plan within their respective agencies and offices, and 

identifying opportunities to work with colleagues inside and outside of government to improve 

our response to viral hepatitis. I would also like to thank Dr. Ronald Valdiserri, Deputy 

Assistant Secretary for Health, Infectious Diseases, and the Director of the Office of 

HIV/AIDS and Infectious Disease Policy at the Department of Health and Human Services for 

his leadership of the efforts to implement the Action Plan. He and his team have been key to the 

progress that we have made since the Action Plan’s release. 

Our progress in 2012 certainly advanced us toward the Action Plan’s 2020 goals and provides a 

strong foundation on which we continue to build our efforts during 2013. The Action Plan 

originally detailed goals, strategies, and actions to be undertaken by federal agencies and 

offices from 2011 to 2013. I am pleased to state that we are engaged in a process to renew the 

plan for another 3 years, from 2014 to 2016. Renewing the Action Plan will sustain our 

momentum while enabling us to strengthen our cross-agency collaborations, sharpen the focus 

of our activities, and expand the reach of our programs. This report of our 2012 progress will 

inform the renewal of the Action Plan along with public comments and expert input obtained from 

across the federal government and many committed stakeholders. 

We intend to continue to work in concert with key allies from state and local government, 

nonprofit education and advocacy organizations, industry, medical and behavioral health care 

organizations, community advocates and people affected by viral hepatitis so as to sustain and 

enhance the efforts reported here and identify innovative new strategies to meet the needs of 

ALL persons living with or at risk for viral hepatitis. 

Sincerely yours, 

Howard K. Koh, M.D., M.P.H. 

Assistant Secretary for Health 
 

 

Excerpt from Presidential Proclamation on World Hepatitis Day 2012 

I encourage all Americans to talk with a physician about hepatitis 

prevention to learn more about what they can do to stay healthy. 

My Administration remains committed to addressing viral hepatitis. As 

part of our Action Plan for the Prevention, Care, and Treatment of 

Viral Hepatitis; the Healthy People 2020 initiative; and other Federal 

programs, agencies across the Federal Government are partnering 

with States, communities, and stakeholders throughout the private 

and nonprofit sectors to prevent new cases of hepatitis and help 

Americans who have already been affected. We are promoting 

hepatitis outreach and education that shines a light on this public 

health issue. With the White House Initiative on Asian Americans and 

Pacific Islanders, we are working to prevent, treat, and control 

hepatitis B infections in AAPI communities. And by bringing health 

insurance within reach for more Americans, the Affordable Care Act 

is helping improve patient access to comprehensive viral hepatitis 

prevention and treatment services. 

—President Barack Obama 

World Hepatitis Day Proclamation 

July 29, 2012 
 

 

Table of Contents 

Background ........................................................................................................................................... i
 

Introduction .......................................................................................................................................... ii
 

Priority 1 Educating Providers and Communities to Reduce Health Disparities ....................... 1
 

Priority 2 Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer ........ 4
 

Priority 3 Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease..... 7
 

Priority 4 Eliminating Transmission of Vaccine-Preventable Viral Hepatitis ........................... 10
 

Priority 5 Reducing Viral Hepatitis Caused by Drug Use Behaviors ........................................ 12
 

Priority 6 Protecting Patients and Workers From Health Care-Associated Viral Hepatitis .... 15
 

Appendix A. Overview of Federally Funded Viral Hepatitis Testing Activities .............................. i
 

Appendix B. Citations of Publications by Priority Area ................................................................. iv
 

Appendix C. Abbreviations .............................................................................................................. xiii
 
 

 

 

 

 

 

 

 

Background 

On May 12, 2011, the U.S. Department of Health and Human Services (HHS) issued Combating 

the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care, and Treatment of 

Viral Hepatitis (Action Plan). The Action Plan details more than 150 actions to be undertaken 

over the course of 3 years by agencies and offices across HHS and partners at the Federal 

Bureau of Prisons (FBOP) and the U.S. Department of Veterans Affairs (VA) that will improve 

the prevention, diagnosis, and treatment of viral hepatitis in the United States. 

The Action Plan put a spotlight on this silent epidemic and its growing impact in the United 

States, where as many as 5.3 million persons are living with chronic hepatitis B virus (HBV) or 

hepatitis C virus (HCV) infection and tens of thousands are at risk of infection. While viral 

hepatitis has previously been addressed by various Federal research, prevention, care, and 

treatment programs, much of this work was conducted independently, sometimes in isolation 

from other related efforts. Following the Institute of Medicine’s (IOM) 2010 report, Hepatitis and 

Liver Cancer, which recommended steps to reduce the threats posed by HBV and HCV, 

Assistant Secretary for Health Dr. Howard Koh convened an interagency workgroup composed 

of subject matter experts from various HHS agencies to review the IOM recommendations and 

develop a comprehensive strategic viral hepatitis action plan that would 

•	 Address IOM recommendations for viral hepatitis prevention, care, and treatment; 

•	 Set forth actions to improve viral hepatitis prevention and ensure that infected persons are 

identified and provided with quality care and treatment; and 

•	 Improve coordination of all activities related to viral hepatitis across HHS and promote 

collaborations with other government agencies and nongovernmental organizations. 

Stakeholders from other Federal agencies; professional societies; and state, tribal, local, and 

community partners also provided critical input into the Action Plan. The steps set forth in the 

Action Plan represent efforts to be undertaken in calendar years 2011, 2012, or 2013. Some 

actions outlined in the Plan can be accomplished by using existing resources through improved 

coordination and integration, while others are subject to the availability of funds. 

Following the Action Plan’s release, agencies and offices across HHS began working to 

implement the actions assigned to them in the Action Plan. To support these efforts, HHS 

convened a Viral Hepatitis Implementation Group (VHIG) and charged it with coordinating, 

supporting, and overseeing activities related to the Action Plan. The VHIG comprises 

representatives from across HHS and other Federal agencies and is chaired by Dr. Ronald 

Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases. Members of the VHIG 

have met numerous times over the first 2 years of implementing the Action Plan and have 

served as representatives within their respective agencies and offices on matters related to viral 

hepatitis. Read more about the Action Plan at http://aids.gov/hepatitis. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis

Interagency Implementation Progress Report – 2012 

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Introduction 

This second progress report features select highlights of progress made in implementing the 

Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis during 2012. Compiled by 

the HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP), the report spotlights 

several key accomplishments under each of the Action Plan’s six priority areas. These 

highlights were reported by the Federal partners engaged in implementing the Action Plan but 

are only a sampling of the numerous activities that the partners undertook during 2012. 

One recurrent theme across the Action Plan is the need for additional evidence to guide policy 

and practice at every level. Throughout 2012, Federal partners made important contributions to 

addressing gaps in our understanding of the prevention, care, and treatment of viral hepatitis 

through the publication of articles in the peer-reviewed literature along with the development of 

reports and other technical documents. These publications from across VHIG partner 

organizations advance efforts to develop and implement evidence-based programs, clinical 

services, and policies, and many are featured in this report. 

Finally, this 2012 report features a brief analysis of HBV and HCV testing activities taking place 

in federally funded programs. HBV and HCV testing services are a foundation on which we can 

build progress toward the goals of the Action Plan. Testing identifies chronically infected people 

and provides an oppurtunity to link them to services and therapies that can decrease their risk of 

liver disease. This report is the first time that viral hepatitis testing data has been requested from 

across government programs. 

All of the described activities support progress toward the four overarching goals that the Action 

Plan charts for accomplishment by 2020: 

•	 An increase in the proportion of persons who are aware of their HBV infection, from 33 to 66 

percent; 

•	 An increase in the proportion of persons who are aware of their HCV infection, from 45 to 66 

percent; 

•	 A 25 percent reduction in the number of new cases of HCV infection; and 

•	 Elimination of mother-to-child transmission of HBV. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis

Interagency Implementation Progress Report – 2012 

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Federal Partners in Implementing the Action Plan for the 

Prevention, Care, and Treatment of Viral Hepatitis 

U.S. Department of Health and Human Services 

x Agency for Healthcare Research and 

Quality 

x Centers for Disease Control and 

Prevention 

x Centers for Medicare & Medicaid Services 

x Food and Drug Administration 

x Health Resources and Services 

Administration 

x Indian Health Service 

x National Institutes of Health 

x Office of the Assistant Secretary for 

Health 

o	 National Vaccine Program Office 

o	 Office of HIV/AIDS and Infectious 

Disease Policy 

o	 Office of Minority Health 

o Office of the Surgeon General 

o Office on Women’s Health 

o Regional Health Administrators 

x	 Office of the National Coordinator for 

Health Information Technology 

x	 Substance Abuse and Mental Health 

Services Administration 

U.S. Department of Housing and Urban Development 

x Community Planning and Development 

U.S. Department of Justice 

x Federal Bureau of Prisons 

U.S. Department of Veterans Affairs 

x Office of Public Health, Veterans Health Administration 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis

Interagency Implementation Progress Report – 2012 

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Viral Hepatitis Implementation Group Member List:
 

Office of the Assistant Secretary for Health 

Ronald Valdiserri, M.D., M.P.H. (Chair) 

Deputy Assistant Secretary for Health, Infectious 

Diseases 

Corinna Dan, R.N., M.P.H. 

Viral Hepatitis Policy Advisor 

Christopher Bates, M.P.A. 

Senior Advisor to the Director 

Agency for Healthcare Research and Quality 

(AHRQ) 

William B. Baine, M.D. 

Senior Medical Advisor 

Center for Outcomes and Evidence 

Centers for Disease Control and Prevention 

(CDC) 

John Ward, M.D. 

Director 

Division of Viral Hepatitis (DVH), National Center 

for HIV/AIDS, Viral Hepatitis, STD and TB
 

Prevention (NCHHSTP)
 

Centers for Medicare & Medicaid Services 

(CMS) 

Indira Jevaji, M.S., M.S.L. 

Medical Advisor 

Quality Improvement Group 

Center for Clinical Standards and Quality 

Department of Housing and Urban 

Development (HUD) 

Marlisa Grogan 

Office of Special Needs Assistance Programs 

Community Planning and Development 

Department of Justice (DOJ) 

Jeff Allen, M.D. 

