FEDERAL IMPLEMENTATION 

PROGRESS REPORT FOR THE ACTION 

PLAN FOR THE PREVENTION, CARE, 

AND TREATMENT OF VIRAL HEPATITIS

2014
This report was prepared under the direction of the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP), the Office 

of the Assistant Secretary for Health (OASH), and the 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, the Department of Justice Federal Bureau of Prisons (FBOP), and the Department of Housing and Urban Development (HUD). Corinna Dan, R.N., M.P.H., OHAIDP Viral Hepatitis Policy Advisor and Michelle Moses-Eisenstein, M.P.H., 

Public Health Analyst, coordinated development of this report. Jamie Weinstein, M.P.H., Jhilya Mayas, Ph.D., Kelly Wagner, 

and Barbara Draley of The MayaTech Corporation; and Steve Holman, M.B.A., all working under contract to OHAIDP, assisted OHAIDP staff in compiling and formatting the report.

Karen B. DeSalvo, M.D., M.P.H., M.Sc.................................................................Acting Assistant Secretary for Health, HHS

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

December 2015 
AN EXCERPT FROM THE 

PRESIDENTIAL PROCLAMATION ON

WORLD HEPATITIS DAY 2014

Through the Affordable Care Act, my Administration has made 

major strides in expanding access to viral hepatitis prevention, 

care, and treatment. New health plans must now cover 

hepatitis C routine screening for individuals at high-risk and 

one-time screening for adults born between 1945 and 1965. 

These preventive services will allow more Americans to know 

their status and seek treatment.

Earlier this year, my Administration updated our Nation's firstever comprehensive Action Plan for the Prevention, Care, and 

Treatment of Viral Hepatitis. Alongside Federal, private, and 

non-profit stakeholders across our country, we will continue 

to strengthen our Nation's response. Together, we can raise 

awareness, reduce the number of new cases, and save lives.

Thanks to the tireless leadership of researchers and 

advocates, we are beginning to break the silence surrounding 

viral hepatitis. Today, we once again raise our voices, educate 

our at-risk communities, and support those living with this 

disease.

 — President Barack Obama

World Hepatitis Day Proclamation
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

TABLE OF CONTENTS

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

Introduction ...........................................................................................................................................iii

Federal Partners in Implementing

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

Viral Hepatitis Implementation Group (VHIG) Members.........................................................................v

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

The HCV Care Continuum: Measure the Progress to Curing HCV..................................................... 10

Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer ................ 13

Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease............... 24

Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis ....................................... 28

Priority 5: Reducing Viral Hepatitis Caused by Drug Use Behaviors................................................... 31

Priority 6: Protecting Patients and Workers from Health Care-Associated Viral Hepatitis .................. 36

The End of the Beginning.................................................................................................................... 39

APPENDIX A......................................................................................................................................A-1

APPENDIX B......................................................................................................................................B-1
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis i

BACKGROUND

Updated in 2014, the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis (Action 

Plan) builds on the foundation established in 2010 with the release of the Institute of Medicine (IOM) 

report, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B 

and C. The IOM report identified viral hepatitis as an “underappreciated” health concern in the U.S., 

outlined barriers to prevention and control, and provided 22 recommendations to help improve 

the U.S. public health response to viral hepatitis. Spurred by the IOM report, HHS developed and 

released in 2011 Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, 

Care, and Treatment of Viral Hepatitis, our nation’s first comprehensive viral hepatitis strategic plan.

The updated national Action Plan, released in April 2014, details more than 150 actions to be 

undertaken from 2014 through 2016 by agencies and offices across HHS and partners at the 

Department of Housing and Urban Development (HUD), the Department of Justice’s (DOJ) Federal 

Bureau of Prisons (FBOP), and the Department of Veterans Affairs (VA). Some actions outlined 

in the Action Plan can be accomplished using existing resources through improved coordination 

and integration, while others are subject to the availability of funds. All of the actions contribute to 

improving the prevention, diagnosis, and treatment of viral hepatitis in the United States.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis ii

Nonfederal stakeholders were strongly supportive of the renewal effort, providing input into the 

process. For the first time, the updated Action Plan included sample “Opportunities for Nonfederal 

Stakeholders” to further underscore the importance of contributions from all sectors of society and 

foster increased participation and collaboration in efforts toward attaining Action Plan goals. 