Chief of Health Programs 

Federal Bureau of Prisons 

Michelle Williams, Pharm.D. 

Lieutenant, U.S. Public Health Service 

HIV/Hepatitis C Program Manager 

Health Services Division 

Federal Bureau of Prisons 

Department of Veterans Affairs (VA) 

Janet Durfee, R.N., M.S.N., A.P.R.N. 

Deputy Chief Consultant 

Office of Public Health/Clinical Public Health 

Veterans Health Administration 

Food and Drug Administration (FDA) 

Jonca Bull, M.D. 

Director 

Office of Minority Health 

Health Resources and Services Administration 

(HRSA) 

Sarah Linde, M.D. 

Chief Public Health Officer 

Rupali Kotwal Doshi, M.D., M.S.
 

Medical Officer
 

HIV/AIDS Bureau
 

Indian Health Service (IHS) 

Lisa Neel, M.P.H.
 

Program Analyst, HIV Program
 

National Institutes of Health (NIH) 

Jay Hoofnagle, M.D. 

Director 

Liver Disease Research Branch, National Institute 

of Diabetes and Digestive and Kidney Diseases 

Jag H. Khalsa, Ph.D., M.S. 

Chief 

Medical Consequences Branch, National Institute 

on Drug Abuse 

National Vaccine Program Office (NVPO) 

Jody Sachs, D.P.M. 

Senior Scientist 

Office of Minority Health (OMH) 

Sonsiere Cobb-Souza 

Director 

Division of Program Operations 

Office of the National Coordinator for Health 

Information Technology 

Jesse James, M.D., M.B.A. -

Senior Medical Officer, Meaningful Use 

Office of the Surgeon General 

LCDR Sarah Schillie, M.D., M.P.H., M.B.A. 

Medical Epidemiologist, Division of Viral Hepatitis 

Centers for Disease Control and Prevention 

Office of Women’s Health 

Ledia Martinez, M.D., M.P.H. 

Regional Women’s Health Liaison 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Regional Health Offices 

Patrick O’Carroll, M.D., M.P.H., F.A.C.P.M., 

F.A.C.M.I. 

Regional Health Administrator, Region X 

Substance Abuse and Mental Health Services 

Administration (SAMHSA) 

Robert Lubran, M.P.A., M.S. 

Director 

Division of Pharmacologic Therapies 

Center for Substance Abuse Treatment 

Elinore “Ellie” McCance-Katz, M.D., Ph.D. 

Chief Medical Officer 

White House Initiative on Asian Americans and 

Pacific Islanders 

Francisco Sy, M.D., Dr.P.H. 

HHS Liaison 

Interagency Implementation Team 

This list reflects members as of the release of this report. Not all partners listed here contributed 

to the activities summarized in this report since new members have joined in 2013. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Priority 1 Educating Providers and Communities to 

Reduce Health Disparities 

Goals 

1.1 Build a U.S. health care workforce prepared to prevent and diagnose viral 

hepatitis and provide care and treatment to infected persons. 

1.2 Decrease health disparities by educating communities about the benefits of 

viral hepatitis prevention, care, and treatment. 

Increased provider knowledge has been shown to improve delivery of preventive services, 

including those for viral hepatitis. Expanding the number of patients aware and providers 

knowledgeable about viral hepatitis testing, care, and treatment is key to maximizing the 

benefits afforded by new viral hepatitis testing and treatment options, as well as opportunities 

presented in a reformed health care system. 

Reducing viral hepatitis health disparities will require that disproportionately affected 

communities, and the providers at all levels of the health systems that serve them, all become 

better educated and more aware of opportunities for prevention, care, and treatment. Providers’ 

enhanced understanding of the diversity of patients at risk for viral hepatitis (e.g., Asian 

Americans and Pacific Islanders [AAPI], African Americans, HIV-infected persons, injection drug 

users [IDUs], men who have sex with men [MSM], baby boomers [persons born during 1945– 

1965]) will help improve their ability to find, manage, and treat people who have chronic viral 

hepatitis. This diverse patient population is cared for by an equally diverse group of clinical care 

providers, from community health providers in remote Alaskan villages to drug treatment 

providers in inner cities. To be effective, activities to improve viral hepatitis education must 

encompass and engage a wide variety of health care providers and communities. 

In 2012, the following were among the actions undertaken by Federal partners to educate 

communities about viral hepatitis and build a strong workforce of viral hepatitis providers: 

Launching national hepatitis education activities and campaigns. In 2012, the CDC’s 

NCHHSTP launched “Know More Hepatitis,” an educational campaign to inform the general 

public, persons at risk, and health care providers about the serious consequences of 

unrecognized viral hepatitis infections. The campaign is designed to encourage testing of 

persons at risk, as well as linkage to care for persons who test positive for viral hepatitis. 

“Know More Hepatitis” includes a targeted multimedia campaign, which comprises news media 

outreach, print and broadcast ads, transit ads, radio public service announcements (PSA), 

airport dioramas, magazine ads, a Web presence, and social media such as Facebook and 

Twitter. Additionally, the campaign has featured PSAs from Assistant Secretary for Health Dr. 

Howard Koh and then-Surgeon General Dr. Regina Benjamin. CDC Director Dr. Thomas 

Frieden led media outreach efforts. In 2012, more than $4.8 million of donated space was 

available for campaign material placement. Many donated placements that were secured in 

2012 will continue to accrue value and have an impact in 2013. 

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Priority 1: Educating Providers and Communities to Reduce Health Disparities 

The first-ever national Hepatitis Testing Day. The campaign included the successful launch of 

the first annual observance of National Hepatitis Testing Day on May 19, 2012, which featured 

far more than 100 testing events across the country. Members of the VHIG were actively 

engaged in testing day activities through outreach and awareness messaging with Federal staff, 

grantees, partners, and others. 

Training for health care providers. The “Know More Hepatitis” campaign included the 

development of online training delivered by medical educators to health care providers. Health 

care providers also received online training developed by NCHHSTP grantees. 

Hepatitis B education and awareness. In 2012, the formative stages of an HBV education and 

awareness campaign targeting at-risk communities was initiated, including review of materials 

by key stakeholders from target communities across the country. A variety of educational 

materials were developed in English, Chinese, Korean, and Vietnamese in order to address the 

health disparities in these populations related to HBV. The campaign was launched in June 

2013. 

Addressing viral hepatitis co-infections to improve health outcomes. HRSA’s HIV/AIDS 

Bureau (HAB) understands that viral hepatitis is among the co-occurring conditions that must be 

addressed to improve health outcomes for people living with HIV. HCV is a leading cause of 

morbidity and mortality among people living with HIV. On average, one-third of people living with 

HIV are co-infected with HCV (prevalence rates are even higher among IDUs), and an 

estimated 10 percent of people living with HIV are co-infected with chronic HBV. One important 

initiative addressing this issue is HAB’s Hepatitis C Treatment Expansion Initiative. Funded as a 

Special Project of National Significance (SPNS), this initiative supported 29 Ryan White 

HIV/AIDS Program grantees in 2012. Each grantee received resources to test new models of 

integrating HCV treatment into their clinical practice, with an overall goal to enable sites to 

increase the number of co-infected patients treated for HCV. This initiative will evaluate the 

effectiveness of the interventions to deliver HCV treatment among HIV-positive populations and 

will share best-practice models with Ryan White grantees and other HIV medical providers to 

improve access to and quality of HCV care and treatment for HIV patients. At the November 

2012 Ryan White HIV/AIDS Program Grantee Meeting, AIDS Care Group of Chester, 

Pennsylvania, and the Siouxland Community Health Center of Sioux City, Iowa shared their 

experiences. The University of South Florida, which has a cooperative agreement to serve as 

the training and evaluation center for this SPNS initiative, also presented at the grantee 

meeting, highlighting elements of a successful HIV/HCV program and four models of care 

delivery being used by the SPNS grantees: primary care delivery with expert backup, integrated 

care without a designated HCV clinic (expert consultation used for severe complications), 

integrated care with a designated internal HCV clinic, and co- located care with a specialist who 

manages treatment at Ryan White clinical site. Outcomes to be measured across all sites 

include the number of HIV/HCV-co-infected patients treated or not treated for HCV, barriers to 

HCV treatment, sustained virologic response, services utilization, and cost. Grantees are also 

encouraged to conduct projects designed to investigate local issues that affect HCV treatment in 

their populations. 

Expanding provider capacity for treating viral hepatitis. In summer 2012, HAB was awarded 

HHS Secretary’s Minority AIDS Initiative funds to expand the number of AIDS Education and 

Training Centers (AETC) Telehealth Training Centers. HAB currently supports 11 Telehealth 

Training Centers, to include support of viral hepatitis treatment expansion. This effort is 

scheduled through June 2015. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Priority 1: Educating Providers and Communities to Reduce Health Disparities 

Creating a viral hepatitis specialty care network for Veterans. The VA developed a 

comprehensive HCV Specialty Care Access Network (SCAN)/Extension for Community 

Healthcare Outcomes (ECHO) standardized curriculum. In collaboration with a technical 

advisory group and the VA’s Employee Education System, the SCAN/ECHO curriculum is 

designed to support training and mentorship of providers in rural and underserved areas to 

promote the VA’s high-quality standards of care for diagnosis, care, and treatment for all 

Veterans with chronic HCV. There are currently seven hub sites for the SCAN/ECHO program, 

with more than 600 consults received. VA sites participating in 2012 are from California, 

Washington, Oregon, Alaska, Connecticut, Vermont, Virginia, North Carolina, New Hampshire, 

New Mexico, Texas, Arizona, Michigan, and Indiana. The VA has looked at provider 

satisfaction, which is high, as well as specialty team satisfaction. Future measures will include 

rates of confirmatory testing, referrals for mental health and substance use care, sustained 

virologic response, and assessing travel miles averted. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Priority 2	 Improving Testing, Care, and Treatment to 

Prevent Liver Disease and Cancer 

GOALS 

2.1 Identify persons infected with viral hepatitis early in the course of their 

disease. 

2.2 Link and refer persons infected with viral hepatitis to care and treatment. 

2.3 Improve access to and quality of care and treatment for persons infected with 

viral hepatitis. 

2.4 Advance research to facilitate viral hepatitis prevention and enhance care and 

treatment for infected persons. 

Timely diagnosis of HBV and HCV and better provision of care and treatment to those who are 

infected can decrease the burden of cirrhosis and liver cancer, reduce the need for liver 

transplantation, and reduce the number of deaths due to viral hepatitis in the United States. 

Provision of these services also can help reduce the viral-hepatitis-related health disparities 

experienced by populations at high risk for viral hepatitis, such as IDUs, MSM, HIV-infected 

persons, baby boomers, African-Americans, and AAPIs. 

In 2012, the following were among the actions undertaken by Federal partners to improve 

testing, care, and treatment to prevent liver disease and cancer: 

Expanding viral hepatitis testing recommendations. The CDC conducted a comprehensive 

scientific analysis to provide the justification for new recommendations for HCV testing. In doing 

so, the CDC employed an evidence-based policy development model which was informed by 

the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) 

framework. The GRADE framework provided guidance and tools to define research questions, 

conduct a systematic review, assess the overall quality of evidence, and determine the strength 

of the recommendations that the CDC considered. 

A recommendation for one-time routine HCV testing of all persons born between 1945 and 

1965, without ascertainment of risk factors, was developed via the GRADE methodology and 

released by the CDC on August 12, 2012. This recommendation is in addition to the CDC’s 

1998 recommendation that all adults with identified risk factors for HCV infection should be 

tested. 

Expanding HBV and HCV testing for persons at risk. To expand HBV and HCV testing, the 

CDC awarded $6.6 million from the Patient Protection and Affordable Care Act’s Prevention and 

Public Health Fund to 35 sites to provide HBV or HCV testing for persons at risk for hepatitis 

and to provide linkages to care for infected persons. HBV testing and referral sites focus on 

Asian Americans, who bear nearly half the chronic HBV infection burden in this country. HCV 

testing and referral sites included programs that serve persons who inject drugs, community 

health centers, and other venues that serve persons at risk for HCV infection. Since awarding 

the funds, the CDC has held a grantee meeting where counseling guidelines, reporting 

4 
 

 

 

 

 

 

 

 

 

 

 

 

 

Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer 

requirements, and evaluation tools were discussed. The CDC also developed a secure Webbased system to collect data from grantees. The system has subsequently received Office of 

Management and Budget approval and all security clearances; trainings have been provided to 

grantees, and data entry has begun. In addition, the CDC began to develop a simple yet 

expandable data-monitoring system that will include indicators related to both target populations 

(e.g., current and past risk behaviors, race/ethnicity) and levels of achievement (e.g., number of 

tests conducted for HBV and HCV, number of new cases identified). To support these new 

efforts, technical assistance was provided to grantees in preparation for testing and referral to 

care activities, which most grantees began in December of 2012. 

Coordinating an HCV demonstration project. HRSA’s Bureau of Primary Health (BPHC) 

facilitated the initial dialogue and introduction of partners, including the Community Health Care 

Association of New York State (CHCANYS), which received funding from Health Research, Inc., 

for a 2-year collaborative HCV demonstration project in partnership with the New York State 

Department of Health (NYSDOH) AIDS Institute, the New York City Department of Health and 

Mental Hygiene’s Office of Viral Hepatitis Coordination, and the Harm Reduction Coalition. The 

objective of the project was to improve prevention, screening, and treatment of HCV within the 

community health center model. Six health center sites were selected to participate in the 

project. CHCANYS used a learning collaborative model and videoconferencing technology to 

ensure the transfer of knowledge, new skills, and capability to participants while supporting their 

improvement work. The teams participated in an 8-month learning collaborative and created 

quality improvement teams focused on addressing HCV. A number of best practices were 

collectively implemented as a result of the improvement process: 

•	 Training of front-desk staff to promote continuity of care, 

•	 Training of clinical staff to support HCV illness improvement, 

•	 Development of registry to capture HCV positive patients, 

•	 Development and utilization of assessment surveys to screen indicators to increase 

screening rates and optimize waiting room time, 

•	 Partnerships with pharmaceutical and/or lab companies to subsidize screening tests and 

treatment drugs, 

•	 Utilization of community health workers and staff for outreach and patient support, and 

•	 Support groups to increase treatment compliance. 

Creating electronic health record tools to improve HCV screening for American Indians. 

The IHS has been innovative in using computer technology to capture clinical and public health 

data to support the provision of health services. In 2012, the IHS developed a HCV screening 

clinical reminder module in the electronic health record (EHR) and launched it in two pilot sites. 

The reminder module is modeled on the logic used in the VA, which has a very well-developed 

EHR. In clinical practice, the module reminds clinicians to screen patients born between 1945 

and 1965 for HCV infection. 

Monitoring outcomes of newly approved anti-HCV therapies. FDA’s Center for Drug 

Evaluation and Research engaged in a collaborative with the Hepatitis C Therapeutic Registry 

and Research Network (HCV-TARGET) to monitor outcomes of newly approved anti-HCV 

therapies. HCV-TARGET is a cooperative academic consortium of leading HCV investigators 

and community-based sites affiliated with the academic sites in geographic proximity. The 

project is a longitudinal, observational study that will create a research registry of patients 

treated with telaprevir or boceprevir. The registry will be designed to rapidly inform strategies for 

better management of populations underrepresented in clinical trials, identify and remediate 

educational gaps relative to treatment guidelines and adverse event management in order to 

optimize rates of sustained virological response, and serve as the core resource for important 

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Interagency Implementation Progress Report – 2012 

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Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer 

collaborative translational studies using biospecimens and clinical data from diverse patient 

populations. The HCV-TARGET registry seeks to characterize patients underrepresented in 

clinical trials of telaprevir and boceprevir, including African Americans, patients with cirrhosis, 

and patients considered null responders to treatment. 

Advancing the development of new therapeutic agents for HCV infection. NIH’s National 

Institute of Allergy and Infectious Diseases (NIAID) is supporting the development of several 

new therapeutic agents for HCV infection (e.g., HCV Entry Inhibitor ITX 5061 [NCT01165359], 

HCV Protease Inhibitor Bocepravir [NCT01482767]) and adjunct treatments (e.g., pioglitazone, 

nitazoxanide) to increase the response rate to PEGylated interferon plus ribavirin treatment for 

HIV/HCV-co-infected patients (e.g., NCT00665353, NCT00991289). NIAID’s research includes 

initial screening for active compounds in in vitro and in vivo models, preclinical development of 

selected compounds, and clinical studies. 

Providing Direct-Acting Antivirals (DAA) to Veterans. The VA engaged in a comprehensive, 

multifaceted approach to examine the operational adoption of DAA regimens for the treatment 

of hepatitis C—spanning all VA levels—relying upon a basic framework of education and 

training, real-time oversight and feedback from a higher organization level, provision of data to 

front-line clinical staff for effective regional and local management, and prompt outcome 

sharing. In 2011, 865 Veterans received their first DAA from VA prescribers. In 2012, the first 

full year after FDA approval, more than 4,000 Veterans with genotype 1 received their first DAA, 

out of 97,011 Veterans in VA care mono-infected with genotype 1 HCV. 

Within the first 6 months after FDA approval, boceprevir or telaprevir had been prescribed at 94 

of 130 VA facilities. One year after FDA approval, DAAs were prescribed at 120 of 130 VA 

facilities. Five of those sites not prescribing DAAs had fewer than 250 HCV-infected Veterans in 

care and were referring patients to non-VA facilities for HCV care. Comprehensive data and 

outcome sharing improved clinical practice, as measured by improved HCV RNA monitoring 

and attention to adherence, and further contributed to more appropriate management of DAArelated anemia and neutropenia. Almost 60 percent of these Veterans started DAA regimens 

prescribed by mid-level providers. Facility treatment initiation rate, response to treatment, and 

sustained viral responses are closely monitored and made available to front-line clinical staff. 

Providing Direct-Acting Antivirals (DAA) to Inmates. In March 2012, FBOP began providing 

the Direct-Acting Antivirals to Inmates with HCV genotype 1 infection. As of August, 2013, 214 

inmates have initiated treatment with these medications, 55 have completed a course of therapy 

and 92 remain on active treatment. The FBOP Regional and National Pharmacy Consultants 

monitor treatment and outcomes of all inmates treated with the new anti-HCV therapies. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

6 
 

 

 Priority 3	 Strengthening Surveillance to Detect Viral 

Hepatitis Transmission and Disease 

GOALS 

3.1 Build a network of State and local surveillance systems with sufficient capacity to 

monitor viral hepatitis transmission and disease. 

3.2 Monitor viral-hepatitis-associated health disparities. 

3.3 Monitor provision and impact of viral hepatitis prevention, care, and treatment 

services. 

3.4 Develop and implement new technologies and laboratory procedures to improve viral 

hepatitis surveillance. 

Surveillance data affords public health professionals insight into the current prevalence and 

incidence of disease. Data from surveillance systems can highlight trends in the burden of 

disease, identify disparities in health, inform the evaluation of public health programs and 

policies, and monitor changes in health care practices. While there exist a number of viralhepatitis-related data sources that help provide insight into current disease prevalence and 

incidence at the State and local levels, including the National Notifiable Disease Surveillance 

System, which serves as the primary source of viral hepatitis surveillance data in the United 

States, this source does not fully capture chronic viral hepatitis prevalence or specifically target 

populations at high risk for viral hepatitis. Employing active surveillance and serologic surveys 

that target priority populations would provide more accurate estimates of the burden of HBV and 

HCV in the United States. 

With additional resources, viral hepatitis surveillance could be enhanced in several dimensions. 

For instance, automated surveillance systems can be linked to electronic medical records 

(EMR), which incorporate essential information regarding patient demographics; test results; 

clinical conditions; and the prevention, care, and treatment services rendered by health care 

providers. Increased resources also would enable case definitions to be revised to reflect the 

advent of new laboratory technologies and meet new data needs of prevention programs. 

Finally, data standards and IT systems could be employed to link viral hepatitis surveillance with 

other surveillance systems (e.g., those used to monitor HIV, cancer, and immunization). 