In the U.S., as many as 5.3 million people are living with chronic hepatitis B virus (HBV) or hepatitis C 

virus (HCV) infection, and tens of thousands are at risk of infection. Beginning in 2011 and continuing 

through today, the development, updating, and implementation of the Action Plan has brought 

increased attention to both the previously silent epidemic of viral hepatitis and to the opportunities 

to halt its growing impact in communities across the nation. Prior to 2011, much of the work on viral 

hepatitis was conducted independently, sometimes in isolation from related efforts. The Action Plan 

has enabled further collaboration, resulting in advances in:

• Addressing IOM recommendations for viral hepatitis prevention, care, and treatment. 

• Setting forth actions to improve viral hepatitis prevention and ensuring that infected persons 

are identified and provided with quality care and treatment. 

• Improving coordination of all activities related to viral hepatitis across the federal government 

and promoting collaborations with state, Tribal, and local government agencies and 

nongovernmental organizations. 

Since 2011, agencies and offices across HHS have been working to implement the actions 

described in the Action Plan. To support these efforts, OHAIDP/OASH convenes a Viral Hepatitis 

Implementation Group (VHIG) charged with coordinating, supporting, and monitoring activities 

related to the Action Plan. The VHIG comprises representatives from across HHS and other federal 

departments and is chaired by Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious 

Diseases and Director of the Office of HIV/AIDS and Infectious Disease Policy. Members of the VHIG 

have met repeatedly during the implementation of the Action Plan and have served as representatives 

within their respective agencies and offices on matters related to viral hepatitis. This progress report 

is an outcome of their collaborative efforts. Read more about the Action Plan, progress reports, and 

updates at http://aids.gov/hepatitis.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis iii

INTRODUCTION 

This report marks the first opportunity to provide highlights of progress made after the release of 

the updated Action Plan. The HHS Office of HIV/AIDS and Infectious Disease Policy is charged 

with coordinating implementation of the Action Plan. As such, it has compiled 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 partners undertook during 2014. 

This report features excellent examples of work by federal partners as well as many activities 

undertaken collaboratively with a variety of stakeholders, such as capacity-building among HBV 

coalition partners; viral hepatitis training and technical assistance for health centers and other 

healthcare providers; increasing participation in the annual observances of May as Hepatitis 

Awareness Month and July 28 as World Hepatitis Day; developing culturally and linguistically 

appropriate materials for communities experiencing high rates of chronic viral hepatitis (including 

African Americans, American Indians/Native Alaskans, and Asian Americans and Pacific Islanders); 

supporting the development of testing and linkage to care programs; and further exploring the use of 

new HCV therapies in special populations and HBV therapies to reduce perinatal transmission.

A recurrent theme across the field of viral hepatitis is the need for additional evidence to guide 

policy and practice at every level. Throughout 2014, federal partners made important contributions 

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

through articles published in peer-reviewed literature along with the development of reports and other 

technical documents. These publications help to advance efforts to develop and implement evidencebased programs, clinical services, and policies; they are compiled in Appendix A and described 

throughout this report. Many projects initiated in 2014 included products that were released in 2015 

and so are included in this report.

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

envisions will be achieved by 2020: 

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

to 66 percent.

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

to 66 percent.

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

• Elimination of mother-to-child transmission of HBV.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis iv

Federal Partners

FEDERAL PARTNERS IN IMPLEMENTING

THE ACTION PLAN FOR THE PREVENTION, CARE, 

AND TREATMENT OF VIRAL HEPATITIS

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)

— Agency for Healthcare Research and Quality (AHRQ)

— Centers for Disease Control and Prevention (CDC)

— Centers for Medicare and Medicaid Services (CMS)

— Food and Drug Administration (FDA)

— Health Resources and Services Administration (HRSA)

— Indian Health Service (IHS)

— National Institutes of Health (NIH)

— Office of the Assistant Secretary for Health (OASH)

• National Vaccine Program Office (NVPO)

• Office of HIV/AIDS and Infectious Disease Policy (OHAIDP)

• Office of Minority Health (OMH)

• Office of Population Affairs (OPA)

• Office of the Surgeon General (OSG)

• Office on Women’s Health (OWH)

• Regional Health Administrators (RHA)

— Office of the National Coordinator for Health Information Technology (ONC)

— Substance Abuse and Mental Health Services Administration (SAMHSA)

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD)

— Office of Community Planning and Development (CPD)

U.S. DEPARTMENT OF JUSTICE (DOJ)

— Federal Bureau of Prisons (FBOP)

U.S. DEPARTMENT OF VETERANS AFFAIRS (VA)

— Patient Care Services, Veterans Health Administration (VHA)

WHITE HOUSE

— Office of National Drug Control Policy (ONDCP)

— White House Initiative on Asian Americans and Pacific Islanders (WHIAAPI)
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis v

VHIG Members

VIRAL HEPATITIS IMPLEMENTATION GROUP

(VHIG) MEMBERS

OFFICE OF THE ASSISTANT 

SECRETARY FOR HEALTH

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

Deputy Assistant Secretary for Health, Infectious

Diseases 

Director, Office of HIV/AIDS and Infectious

Disease Policy 

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

Viral Hepatitis Policy Advisor

Office of HIV/AIDS and Infectious Disease Policy

Michelle Moses-Eisenstein, M.P.H.

Public Health Analyst

Office of HIV/AIDS and Infectious Disease Policy

AGENCY FOR HEALTHCARE 

RESEARCH AND QUALITY

William B. Baine, M.D.

Senior Medical Advisor

Center for Outcomes and Evidence 

CENTERS FOR DISEASE CONTROL 

AND PREVENTION

John Ward, M.D.

Director

Division of Viral Hepatitis

National Center for HIV/AIDS, Viral Hepatitis,

STD and TB Prevention 

CENTERS FOR MEDICARE & MEDICAID 

SERVICES

Chisara N. Asomugha, M.D., M.S.P.H., F.A.A.P.

Medical Advisor

Quality Improvement Group

Center for Clinical Standards and Quality

DEPARTMENT OF HOUSING AND 

URBAN DEVELOPMENT

Marlisa Grogan, L.M.S.W.

Office of Special Needs Assistance Programs 

Community Planning and Development 

DEPARTMENT OF JUSTICE

Jeff Allen, M.D.

Chief of Health Programs

Federal Bureau of Prisons

Michelle Williams, Pharm.D.

LCDR, U.S. Public Health Service

HIV/Hepatitis C Program Manager

Health Services Division

Federal Bureau of Prisons

DEPARTMENT OF VETERANS AFFAIRS

Maggie Chartier, Psy.D., M.P.H.

Deputy Director

HIV, Hepatitis, and Public Health Pathogens 

Programs

Patient Care Services 

David Ross, M.D., Ph.D.

Director

HIV, Hepatitis, and Public Health Pathogens

Programs

Patient Care Services 

FOOD AND DRUG ADMINISTRATION

Jonca Bull, M.D.

Assistant Commissioner for Minority Health

HEALTH RESOURCES AND SERVICES 

ADMINISTRATION 

Sarah R. Linde, M.D.

RADM U.S. Public Health Service

Chief Public Health Officer

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

Clinical Advisor

Office of the Associate Administrator

HIV/AIDS Bureau
 vi

INDIAN HEALTH SERVICE

Lisa Neel, M.P.H. 

Program Analyst

National HIV/AIDS Program

NATIONAL INSTITUTES OF HEALTH

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

Division of Pharmacotherapies and Medical 

Consequences of Drug Abuse 

National Institute on Drug Abuse

Megan Singh, Ph.D.

Health Science Policy Analyst

Office of Scientific Program and Policy Analysis 

National Institute of Diabetes and Digestive

and Kidney Diseases

NATIONAL VACCINE PROGRAM OFFICE

Karin Bok, Ph.D., M.S.

Public Health Analyst

OFFICE OF MINORITY HEALTH

Sonsiere Cobb-Souza 

Director

Division of Program Operations

OFFICE OF THE NATIONAL 

COORDINATOR FOR HEALTH

INFORMATION TECHNOLOGY 

Michael A. Wittie, M.P.H.