In 2012, the following were among the actions undertaken by Federal partners to strengthen 

surveillance to detect viral hepatitis transmission and disease: 

Conducting Liver Cancer Surveillance. The CDC and the NIH National Cancer Institute, in 

collaboration with the North American Association of Central Cancer Registries, produce official 

Federal statistics on cancer incidence and mortality data available via a Web-based report. 

According to the CDC, liver cancer rates have tripled over the last several decades with at least 

half of the cases attributable to HCV and approximately one-sixth attributable to HBV. 

7 
 

 

 

 

 

 

 

 

Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease 

Suggested Web citation: U.S. Cancer Statistics Working Group. United States cancer statistics: 1999–2009 incidence and mortality Webbased report. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National 

Cancer Institute; 2013. http://apps.nccd.cdc.gov/uscs/. Accessed July 15, 2013. 

Expanding local flexibility to establish performance metrics for viral hepatitis activities. 

The CDC strengthened local jurisdictions’ flexibility and ability to support surveillance activities 

by expanding the Adult Viral Hepatitis Prevention Coordinators’ (AVHPC) funding opportunity 

announcement (FOA) in July 2012; the awards were made in November 2012. The FOA 

combined viral hepatitis prevention activities at State and local surveillance programs and set 

measurable performance goals; it also expanded grantees ability to use awarded funds to 

create performance standards and increase surveillance activities. The previous program 

funding structure provided funding only for the AVHPCs; the modified FOA gave States and 

large metropolitan areas the opportunity to establish performance metrics and ensure that 

surveillance and prevention activities are integrated in the funded jurisdictions, greatly 

expanding their efforts to address viral hepatitis. After the FOA was released, the CDC awarded 

$5.25 million to adult viral hepatitis coordinators in 49 States, the District of Columbia, and four 

metropolitan areas to provide leadership in the implementation of HBV and HCV testing, 

counseling, and linkage to care as a routine service in public health programs and other settings 

serving persons at risk for infection. 

Enhanced surveillance activities through new cooperative agreements. In addition to funding the 

AVHPCs, the CDC also awarded $3.2 million through cooperative agreements with 

Massachusetts, Philadelphia, San Francisco, New York, Florida, Washington, and Michigan to 

conduct active and enhanced surveillance for viral hepatitis. Grantee activities include 

• Monitoring trends in incidence and risk factors for viral hepatitis A, acute and chronic viral 

hepatitis B, and acute and chronic viral hepatitis C; 

•	 Identifying and controlling outbreaks; 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

8 
 

 

Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease 

•	 Identifying the number of infected persons who need linkage to counseling and medical 

follow-up; and 

•	 Identifying and characterizing infected persons who receive treatment. 

Monitoring hepatitis B infection in Veterans. The VA convened an HBV workgroup, including 

key VA stakeholders and subject matter experts, to develop a national and coordinated effort in 

VA to understand HBV testing rates, prevalence, and gaps in care. Through this effort, the VA 

determined HBV testing variables, regional testing rates, and demographics that will be 

extracted from VA’s Corporate Data Warehouse. These efforts will improve monitoring of HBV 

testing and care services for Veterans with chronic hepatitis B. 

Monitoring advanced liver disease in Veterans with chronic hepatitis C. All Veterans in VA 

care known to have chronic hepatitis C are followed via the VA’s National Hepatitis C Clinical 

Case Registry (CCR), an electronic database that captures clinical, laboratory, and pharmacy 

information on HCV care in the VA. VA CCR reports showed that out of 173,416 Veterans with 

chronic hepatitis C in VA care in 2012, 4,267 (2 percent) were newly diagnosed with cirrhosis; 

the prevalence of cirrhosis among Veterans with chronic hepatitis C in VA care in 2012 was 16 

percent. In 2012, of Veterans with chronic hepatitis C in VA care, 1,637 (0.9 percent) were 

newly diagnosed with hepatocellular carcinoma. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

9 
 

 

 

 

Priority 4	 Eliminating Transmission of 

Vaccine-Preventable Viral Hepatitis 

GOALS 

4.1 Eliminate mother-to-child transmission of hepatitis B. 

4.2 Achieve universal hepatitis A virus (HAV) and HBV vaccination for vulnerable 

adults. 

4.3 Design and test new or improved viral hepatitis vaccines and determine the 

indications for their optimal use. 

While there are three types of viral hepatitis that contribute most substantially to the disease 

burden in the United States, only two, HAV and HBV, are vaccine preventable. Development of 

a vaccine that prevents new HCV infections remains a high priority. Hepatitis E virus (HEV), a 

major cause of viral hepatitis infection in Asia and Africa, also likely will be preventable via 

vaccine in the future, as clinical trials have revealed two promising candidate vaccines. 

There are a number of barriers to vaccination, including (1) vaccine affordability for patients and 

adequate vaccine administration reimbursement for providers; (2) vaccine availability in public 

health settings; (3) alternative vaccination sites; (4) inadequate data collection and tracking 

systems; (5) inadequate public health and health system infrastructure for care coordination of 

HBV-infected pregnant women, their newborn infants, and their household contacts; and (6) 

lack of precise vaccination coverage estimates for adults in priority populations. 

Development of new, more effective vaccines that provide long-term protection with fewer doses 

required could increase vaccine acceptance and achieve greater levels of protective immunity 

overall in the United States. The development of vaccines that induce protective immunity in 

those with reduced immune response rates, such as older adults and adults with comorbidities, 

is equally important. Hopefully, research will eventually yield new vaccines to prevent HCV and 

HEV infection. 

In 2012, the following were among the actions undertaken by Federal partners to eliminate the 

transmission of vaccine-preventable viral hepatitis: 

Establishing clinical trials on prevention of perinatal HBV transmission. NIH’s National 

Institute of Child Health and Human Development (NICHD) finalized the protocol for a 

prospective, randomized, placebo-controlled trial of tenofovir (in addition to standard HBV 

immune globulin and vaccine) for prevention of transmission of hepatitis B from HBeAg-positive 

women to their infants in Thailand in 2012. HBeAg is a serologic marker and an indicator of 

infectivity. HBeAg-positive women are at highest risk for transmission of HBV to their infants at 

the time of birth, even with the standard prophylaxis of HBV immunoglobulin and vaccine. 

Regulatory and institutional review board approvals have been obtained and site trainings 

conducted in preparation for initiation of the study in January 2013. This study is funded by 

NICHD in collaboration with the CDC in a cooperative agreement and is expected to complete 

10 
 

 

Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis 

enrollment of more than 300 HBV-infected mothers and their children in 2015. For more 

information about this study, visit http://clinicaltrials.gov/ct2/show/NCT01745822. 

Launching an online vaccine finder. The National Vaccine Program Office launched the 

HealthMap Vaccine Finder (http://flushot.healthmap.org/) in collaboration with HealthMap, a 

team of researchers, epidemiologists, and software developers at Boston Children’s Hospital. 

The Vaccine Finder is a free online service where individuals can search for locations to obtain 

various adult vaccines, including vaccination for HAV and HBV. The site also features an 

assessment tool designed to recommend vaccination based on age, location, and behavioral 

risk. To date, almost 600,000 people have used the tool, and more than 60,000 providers have 

registered for the site. 

Launching a national HCV vaccine study. In March 2012, NIAID launched a double-blinded, 

randomized, phase I/II trial (NCT01436357) to evaluate the safety, immunogenicity, and initial 

efficacy of a vaccine to prevent acute and chronic hepatitis C. Although effective vaccines for 

HAV and HBV are available, there is not a vaccine for HCV. The study is currently in progress 

and expected to enroll approximately 350 active injection drug users, a population heavily 

affected by HCV infection and for which a vaccine is much needed. For more information, visit 

http://www.clinicaltrials.gov/ct2/show/NCT01436357?term=NCT01436357&rank=1. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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 Priority 5	 Reducing Viral Hepatitis Caused by 

Drug Use Behaviors 

GOALS 

5.1 Ensure that persons who inject drugs have access to viral hepatitis prevention, care, 

and treatment services. 

5.2 Mobilize community resources to prevent viral hepatitis caused by injection drug use. 

5.3 Provide persons who inject drugs with access to care and substance abuse treatment 

to prevent transmission and progression of disease. 

5.4 Expand access to and delivery of hepatitis prevention, care, and treatment services in 

correctional settings. 

5.5 Advance research to improve prevention of viral hepatitis among persons who use 

drugs. 

Injection drug use continues to be the most common mode of transmission for HCV in the U.S. 

and is also a risk factor for HBV acquisition. HAV, which is spread by the fecal-oral route, can 

occur among IDUs as a consequence of contaminated drugs, poor hygiene during drug-sharing 

practices, and other activities that involve personal contact. Efforts to address viral hepatitis 

infection must address injection drug use, including behaviors and the population injecting 

drugs. New HBV infections generally occur in drug users who have not been vaccinated, such 

as immigrants and individuals born before the 1991 recommendation to immunize all infants for 

HBV. IDUs are not only disproportionately affected by these viruses, but they are more likely 

than other infected populations to have adverse hepatitis-related health outcomes. Several 

additional factors contribute to the suboptimal health outcomes experienced by IDUs infected 

with viral hepatitis, including lack of awareness of infection status, late diagnosis, and lack of 

access to adequate medical care and treatment. Despite these challenges, public health efforts 

can successfully prevent new viral hepatitis infections among IDUs. 

In 2012, the following were among the actions undertaken by Federal partners to reduce viral 

hepatitis caused by drug using behaviors: 

Supporting new research studies on HCV infection in IDUs. NIH’s National Institute on Drug 

Abuse (NIDA) has invested in research aimed at breaking down the barriers that IDUs often 

confront when accessing HCV screening, treatment, and prevention services. IDUs are 

particularly prone to HIV and HCV infection through exposure during injection drug use. During 

2012, NIDA supported four new major research studies on hepatitis C focusing on prevention, 

screening, and treatment issues to develop evidence-based treatment and prevention strategies 

for those who suffer from addiction and other health consequences that result from drug use. 

These research studies are ongoing. 

NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) sponsored in September 

2012 an International meeting, “Interactions of Alcohol Consumption and Viral Hepatitis in Liver 

Injury.” Presentations are published in a special 2013 issue of the Journal of Gastroenterology 

and Hepatology, volume 28, supplement 1, pages 18-25. 