Program Analyst

Office of Clinical Quality and Safety

OFFICE OF NATIONAL DRUG CONTROL 

POLICY

Christine Kourtides

Senior Policy Advisor

OFFICE OF POPULATION AFFAIRS

Sue Moskosky, M.S., R.N.C.

Deputy Director 

OFFICE OF SURGEON GENERAL

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

Representing the Office of the Surgeon General

Medical Epidemiologist

Division of Viral Hepatitis

Centers for Disease Control and Prevention

OFFICE ON WOMEN’S HEALTH

Martha Bond, M.A.

Senior Public Health Advisor

Division of Program Innovation

REGIONAL HEALTH OFFICES

CAPT James Lando, M.D., M.P.H., F.A.C.P.M.

Regional Health Administrator, Region V

Representing Regional Health Offices

SUBSTANCE ABUSE AND MENTAL 

HEALTH SERVICES ADMINISTRATION 

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

Director

Division of Pharmacologic Therapies

Center for Substance Abuse Treatment

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 of VHIG as 

of the release of this report.

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

VHIG Members
PRIORITY 1:

EDUCATING PROVIDERS AND COMMUNITIES

TO REDUCE HEALTH DISPARITIES

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

hepatitis and provide care and treatment to infected persons.

GOAL 1.2 — Decrease health disparities by educating communities about the benefits of 

viral hepatitis prevention, care, and treatment.

For too long, the epidemic of viral hepatitis has been fueled by silence and ignorance, resulting in 

significant health disparities. A two-pronged educational approach is critical to changing this situation 

by ensuring that providers are armed with the most current evidence-based tools and resources and 

that communities are empowered with the information needed to develop a culturally appropriate and 

effective response. 

In 2014, the following were among the actions undertaken by federal partners to build a strong 

workforce of providers trained to diagnose and manage viral hepatitis and educate communities: 

Building community capacity to address hepatitis B. CDC’s Division of Viral Hepatitis (DVH) 

awarded a cooperative agreement to the Hepatitis B Foundation to provide capacity building, training, 

and technical assistance to more than 17 Hep B United coalition partners throughout the nation. Hep 

B United coalition partners aim to increase hepatitis B awareness, testing, vaccination, and treatment 

in Asian American and Pacific Islander (AAPI) communities — among individuals who may already 

be infected as well as their families and loved ones. Also, the Substance Abuse and Mental Health 

Services Administration has developed a variety of Minority AIDS Initiative (MAI) programs to build 

community capacity to address HIV and viral hepatitis.

Sharing updates on new therapies for viral hepatitis. FDA’s Office of Health and Constituent 

Affairs hosts a viral hepatitis listserv that, together with the FDA Division of Antiviral Products, keeps 

healthcare providers, patients, and other interested parties abreast of information about: 1) new 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 1

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

therapeutic drugs for treating hepatitis; 2) important safety updates regarding the use of antiviral 

therapies for treating viral hepatitis; and 3) significant labeling changes that might impact the use of 

FDA-regulated products used in the diagnosis or treatment of viral hepatitis. The listserv currently 

has 52,275 subscribers. Information is also posted on the FDA Viral Hepatitis Website, including 

the seven updates shared in 2014. FDA also maintains web links to ClinicalTrials.gov, which helps 

patients with viral hepatitis find on-going clinical trials and provides information about approved and 

investigational therapeutics.

Identifying opportunities to share new information, policies, and best practices and further 

leveraging resources to enhance the national response to viral hepatitis. OHAIDP coordinated 

efforts across federal partners for the observance of Hepatitis Awareness Month in May and the 

2014 National Viral Hepatitis Testing Day (May 19th). Using blog posts, webinars, and national 

meetings, including the Hep B United Summit (May 21st-22nd) and the State Viral Hepatitis Prevention 

Coordinator Annual Meeting (October 20th-22nd; hosted by the National Alliance of State and Territorial 

AIDS Directors [NASTAD]), OHAIDP disseminated viral hepatitis guidelines and additional materials 

developed by CDC and other federal and community partners. To promote the dissemination of 

critical information, OHAIDP authored or contributed to the development of 56 viral hepatitis-related 

blogs on blog.aids.gov in 2014, maintained and updated the web presence at 

www.AIDS.gov/hepatitis, and supported viral hepatitis Tweets from OASH as well as AIDS.gov social 

media activities. In collaboration with the VHIG, OHAIDP oversaw the development of the 2013 Viral 

Hepatitis Action Plan Progress Report — an update highlighting key federal viral hepatitis activities 

undertaken during 2013.

Supporting health centers in addressing viral hepatitis. HRSA supports the provision of training, 

technical assistance, and information dissemination about a variety of topics including viral hepatitis 

to health centers through its National Cooperative Agreement partners. 

◊ The National Health Care for the Homeless Council (NHCHC) regularly conducts regional and 

national trainings focusing on hepatitis C. In 2014, some of these trainings included: “Talking 

About Hepatitis C: How to Give Clear, Compassionate and Up to Date Information” and 

“Investigating Patient Attitudes Towards Hepatitis C to Guide Implementation of Primary Care 

Based HCV Treatment.” 

◊ The National Association of Community Health Centers (NACHC) developed a three-part 

blog series, “Focus on Hepatitis C: Health Centers Work to Address the Chronic Disease” 

spotlighting strategies used by three health centers to address hepatitis C, focusing on the 

importance of partnerships, the importance of patient and community relationships in providing 

care, and the role of telemedicine in increasing access to holistic, coordinated care for hepatitis 

C patients. 
3

◊ The National LGBT (Lesbian, Gay, Bisexual, and Transgender) Health Education Center 

developed a brief entitled, “Emerging Clinical Issue: Hepatitis C Infection in HIV-Infected Men 

Who Have Sex with Men,” released in June 2014. The brief details the epidemiology of HCV 

among HIV-infected men who have sex with men (MSM), as well as current screening, treatment 

and prevention recommendations for HCV.

◊ In 2014, the National LGBT Health Education Center and NACHC updated a toolkit, “Taking 

Routine Histories of Sexual Health: A System-Wide Approach for Health Centers,” which 

includes strategies for identifying viral hepatitis risk. The toolkit was designed to help health 

centers develop and implement systems for routinely collecting sexual health histories as part 

of the primary care visit. 

◊ The Association of Asian Pacific Community Health Organizations (AAPCHO) is funded by 

HRSA to support health centers in addressing the health care needs of Asian Americans, 

Native Hawaiians, and other Pacific Islanders. AAPCHO recognizes the disproportionate 

burden of hepatitis B in these communities; it provides hepatitis B-related direct training 

and technical assistance to health centers including: support to implement the 2014 U.S. 

Preventive Services Task Force (USPSTF) HBV screening recommendations; staff training to 

use electronic health record tools for HBV prevention, improvement of disease management, 

and the development of patient registry reports; and review and evaluation of existing HBV 

health education videos for use in clinical settings. Additionally, APPCHO provided technical 

assistance to community partners that submitted comments during the development of the 

USPSTF HBV screening recommendations.

Expanding access to expert clinical guidance. In April 2014, VA launched the first hepatitis 

C “Warmline” in collaboration with the University of California, San Francisco. This telephone 

consultation service, available to VA providers weekdays from 9:00 AM to 8:00 PM Eastern, offers 

expert clinical guidance based on federal HCV treatment guidelines, VHA guidelines, current medical 

literature, and clinical best practices. These resources aid frontline VA providers in making important 

decisions about the treatment of patients with hepatitis C.

Enhancing coordination of national viral hepatitis activities among federal and non-federal 

stakeholders. In spring 2014, OASH and the Office of the HHS Secretary released the updated 

Action Plan. The Action Plan’s updating process engaged members of the federal VHIG (composed 

of 27 members from across the Departments of Health and Human Services, Housing and Urban 

Development, Justice, and Veterans Affairs) as well as a broad variety of non-federal stakeholders. 