12
 

 

 

 

 

 

 

 

 

Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors 

Enhancing the capacity of substance abuse treatment programs to integrate viral

hepatitis screening and linkage to care into existing services. SAMHSA’s Center for 

Substance Abuse Treatment released a request for applications (RFA) for the fiscal year 2012 

Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority 

Populations at High Risk for HIV/AIDS grants (RFA No. TI-12-007). The 52 grantees that were 

awarded funding as part of this RFA are required to integrate viral hepatitis screening, 

prevention, and linkage to care efforts for individuals identified as being at risk for HBV or HCV 

infection, based on the CDC’s guidelines. 

Expanding national training and technical assistance for substance abuse grantees and

providers. Under SAMHSA’s 2012 Addiction Technology Transfer Center (ATTC) Grant, which 

includes a collaboration between SAMHSA and NIDA to promote the adoption of evidencebased practices, 15 grantees (10 regional ATTCs, four national focus area ATTCs, and the 

ATTC National Coordinating Office) were awarded $10.53 million to provide training and 

technical assistance services specific to the development of the addictions workforce. A new 

requirement in this round of ATTC funding was the set-aside of $40,000 by each of the 10 

regional ATTC grantees to provide training to staff of Federally Qualified Health Centers on best 

practices related to serving clients with viral hepatitis. The selected ATTCs are in the beginning 

stages of developing a core hepatitis curriculum for opioid treatment providers, with a projected 

delivery date of early 2014. 

Addressing transmission of HCV among young persons who inject drugs. CDC engaged 

in a number of activities to address the epidemic of HCV among young injectors; outlined below 

is a summary of their activities in 2012: 

•	 Allocated funding to six health departments to investigate HCV among young persons who 

inject drugs. CDC allocated funding to six health departments in Wisconsin, Philadelphia, 

Michigan, Florida, Minnesota, and Massachusetts to investigate (1) the phenomenon of 

prescription opiate analogue misuse as a gateway to subsequent heroin injection and HCV 

infection in adolescents and adults 18–25 years of age, (2) other drug use behaviors and 

risk factors associated with HCV infection among young persons who inject drugs, and (3) 

HCV testing and care patterns in these young persons. 

•	 Supported prospective follow-up study of new cases of HCV infection. The CDC provided 

funding to the Philadelphia Department of Public Health (PDPH) for a prospective follow-up 

of new cases of HCV infection in young adults. The PDPH has hired a Young HCV Project 

Coordinator whose focus is to lead case follow-up efforts and to develop targeted prevention 

strategies for this vulnerable population. The PDPH is one of a number of entities to receive 

funding under this activity. 

•	 Supported State Health Department’s investigation of increase of new HCV infections in 

young persons who inject drugs. The CDC initiated a number of studies and activities to 

address transmission of HCV among young persons who inject drugs. At the invitation of the 

NYSDOH, the DVH assisted both the NYSDOH and the Cortland County Health Department 

in the investigation of a recent increase in new HCV infections in Cortland County, NY, 

among young persons who inject drugs. This study yielded important insight into the factors 

associated with the emerging trend of HCV infection among young injectors in rural and 

exurban settings. 

•	 Commenced a study to assess emerging clusters of HCV infections among young injectors 

in rural and suburban settings. The CDC began a study in suburban Chicago and rural 

Milwaukee to assess emerging clusters of HCV infections among young persons who inject 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors 

drugs in rural and suburban settings. This project expands the CDC’s efforts and research 

findings from its investigation in upstate New York. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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 Priority 6 Protecting Patients and Workers From 

Health Care-Associated Viral Hepatitis 

GOALS 

6.1 Reduce transmission of viral hepatitis to patients resulting from misuse of medical 

devices and drugs. 

6.2 Reduce iatrogenic transmission of viral hepatitis associated with blood, organs, and 

tissues. 

6.3 Reduce occupational transmission of viral hepatitis. 

6.4 Enhance understanding of the preventable causes of viral hepatitis transmission in 

health care settings. 

Although receipt of transfused blood products was once a significant risk factor for the 

acquisition of viral hepatitis in the United States, routine blood screening has substantially 

reduced the risk of acquiring HBV and HCV from transfused blood products. To further reduce 

the risk of health care-acquired viral hepatitis among patients and their providers, we must 

ensure continuing infection control education to all health care providers, enhance professional 

and institutional accountability, and improve practice oversight. In addition, collaboration 

between the public and private health sectors is needed to improve the design and labeling of 

medical devices and medications―activities that will facilitate infection control compliance 

among the professionals who use them. 

In 2012, the following were among the actions undertaken by Federal partners to protect 

patients and workers from health care-associated viral hepatitis: 

Updating recommendations for the management of HBV-infected health care providers. 

As called for in the Action Plan, in July 2012, the CDC developed and issued an update to its 

1991 recommendations for the management of HBV-infected health care providers to reduce 

the risk of transmitting HBV to patients during the conduct of exposure-prone invasive 

procedures. Published in the July 6, 2012, issue of MMWR Recommendations and Reports, the 

update reflected changes in both the epidemiology of HBV infection and rates of HBV 

vaccination, as well as advances in hepatitis B diagnosis and therapy in the United States. The 

update also explicitly addressed for the first time the issue of medical and dental students who 

have chronic HBV infection. Approximately one-quarter of current medical and dental students 

are from AAPI communities. In the past, enrollment decisions based on HBV infection status 

have disparately affected members of the AAPI community. The updated guidelines not only 

foster efforts to reduce the occupational transmission of viral hepatitis but also seek to curtail 

unlawful discrimination against students with hepatitis B seeking to pursue studies in the health 

professions. 

Releasing guidance to protect patients from device and drug misuse. To assist oversight 

authorities in ensuring the appropriate use of medical devices and the provision of associated 

training within health care settings to reduce transmission of viral hepatitis to patients resulting 

from misuse of medical devices and drugs, CMS issued two important policy guidances in 2012. 

The first was from CMS’s Survey and Certification Group on glucometers (point-of-care devices) 

and insulin pens issued on May 15, 2012. In that guidance, “Use of Insulin Pens in Health Care 

15
 

 

 

 

 

 

 

 

 

 

 

 

Facilities,” CMS noted that it had recently received reports of use of insulin pens for more than 

one patient in health care facilities, with at least one 2011 episode resulting in the need for postexposure patient notification, indicating that some health care personnel do not adhere to safe 

practices and may be unaware of the risks these unsafe practices pose to patients. The 

guidance emphasized that insulin pens are meant for use by a single patient only with each 

patient or resident having his or her own, since regurgitation of blood into the insulin cartridge 

after injection will create a risk of blood-borne pathogen transmission if the pen is used for more 

than one patient or resident, even when the needle is changed. It instructed State Survey 

Agencies, which monitor health care facilities for compliance with the Medicare Conditions of 

Participation, that sharing of insulin pens is essentially the same as sharing needles or syringes 

and must be cited, in accordance with the applicable provider- or supplier-specific survey 

guidance, in the same manner as reuse of needles or syringes. 

The second guidance from the Survey and Certification Group, “Safe Use of Single Dose/Single 

Use Medications,” was issued on June 15, 2012. In that memo, policy was clarified on the use 

of single dose vials and provided guidance to State Survey Agencies that medication from 

single-dose vials must not be used for more than one patient and, if observed during a health 

care facility survey, must be cited as an infection control deficiency. Medication from single-dose 

vials may be repackaged in accordance with USP 797 standards—issued by the U.S. 

Pharmacopeia to ensure that medications are compounded accurately and appropriately, 

protecting patients from microbially contaminated preparations—either within the facility or 

through a vendor. When a vendor is used, surveyors are instructed to ask for documentation on 

how the facility ensures that its vendor adheres to USP 797 standards. CMS has also provided 

training for surveyors to better assess injection safety as part of the infection control 

assessment in facilities. 

Enhancing quality improvement in dialysis facilities. On June 14, 2012, CMS released a 

new version of its End-Stage Renal Disease (ESRD) information system, the Consolidated 

Renal Operations in a Web-Enabled Network (CROWNWeb). CROWNWeb provides a way for 

dialysis facilities to submit ESRD data electronically to CMS rather than the historical paperbased format in use since the establishment of the ESRD program. 

CROWNWeb is part of the ongoing CMS ESRD Quality Initiative that seeks to improve the 

quality of dialysis care provided to ESRD patients. Through CROWNWeb, all Medicare-certified 

dialysis facilities, along with some transplant and VA facilities that volunteered to participate, 

now submit administrative and patient-level clinical data directly to CMS electronically. This 

initiative provides a more efficient channel for CMS to support quality improvement efforts 

among providers, and the data collected by CROWNWeb will provide critical information on 

quality of care at the facility level (via the Dialysis Facility Compare Web site) that will empower 

patients in their health care decisions. 

CROWNWeb also supports a number of quality initiatives to monitor key concerns in the dialysis 

setting. These concerns include blood-borne infections such as viral hepatitis, which is 

transmitted easily via the vascular access required for hemodialysis. Other elements collected 

include medication allergies, frequency of vascular access inspection, and patient education 

reminders, which encourage health care providers to maintain a close connection to the 

treatment and condition of each patient. Additionally, data on key elements such as vaccinations 

for HBV and other infections are transmitted by facilities using CROWNWeb, allowing CMS to 

track, monitor, and measure the success of efforts to prevent the transmission of these diseases 

via dialysis. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

16 
 

 

 

 

 

Supporting research to improve blood transfusion safety. In addition to supporting 

investigator-initiated research on issues related to viral hepatitis and blood safety, NIH’s 

National Heart, Lung, and Blood Institute continued support of the Retrovirus Epidemiology 

Donor Study–II (REDS-II) and its successor launched in November 2011, the 7-year, $87.2 

million Recipient Epidemiology and Donor Evaluation Study–III (REDS-III). Both studies are 

finding new ways to enhance blood transfusion safety and the practice of blood banking 

domestically and internationally. For example, the REDS-II study is assessing the relative 

prevalence of risk factors in U.S. blood donors who are found to be positive for HIV, HCV, or 

HBV on screening. The data will provide information on changing patterns of transfusiontransmissible infectious risks to guide blood donor screening strategies. The REDS-III 

international programs in Brazil, China, and South Africa collect similar information on risks of 

transmitting HIV, HCV or HBV by blood transfusion in these countries. Findings will protect both 

blood donors and recipients from existing and future risks, benefitting both the United States, 

and other countries that are struggling to ensure blood safety and availability. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Appendix A. Overview of Federally Funded Viral Hepatitis 

Testing Activities 

Viral hepatitis testing is key to building a comprehensive viral hepatitis prevention and care 

strategy. Testing identifies individuals who are chronically infected and offers opportunities for 

education and prevention counseling. Effective testing programs provide linkages to care and 

treatment that can decrease the risk of cirrhosis and liver cancer. This section of the report 

provides preliminary information on the viral hepatitis testing data collected by Federal programs 

in the United States. This compilation of testing data marks an initial effort to collect and analyze 

testing activities supported by Federal agencies. The results highlight the need for increased 

standardization and enhanced coordination of viral hepatitis testing in the United States. 

In order to understand better the status of HBV and HCV testing and confirmatory tests 

conducted by federally supported programs, the VHIG partners across HHS, the DOJ, and the 

VA, including 12 agencies and offices within HHS, were asked to submit the following 

information: 

Hepatitis B Testing 

x Number of HBV-screening (HBsAg) 

tests performed 

x Total number of clients served 

x Number of positive HBsAg tests 

x Number of newly positive clients made 

aware of their infection 

x Years 2010 and/or 2011 requested 

x Source of data provided 

Hepatitis C Testing 

x Number of HCV screening (antibody) 

tests performed 

x Total number of clients served 

x Number of positive HCV antibody tests 

x Number of polymerase chain reaction 

(PCR)/viral tests performed 

x Number of newly positive clients made 

aware of their infection 

x Years 2010 and/or 2011 requested 

x Source of data provided 

The table below summarizes the measures reported by VHIG partners: 

Table 1. Data Collected by Federal Programs Supporting HBV and HCV Testing 

Testing measure 

CDC 

DVH CMS 

DOJ 

FBOP 

HRSA 

HAB 

HRSA 

BPHC IHS OMH SAMHSA VA 

HBV 

# HBsAg tests performed x x x x x x x 

# patients served x x x x x 

# positive HBsAg tests x x x 

# newly positive clients 

made aware of their 

infection x x 

HCV 

# HCV antibody tests 

performed 

x x x x x x 

i 
 

 

 

Testing measure 

CDC 

DVH CMS 

DOJ 

FBOP 

HRSA 

HAB 

HRSA 

BPHC IHS OMH SAMHSA VA 

# patients served x x x x 

# positive HCV antibody 

tests 

x x x x 

# HCV PCR tests 

performed 

x x x 

# newly positive clients 

made aware of their 

infection 

x x 

In some cases, testing and data collection efforts are the early developmental phases; in others, 

they are much more advanced. The measures reported were extracted from Federal health 

services reporting systems, EHRs, outreach and drug treatment program tracking forms, 

Medicare claims database, and a database for viral hepatitis testing and linkage to care. 

Complete data were not available from all sources, as this depended on reporting requirements, 

data source, program and data system capacity, and other factors. In many cases, Federal 

grantees, not the agencies themselves, provide viral hepatitis testing and treatment services 

and represent another source of variability in data reporting. Indeed, the programs and data 

systems they deploy often differ in their definitions, ways of counting, reporting protocols, 

timetables for reporting, and data management and analysis, all of which makes monitoring 

measures and outcomes across programs challenging. Similar issues were identified in a recent 

survey of federally supported HIV prevention, treatment, and care services. Defining and 

deploying data collection standards in viral hepatitis holds significant potential to enhance 

Federal efforts to chart progress in achieving the goals of the Action Plan and is a fertile area for 

further development. 

In the coming years, the VHIG will collaborate to share best practices, identify standards, and 

enhance coordination of federally supported hepatitis testing data collection and reporting. 

Partners Reporting Testing: Year of Report(s) and Data Source

DOJ FBOP 

Currently reviewing data elements to determine what can be obtained from

 existing sources. 

HHS CDC DVH 

Data estimates reported for 2013, testing initiated December 2012. Data will be 

managed in a dedicated database.

 CMS 

Data reported for 2010 and 2011 for Medicare beneficiaries from the Chronic 

Condition Data Warehouse using CPT codes for viral hepatitis serology. 

HRSA HAB 

Data reported for 2010 from Ryan White Services Report. 

HRSA BPHC 

Data reported for 2010 and 2011 from the Uniform Data System using ICD9 

codes. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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IHS 

Currently exploring methods to capture ongoing viral hepatitis testing efforts. 

OMH

 Data reported for 2010–2013 from grantees using a variety of data sources, 

including EMRs, client charts, and other testing tracking systems. Data points 

reported were heterogeneous across grantees. 

SAMHSA Center for Substance Abuse Treatment 

 Data reported for 2010–2012 from grantees using a dedicated tracking form. 

VA Office of Public Health/Population Health 

 Data reported for 2010–2012 from the Corporate Data Warehouse 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

iii 
 

 

 

 

 

 

Appendix B. Citations of Publications by Priority Area
 

Priority 1 

Gracia JN. Addressing viral hepatitis among minority communities. 

http://blog.aids.gov/2012/05/addressing-viral-hepatitis-among-minority-communities.html. 

Accessed May 15, 2013. 

Jorgensen CM, Lewis CA, Liu J. An analysis of hepatitis C virus-related public inquiries from 

health professionals: 2009–2010. Clinical Infectious Diseases. July 2012;55(S1):S54–S57. 

doi:10.1093/cid/cis369insert. 

Morales-Reid B, Klukas E. National Hispanic Hepatitis Awareness Day (NHHAD): adapting a 

highly effective community mobilization model and social marketing campaign. Poster presented 

at the 2012 National Summit on HIV and Viral Hepatitis Diagnosis, Prevention, and Access to 

Care; Washington, DC; November 26–28, 2012. 

Smith BD, Jorgensen C, Zibbell JE, Beckett GA. Centers for Disease Control and Prevention 

initiatives to prevent hepatitis C virus infection: a selective update. Clinical Infectious Diseases. 

2012;55(suppl 1):S49–S53. doi:10.1093/cid/cis363insert. 

Tohme RA, Holmberg SD. Transmission of hepatitis C virus infection through tattooing and 

piercing: a critical review. Clinical Infectious Diseases. April 2012;54(8):1167–1178. 

doi:10.1093/cid/cir991. 

Priority 2 

Achanta G, Pappas S, Fordis M. Comparative effectiveness of treatments for chronic hepatitis C 

virus infection in adults. Rockville, MD: U.S. Department of Health and Human Services, Agency 

for Healthcare Research and Quality; November 27, 2012. 

http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-andreports/?pageaction=displayproduct&productID=1289. Accessed May 9, 2013. 

Alaska Native Tribal Health Consortium. LiverConnect Newsletter: Focus on Hepatitis C. 

Anchorage, AK: Alaska Native Tribal Health Consortium; spring 2012. 

http://www.anthctoday.org/community/hep/docs/LDHPnewsletterSpring2012.pdf. Accessed July 

15, 2013. 

Allen JD, Williams, MR. Evaluation and Treatment of Hepatitis C and Cirrhosis: Federal Bureau 

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Astrakhantseva IV, Campo DS, Araujo A, Teo CG, Khudyakov Y, Kamili S. Differences in 

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iv 
 

 

 

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Campo DS, Dimitrova Z, Yokosawa J, et al. Hepatitis C virus antigenic convergence. Scientific 

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Chary A, Winters MA, Eisen R, Knight TH, Asmuth DM, Holodniy M. Quantitation of hepatitis C 

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Chou R, Cottrell EB, Wasson N, Rahman B, Guise J-M. Screening for hepatitis C virus infection 

in adults: systematic review. Comparative effectiveness review no. 69. AHRQ publication no. 

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virus in a primary care setting. American Journal of Public Health. November 1, 2012;102(11): 

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Ho SB, Groessl EJ, Brau N, et al. Prospective multisite randomized trial of integrated care (IC) 

vs. usual care (uc) for improving access to antiviral therapy for high risk patients with chronic 

HCV. Journal of Hepatology. April 1, 2012;56(suppl 2):S386. 

Hoover KW, Butler M, Workowski K, et al. Low rates of hepatitis screening and vaccination of 

HIV-infected MSM in HIV clinics: opportunities for improving the quality of care. Sexually 

Transmitted Disease. May 2012;39(5):349–353. doi:10.1097/OLQ.0b013e318244a923. 

Kanwal F, Hoang T, Chrusciel T, et al. Process of care for hepatitis C infection is linked to 

treatment outcome and virologic response. Clinical Gastroenterology and Hepatology. 

November 2012;10(11):1270–1277.e3. doi:10.1016/j.cgh.2012.07.015. 

Kanwal F, Hoang T, Kramer J, et al. The performance of process measures in hepatitis C. 

American Journal of Gastroenterology. October 1, 2012;107(10):1512–1521. 

doi:10.1038/ajg.2012.201. 

Kanwal F, Kramer JR, Buchanan P, et al. The quality of care provided to patients with cirrhosis 

and ascites in the Department of Veterans Affairs. Gastroenterology. July 2012;143(1):70–77. 

doi:10.1053/j.gastro.2012.03.038. 

Kramer JR, Kanwal F, Richardson P, Mei M, El-Serag HB. Gaps in the achievement of 

effectiveness of HCV treatment in national VA practice. Journal of Hepatology. February 

2012;56(2):320–325. doi:10.1016/j.jhep.2011.05.032. 

Lara J, Khudyakov Y. Epistatic connectivity among HCV genomic sites as a genetic marker of 

interferon resistance. Antiviral Therapy. 2012; 17(Pt B):1471–1475. doi:10.3851/IMP2478. 

Lara J, Tavis JE, Donlin MJ, et al. Coordinated evolution among hepatitis C virus genomic sites 

is coupled to host factors and resistance to interferon. In Silico Biology. January 1, 2012;11(5– 

6):213–224. doi:10.3233/ISB-2012-0456. 