Community input was solicited via both a Request for Information published on June 5, 2013 in the 

Federal Register and three community engagement webinars that garnered over 100 comments 

and specific recommendations—many of which were incorporated into the updated plan. To further 

increase engagement of all stakeholders in the updated Action Plan, OHAIDP hosted an Action 

Plan Launch Event on April 3, 2014, in the HHS headquarters auditorium in Washington, DC. It was 

webcast to an estimated 760 sites across the nation. Then-Secretary of Health and Human Services 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 1: Educating Providers and Communities to Reduce Health Disparities
4

Kathleen Sebelius and then-Assistant Secretary for Health Dr. Howard Koh participated in the launch 

along with federal and non-federal viral hepatitis leaders, experts, and community advocates.

Immediately following the launch of the Action Plan, OHAIDP convened a one-day stakeholder 

consultation on Expanding Roles and Opportunities for Nonfederal Stakeholders to Implement 

the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis (2014-2016). A range 

of stakeholder groups were represented by the approximately 50 participants. They included 

professional organizations, national advocacy organizations, Perinatal Hepatitis B Prevention 

Coordinators, State Viral Hepatitis Prevention Coordinators, state health departments, health 

professionals, and others working to address HBV and HCV in the U.S. 

Concurrent with the Action Plan update release, OHAIDP released a companion document — the 

Stakeholder’s Workbook: Exploring Vital Roles and Opportunities to Break the Silence. The workbook 

provides a questions-based tool that assists health departments, community organizations, and 

other stakeholders in identifying opportunities to advance and promote the goals of the updated 

Action Plan. The workbook contains easy-to-use worksheets to help prioritize activities, identify 

strategic partners and measures, and set target dates for completion. After its release, OHAIDP 

conducted outreach to key stakeholders including: the CDC-funded State Viral Hepatitis Prevention 

Coordinators, the Association of State and Territorial Health Officials (ASTHO), the National 

Association of City and County Health Officials (NACCHO), the National Alliance of State and 

Territorial AIDS Directors (NASTAD), HHS Regional Resource Coordinators, and coalitions such 

as Hep B United and the National Viral Hepatitis Roundtable. OHAIDP consulted with and provided 

technical assistance to organizations and groups that expressed interest in using the Stakeholder’s 

Workbook for the purpose of guiding viral hepatitis strategic planning activities such as the Hep B 

United Strategic Plan and Project Inform’s report, Scaling up Risk-based Hepatitis C Screening in the 

United States.

Highlights of additional activities to educate healthcare providers conducted during 2014 are listed in 

the following tables.

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 1: Educating Providers and Communities to Reduce Health Disparities
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 5

AGENCY

OR OFFICE HEALTH PROFESSIONAL TRAINING ACTIVITIES

FBOP

FBOP provided a live, instructor-led webcast training, “Hepatitis C Treatment 

Update” on newly available HCV medications to Health Services Division staff in 

February 2014. It also led in-person educational sessions on the “Management of 

Chronic Hepatitis C Infection” to health care providers and staff at the FBOP Clinical 

Director and Health Service Administrator Conference in June 2014 and the FBOP 

Pharmacy Residential Meeting in August 2014.

HRSA

HRSA’s Bureau of Primary Health Care (BPHC) works closely with HHS operating 

and staff divisions, national partners, and key stakeholders to promote viral hepatitis 

training and technical assistance opportunities (webinars, publications, tools) for 

Health Center Program participants. The weekly Primary Health Care Digest has a 

distribution list of almost 13,000. It includes updates, announcements, and training 

opportunities relating to viral hepatitis. These have included notices of the 2014 

CMS Medicare National Coverage Determination for HCV testing and Hepatitis 

Awareness Month resources. 

In 2014, the Ryan White HIV/AIDS Program-funded AIDS Education and Training 

Centers (AETCs) funded more than 1000 training programs in hepatitis C across 

the 11 regional centers (with more than 100 local performance sites), and 3 national 

centers, and ongoing hepatitis C management support for healthcare providers in 9 

telehealth centers. 

IHS

In 2014, IHS continued its virtual viral hepatitis provider training program. Technical 

assistance was directly provided to 108 sites and included topics on HCV diagnosis, 

care and treatment. More broadly, the agency developed 12 national webinars 

on HCV screening, diagnosis and treatment, attended by over 200 professionals. 