Li H, Atkins E, Bruckner J, et al. Genetic and functional heterogeneity of the hepatitis C virus p7 

ion channel during natural chronic infection. Virology. February 5, 2012;423(1):30–37. 

doi:10.1016/j.virol.2011.11.011. 

Litwin AH, Smith BD, Drainoni ML, et al. Primary care-based interventions are associated with 

increases in hepatitis C virus testing for patients at risk. Digestive Liver Diseases. June 2012; 

44(6):497–503. doi:10.1016/j.dld.2011.12.014. 

Liu J, Florian JA Jr., Birnkrant D, Murray J, Jadhav PR. Interferon responsiveness does not 

change in treatment-experienced hepatitis C subjects: implications for drug development and 

clinical decisions. Clinical Infectious Diseases. September 2012;55(5):639–644. 

Liu S, Cipriano LE, Holodniy M, Ownes DK, Goldhaber-Fiebert JD. New protease inhibitors for 

the treatment of chronic hepatitis C: a cost-effectiveness analysis. Annals of Internal Medicine. 

February 21, 2012;156(4):279–290. doi:10.1059/0003-4819-156-4-201202210-00005. 

Livingston SE, Townshend-Bulson LJ, Bruden DL, et al. Treatment eligibility in Alaska Native 

and American Indian persons with hepatitis C virus infection. International Journal of 

Circumpolar Health. April 24, 2012;71:1–7. doi:10.3402/ijch.v71i0.18445. 

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Lok AS, Ward JW, Perrillo RP, et al. Reactivation of hepatitis B during immunosuppressive 

therapy: potentially fatal yet preventable. Annals of Internal Medicine. May 15, 2012;156(10): 

743–745. doi:10.1059/0003-4819-156-10-201205150-00013. 

McMahon BJ, Block J, Haber B, et al. Internist diagnosis and management of chronic hepatitis B 

virus infection. American Journal of Medicine. November 2012;125(11):1063–1067. 

doi:10.1016/j.amjmed.2012.03.010. 

McMahon BJ, Simons BC. Interpreting hepatitis B surface antigen levels: useful clinical test or 

just another confusing assay? Clinical Gastroenterology and Hepatology. March 2012;10(3): 

218–219. doi:10.1016/j.cgh.2011.11.017. 

Oser M, Cucciare M, McKellar J, Weingardt K. Correlates of hazardous drinking among 

Veterans with and without hepatitis C. Journal of Behavioral Medicine. December 2012;35:634– 

641. 

Osinusi A, Chary A, Winters MA, et al. IL28B polymorphism is not associated with HCV 

protease diversity in patients coǦinfected with HIV and HCV treated with PEGylated interferon 

and ribavirin. Journal of Medical Virology. October 2012;84(10):1522–1527. 

doi:10.1002/jmv.23376. 

Prokunina-Olsson L, Muchmore B, Tang W, et al. A variant upstream of IFNL3 (IL28B) creating 

a new interferon gene IFNL4 is associated with impaired clearance of hepatitis C virus. Nature 

Genetics. February 2013;45(2):164–171. doi:10.1038/ng.2521. 

Rein DB, Smith BD, Wittenborn JS, et al. The cost-effectiveness of birth cohort screening for 

hepatitis C antibody in U.S. primary care settings. Annals of Internal Medicine. February 21, 

2012;156(4):263–270. doi:10.1059/0003-4819-156-4-201202210-00378. 

Skums P, Campo DS, Dimitrova Z, Vaughan G, Lau DT, Khudyakov Y. Numerical detection, 

measuring, and analysis of differential interferon resistance for individual HCV intra-host 

variants and its influence on the therapy response. In Silico Biology. January 1, 2012;11(5– 

6):263–269. doi:10.3233/ISB-2012-0460. 

Smith AW, Pappas S, Fordis M. Treating chronic hepatitis C: a review of the research for adults. 

Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare 

Research and Quality; November 27, 2012. http://www.effectivehealthcare.ahrq.gov/search-forguides-reviews-and-reports/?pageaction=displayproduct&productID=1288. 

Smith BD, Jewett A, Drobeniuc J, Kamili S. Rapid diagnostic HCV antibody assays. Antiviral 

Therapy. 2012;17(7 part B):1409–1413. doi:10.3851/IMP2470. 

Smith BD, Morgan RL, Beckett, GA, et al. Recommendations for the identification of chronic 

hepatitis C virus infection among persons born during 1945–1965. MMWR Recommendations 

and Reports. August 17, 2012;61(RR-4);1–32. 

Sun X, Patnode CD, Williams C, Senger CA, Kapka TJ, Whitlock EP. Interventions to improve 

patient adherence to hepatitis C treatment: comparative effectiveness. Comparative 

effectiveness review no. 91. AHRQ publication no. 13-EHC009-EF. Rockville, MD: U.S. 

Department of Health and Human Services; December 20, 2012. 

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Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Teo CG. Changing strategies for hepatitis C testing. Antiviral Therapy. 2012;17(7 part B):1391– 

1395. doi:10.3851/IMP2468. 

Thai H, Campo DS, Lara J, et al. Convergence and coevolution of hepatitis B virus drug 

resistance. Nature Communications. April 17, 2012;3:789. doi:10.1038/ncomms1794. 

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 

Treatment for hepatitis C virus infection in adults: comparative effectiveness. Rockville, MD: 

HHS; reviewed August 2012. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-forguides-reviews-andreports/?pageaction=displaycmeactivity&activityID=327&cmepage=cme_info. Accessed May 9, 

2013. 

Ward JW, Valdiserri RO, Koh HK. Hepatitis C virus (HCV) prevention, care and treatment: from 

policy to practice. Clinical Infectious Diseases. July 2012;55(suppl 1):S58–S63. 

doi:10.1093/cid/cis392. 

Wedemeyer H, Jensen DM, Godofsky E, et al. Recommendations for standardized 

nomenclature and definitions of viral response in trials of hepatitis C virus investigational agents. 

Hepatology. 2012;56(6):2398–2403. 

Welch G. IHS provider guidelines: hepatitis C virus (HCV) testing and management. EAGLE. 

Spring 2012;2(1):3. 

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f. Accessed July 15, 2013. 

Yee HS, Chang MF, Pocha C, et al. Update on the management and treatment of hepatitis C 

virus infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource 

Center Program and the National Hepatitis C Program Office. American Journal of 

Gastroenterology. May 2012;107(5):669–689. doi:10.1038/ajg.2012.48. 

Zeissig S, Murata K, Sweet L, et al. Hepatitis B virus-induced lipid alterations contribute to 

natural killer T cell-dependent protective immunity. Nature Medicine. 2012;18(7):1060–1068. 

doi:10.1038/nm.2811. 

Zickmund SL, Campbell SA, Tirado CF, Zook CL, Weinrieb RM. Perceived barriers to hepatitis 

C therapy for patients receiving opioid agonist treatment. Journal of Addiction Medicine. 

September 2012;6(3):233–239. 

Priority 3 

Averhoff FM, Glass N, Holtzman D. Global burden of hepatitis C: considerations for healthcare 

providers in the United States. Clinical Infectious Diseases. 2012;55(suppl 1):S10–S15. 

doi:10.1093/cid/cis361. 

Chasela CS, Wall P, Drobeniuc J, et al. Prevalence of hepatitis C virus infection among human 

immunodeficiency virus-1-infected pregnant women in Malawi: the BAN study. Journal of 

Clinical Virology. August 2012;54(4):318–320. doi:10.1016/j.jcv.2012.05.003. 

Dimitrova Z, Campo DS, Ramachandran S, et al. Evaluation of viral heterogeneity using nextgeneration sequencing, end-point limiting-dilution and mass spectrometry. In Silico Biology. 

January 1, 2012;11(5–6):183–192. doi:10.3233/ISB-2012-0453. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Forbi JC, Purdy MA, Campo DS, et al. Epidemic history of hepatitis C virus infection in two 

remote communities in Nigeria, West Africa. The Journal of General Virology. July 2012;93(part 

7):1410–1421. doi:10.1099/vir.0.042184-0. 

Ganova-Raeva LM, Dimitrova ZE, Campo DS, Khudyakov Y. Application of mass spectrometry 

to molecular surveillance of hepatitis B and C viral infections. Antiviral Therapy. 2012; 17 (7 part 

B):1477–1482. doi:10.3851/IMP2466. 

Holmberg SD. Hepatitis A epidemiology goes global. Clinical Infectious Diseases. March 2012; 

54(6):782–783. doi:10.1093/cid/cir945. 

Holmberg SD. Hepatitis C virus and the infectious diseases community. Clinical Infectious 

Diseases. July 2012;55(suppl 1):S1–S2. doi:10.1093/cid/cis360. 

Iqbal K, Klevens RM, Jiles RB. Comparison of acute viral hepatitis data quality using two 

methodologies, 2005–2007. Public Health Reports. November–December 2012;127(6):591– 

597. 

Kamili S, Drobeniuc J, Araujo AC, Hayden TM. Laboratory diagnostics for hepatitis C virus 

infection. Clinical Infectious Diseases. July 2012;55(suppl 1):S43–S48. 

Khudyakov Y. Molecular surveillance of hepatitis C. Antiviral Therapy. 2012;17(7 part B):1465– 

1470. doi:10.3851/IMP2476. 

Klevens RM, Hu DJ, Jiles R, Holmberg SD. Evolving epidemiology of hepatitis C virus in the 

United States. Clinical Infectious Diseases. 2012;55(suppl 1):S3–S9. doi:10.1093/cid/cis393. 

Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of 

mortality from viral hepatitis in the United States between 1999 and 2007. Annals of Internal 

Medicine. February 21, 2012;156(4):271–278. doi:10.1059/0003-4819-156-4-201202210-00004. 

Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: 

new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. March 9, 2012; 

30(12):2212–2219. doi:10.1016/j.vaccine.2011.12.116. 

Reilly ML, Schillie SF, Smith E, et al. Increased risk of acute hepatitis B among adults with 

diagnosed diabetes mellitus. Journal of Diabetes Science and Technology. July 1, 2012;6(4): 

858–866. 

Schillie SF, Xing J, Murphy TV, Hu DJ. Prevalence of hepatitis B virus infection among persons 

with diagnosed diabetes mellitus in the United States, 1999–2010. Journal of Viral Hepatitis. 

September 2012;19(9):674–676. doi:10.1111/j.1365-2893.2012.01616. 

Spradling PR, Rupp L, Moorman AC, et al. Hepatitis B and C virus infection among 1.2 million 

persons with access to care: factors associated with testing and infection prevalence. Clinical 

Infectious Diseases. October 2012;55(8):1047–1055. 

Ward J, Byrd K. Hepatitis B in the United States: a major health disparity for foreign-born 

minorities, 2012. Hepatology. August 2012;56(2):419–421. doi:10.1002/hep.25799. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

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Priority 4 

Byrd KK, Lu P-J, Murphy TV. Baseline hepatitis B vaccination coverage among persons with 

diabetes before implementing a U.S. recommendation for vaccination. Vaccine. May 14, 2012; 

30(23):3376–3382. doi:10.1016/j.vaccine.2012.03.055. 

Chaves SS, Fischer G, Groeger J, et al. Persistence of long-term immunity to hepatitis B among 

adolescents immunized at birth. Vaccine. February 21, 2012;30(9):1644–1649. 

doi:10.1016/j.vaccine.2011.12. 

Crum-Cianflone NF, Curry J, Drobeniuc J, et al. Hepatitis E virus infection in HIV-infected 

persons. Emerging Infectious Diseases. March 2012;18(3):502–506. 

doi:10.3201/eid1803.111278. 

Dong C, Zafrullah M, Mixson-Hayden T, et al. Suppression of interferon-α signaling by hepatitis 

E virus. Hepatology. May 2012;55(5):1324–1332. doi:10.1002/hep.25530. 

Dorell CG, Yankey D, Byrd KK, Murphy TV. Hepatitis A vaccination coverage among 

adolescents in the United States. Pediatrics. February 2012;129:213–221. 

doi:10.1542/peds.2011-2197. 

Giang E, Dorner M, Prentoe JC, et al. Human broadly neutralizing antibodies to the envelope 

glycoprotein complex of hepatitis C virus. Proceedings of the National Academy of Sciences of 

the United States of America. April 17, 2012;109(16):6205–6210. 

doi:10.1073/pnas.1114927109. 

Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. New England Journal of Medicine. 

2012;367(13):1237–1244. 

Lara J, Khudyakov Y. Association of antigenic properties to structure of the hepatitis C virus 

NS3 protein. In Silico Biology. January 1, 2012;11(5–6):203–212. doi:10.3233/ISB-2012-045. 

National Vaccine Advisory Committee. A pathway to leadership for adult immunization: 

recommendations of the National Vaccine Advisory Committee. Public Health Reports. 

January–February 2012;127(suppl 1):1–42. 

Purdy MA. Evolution of the hepatitis E virus polyproline region: order from disorder. Journal of 

Virology. September 2012;86(18):10186–10193. doi:10.1128/JVI.01374-12. 

Purdy MA, Dell’Amico MC, Gonzales JL, et al. Human and porcine hepatitis E viruses, 

southeastern Bolivia. Emerging Infectious Diseases. February 2012;18(2):339–340. 

doi:10.3201/eid1802.111453. 

Purdy MA, Lara J, Khudyakov YE. The hepatitis E virus polyproline region is involved in viral 

adaptation. PLoS One. 2012;7(4):e35974. 

Schillie SF, Spradling PR, Murphy TV. Immune response of hepatitis B vaccine among persons 

with diabetes: a systematic review of the literature. Diabetes Care. 2012;35:2690–2097. 

doi:10.2337/dc12-0312. 

Sharapov UM, Bulkow LR, Negus SE, et al. Persistence of hepatitis A vaccine-induced 

seropositivity in infants and young children by maternal antibody status: 10-year follow-up. 

Hepatology. August 2012;56(2):516–522. doi:10.1002/hep.25687. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

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Smith E, Jacques-Carroll L, Walker TY, Sirotkin B, Murphy TV. The National Perinatal Hepatitis 

B Prevention Program, 1994–2008. Pediatrics. April 2012;129:609–616. 

doi:10.1542/peds.2011-2866. 

Spradling PR, Williams RE, Xing J, Soyemi K, Towers J. Serologic testing for protection against 

hepatitis B virus infection among students at a health sciences university in the United States. 

Infectious Control and Hospital Epidemiology. 2012;33:732–736. doi:10.1086/666335. 

Teo CG. Fatal outbreaks of jaundice in pregnancy and the epidemic history of hepatitis E. 

Epidemiology and Infection. May 2012;140(5):767–787. doi:10.1017/S0950268811002925. 

Zhang L, Yesupriya A, Hu DJ, et al. Variants in ABCB1, TGFB1, and XRCC1 genes and 

susceptibility to viral hepatitis A infection in Mexican Americans. Hepatology. April 2012;55(4): 

1008–1018. 

Zhao Z, Murphy TV. The association of hepatitis B vaccine supply policy with timing of receipt of 

the first dose of hepatitis B vaccination. Open Journal of Statistics. October 2012;2(4):429–434. 

doi:10.4236/ojs.2012.24053. 

Priority 5 

Garfein RS, Rondinelli A, Barnes RF, et al. HCV infection prevalence lower than expected 

among 18–40-year-old injection drug users in San Diego, CA [published online ahead of print 

July 6, 2012]. Journal of Urban Health. 

Grebely J, Morris MD, Rice TM, et al. Cohort profile: The International Collaboration of Incident 

HIV and Hepatitis C in Injecting Cohorts (InC3) Study [published online ahead of print 

November 30, 2012]. International Journal of Epidemiology. 

Jewett A, Smith BD, Garfein RS, Cueva-Mota J, Teshale E, Weinbaum CM. Field-based 

performance of three pre-market rapid hepatitis C virus antibody assays in STAHR (Study to 

Assess Hepatitis C Risk) among young adults who inject drugs in San Diego, CA. Journal of 

Clinical Virology. July 2012;54(3):213–217. doi:10.1016/j.jcv.2012.04.003. 

Priority 6 

Holmberg SD, Suryaprasad A, Ward JW. Updated CDC recommendations for the management 

of hepatitis B virus-infected health-care providers and students. MMWR. July 6, 

2012;61(RR03):1–12. 

Holodniy M, Oda G, Schirmer PL, et al. Results from a large-scale epidemiologic look-back 

investigation of improperly reprocessed endoscopy equipment. Infection Control and Hospital 

Epidemiology. July 2012;33(7):649–656. doi:10.1086/666345. 

Sawyer MH, Hoerger TJ, Murphy TV, et al. Use of hepatitis B vaccination for adults with 

diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices 

(ACIP). MMWR. December 23, 2011;60(50):1709–1711. 

Schaffzin JK, Southwick KL, Clement EJ, et al. Transmission of hepatitis B virus associated with 

assisted monitoring of blood glucose at an assisted living facility in New York State. American 

Journal of Infection Control. October 2012;40(8):726–731. doi:10.1016/j.ajic.2011.11.002. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

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Williams RE, Sena AC, Moorman AC, et al. Hepatitis B vaccination of susceptible elderly 

residents of long term care facilities during a hepatitis B outbreak. Vaccine. May 2, 2012;30: 

3147–3150. doi:10.1016/j.vaccine.2012.02.078. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

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Appendix C. Abbreviations
 

AETC AIDS Education and Training Center (HRSA) 

AHRQ Agency for Healthcare Research and Quality (HHS) 

AAPI Asian American and Pacific Islander 

ATTC Addiction Technology Transfer Center (SAMHSA) 

AVHPC Adult Viral Hepatitis Prevention Coordinator 

BPHC Bureau of Primary Health Care (HRSA) 

CDC Centers for Disease Control and Prevention (HHS) 

CHCANYS Community Health Care Association of New York State 

CMS Centers for Medicare & Medicaid Services (HHS) 

CROWNWeb Consolidated Renal Operations in a Web-Enabled Network 

DOJ U.S. Department of Justice 

DVH Division of Viral Hepatitis (CDC) 

ECHO Extension for Community Healthcare Outcomes 

EHR electronic health record 

ESRD end-stage renal disease 

FBOP Federal Bureau of Prisons (DOJ) 

FDA Food and Drug Administration (HHS) 

FOA funding opportunity announcement 

GRADE Grading of Recommendations Assessment, Development, and Evaluation 

HAB HIV/AIDS Bureau (HRSA) 

HAV hepatitis A virus 

HBV hepatitis B virus 

HCV hepatitis C virus 

HCV-TARGET Hepatitis C Therapeutic Registry and Research Network 

HEV hepatitis E virus 

HHS U.S. Department of Health and Human Services 

HRSA Health Resources and Services Administration (HHS) 

HUD U.S. Department of Housing and Urban Development 

IDU injection drug user 

IHS Indian Health Service (HHS) 

xiii 
 

 

 

 

IOM Institute of Medicine 

MSM men who have sex with men 

NCHHSTP National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 

NIAAA National Institute of Alcohol Abuse and Alcoholism (NIH) 

NIAID National Institute of Allergy and Infectious Diseases (NIH) 

NICHD Eunice Kennedy Shriver National Institute of Child Health and Human 

Development (NIH) 

NIDA National Institute on Drug Abuse (NIH) 

NIH National Institutes of Health (HHS) 

NVPO National Vaccine Program Office (HHS) 

NYSDOH New York State Department of Health 

OHAIDP Office of HIV/AIDS and Infectious Disease Policy (HHS) 

OMH Office of Minority Health (HHS) 

PCR polymerase chain reaction 

PDPH Philadelphia Department of Public Health 

PSA public service announcement 

REDS-II Retrovirus Epidemiology Donor Study–II 

REDS-III Recipient Epidemiology and Donor Evaluation Study–III 

RFA Request for Application 

SAMHSA Substance Abuse and Mental Health Services Administration 

SCAN Specialty Care Access Network 

SPNS Special Project of National Significance 

VA U.S. Department of Veterans Affairs 

VHAP Viral Hepatitis Action Plan 

VHIG Viral Hepatitis Action Plan Implementation Group 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 

Interagency Implementation Progress Report – 2012 

xiv