Ongoing training opportunities were made available via collaborations with ECHO 

telehealth programs in Albuquerque, NM; Seattle, WA; and Phoenix, AZ. IHS 

also has a longstanding telehealth program that provides support for healthcare 

providers in remote locations to manage viral hepatitis along with other health 

conditions, hosted by the Alaska Native Tribal Health Consortium. In the fall of 

2014, a new telehealth network was launched that includes support for HCV 

management and serves the Cherokee Nation with a hub in Tahlequah, OK.

RHA

Regional Resource Coordinators (RRC) and other regional staff collaborated with 

federal and nonfederal stakeholders to identify and disseminate promising and 

best practices for viral hepatitis prevention, care, and treatment. In Region II, the 

RRC partnered with Columbia University’s New York/New Jersey AIDS Education 

and Training Center to host a hepatitis C webinar series titled: “Hepatitis C in 

2014.” The three-part series, hosted on March 7th, March 31st, and May 5th 2014, 

targeted clinicians and focused on the updated AASLD and IDSA Recommendations 

for Testing, Managing, and Treating Hepatitis C. Each webinar had over 200 

participants from New York and New Jersey.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 6

AGENCY

OR OFFICE CLINICAL GUIDELINES

FBOP FBOP released updated Clinical Practice Guidelines, “Interim Guidance for the 

Management of Chronic Hepatitis C Infection-June 2014.”

NIH

Staff from the intramural research program at the NIDDK continue to participate in 

the ongoing development and evolution of clinical guidelines for testing, managing, 

and treating hepatitis C under the auspices of the American Association for the 

Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America 

(IDSA). These guidelines are updated every three months.

OPA

In April 2014, OPA, in collaboration with CDC, released “Providing Quality Family 

Planning Services: Recommendations of CDC and the U.S. Office of Population 

Affairs.” Issued as a CDC MMWR Recommendations and Reports, this document 

targets Title X family planning clinics, primary care providers, and others providing 

family planning services. It includes recommendations for HCV screening and 

routine hepatitis B vaccination to all individuals under age 19 and all adults who are 

unvaccinated and do not have a documented history of hepatitis B infection.

VA

In November 2014, VA’s National Center for Health Promotion and Disease 

Prevention updated screening guidelines for hepatitis B infection to reflect current 

CDC guidelines and U.S. Preventive Task Force recommendations.

In December 2014, VA published an Information Letter on the care and treatment 

of hepatitis B infection, providing guidance to front-line clinical providers on the 

management of veterans.

VA’s internationally recognized “Chronic HCV Infection: Treatment Considerations” 

was launched in March 2014 and updated in May and December of the same 

year by a group of VA subject matter experts. The Treatment Considerations are 

continually updated to ensure that VA providers have the most current, objective, 

evidence-based information about HCV treatment regimens, drug interactions, and 

co-morbidity management to inform 

high-quality clinical decisions in caring for those living with chronic HCV. Paired with 

this document, VA’s Pharmacy Benefits Management has provided detailed “Criteria 

for Use” to support safe and clinically appropriate medication-prescribing practices 

for all HCV direct-acting antivirals on formulary.
Enhancing public educational materials for viral hepatitis. In 2014, CDC developed a new 

phase of the Know More Hepatitis national education campaign. It is designed to encourage 

people born from 1945 to 1965 to get tested for hepatitis C. This initiative supports CDC’s overall 

efforts to improve HCV testing, linkage to care, and treatment. New materials, released in early 

2015, include a fact sheet for persons who inject drugs. CDC also developed new public service 

announcements and educational and outreach 

materials in several Asian languages for the Know 

Hepatitis B national campaign. 

Increasing access to hepatitis B medication 

safety information. FDA coordinated the translation 

of several consumer resources, including medication 

safety education materials on hepatitis B, into 

Vietnamese, Korean, Chinese, and Thai for use in 

community clinics and hepatitis B screening events, 

and a document titled “Sometimes Drugs and the 

Liver Don’t Mix” into five Asian languages. 

Expanding HCV outreach to American Indian and 

Alaska Native communities. In 2014, IHS Tribal 

partner, the Northwest Portland Area Indian Health 

Board, recognized the high rate of chronic hepatitis C. 

It released a pamphlet and two Public Service Announcements in early 2015 to disseminate 

birth-cohort hepatitis C screening recommendations to American Indian/ Alaska Native (AI/AN) 

communities.

Identifying opportunities to integrate viral hepatitis into HIV and related activities. Regional 

Health Administrators (RHAs) and their staff identified opportunities to integrate activities in 

support of the Action Plan and the National HIV/AIDS Strategy. Some of these activities educated 

providers and communities on issues relating to the Affordable Care Act and viral hepatitis. 

In partnership with regional, state, local, and tribal organizations, these efforts also increased 

awareness and education in communities disproportionately affected by viral hepatitis. Regional 

Resource Coordinators (RRCs) participated — and, in many cases, helped to coordinate — 

over 25 events across the nation to ensure inclusion of viral hepatitis in HIV and other regional 

prevention activities, including World AIDS Day events.

Increasing public awareness and education. Many federal partners took steps to increase 

public awareness and education. 

Since its inception in 

2012, the Know More 

Hepatitis campaign — 

focused on educating baby 

boomers about hepatitis C

— has garnered more 

than one billion audience 

impressions, worth an 

estimated $1.4 million of 

donated media time and 

space.

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 7

Priority 1: Educating Providers and Communities to Reduce Health Disparities
◊ CDC regularly updates material posted on its website and develops and shares digital tools 

and resources such as an online hepatitis risk assessment, web buttons, badges, and widgets 

and more. CDC has an active Twitter presence via @cdchep with over 28,000 followers. In 

2014, CDC also worked with the National Prevention Information Network to feature a Hepatitis 

Event Page during May’s observance of Hepatitis Awareness Month; organizations posted 

information about their viral hepatitis testing events and individuals were able to search for 

testing locations on this page.

◊ HUD distributed a Hepatitis Awareness Month message via its listserv to grantee and staff 

networks (over 30,000 individuals), reinforcing the association between homelessness and 

increased risk for viral hepatitis and providing information about resources and how to get 

more involved in raising awareness.

◊ In July 2014, OHAIDP and CDC collaborated with the Office of National AIDS Policy (ONAP) 

and ONDCP to plan and conduct a World Hepatitis Day event in the White House South Court 

Auditorium and via webcast. The event included remarks by then-Assistant Secretary for 

Health Dr. Howard Koh, Ambassador Deborah Birx who leads the President’s Emergency Plan 

for AIDS Relief (PEPFAR), and Dr. Paul Farmer, founder of Partners in Health and Harvard 

Professor of Global Health and Social Medicine. Twelve leaders in the field of viral hepatitis 

were recognized for their contributions toward achieving the goals of the Action Plan.

◊ OPA supported hepatitis awareness efforts via email and Twitter messages in 2014. OPA 

regularly disseminates family planning and related preventive health information to more than 

5,500 stakeholders, including its Title X-funded grantees, service site providers, and the public. 

In 2014, OPA shared 35 messages regarding hepatitis webinars for providers, materials for 

at-risk populations, and other prevention, care and treatment updates — including information 

about the updated Action Plan, viral hepatitis funding opportunities, and the CDC’s Viral 

Hepatitis Risk Assessment.

◊ OMH launched a targeted communications and awareness campaign for the annual 

observances of National Hepatitis Testing Day, Hepatitis Awareness Month, and World 

Hepatitis Day including a Director’s blog post on viral hepatitis in African-American 

communities. The campaign included traditional media placement, social media, materials, 

a toolkit for testing events and health fairs, and webinars. The campaign reached more than 

25,000 through OMH newsletters. The Twitter campaign potentially reached 4.8 million 

consumers and professionals, and included tweets in Spanish. 

◊ OWH promoted viral hepatitis information to the public and to health care providers via its 

website including cross-posting blogs. During the month of May, OWH prepared hepatitisrelated messages for callers waiting on hold to be connected to the OWH hotline, developed 

and sent hepatitis-themed tweets in English and Spanish, and re-tweeted messages 

throughout calendar year 2014. 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 8

Priority 1: Educating Providers and Communities to Reduce Health Disparities
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 9

The HCV Care Continuum: Measure the Progress to Curing HCV

THE HCV CARE CONTINUUM:

MEASURE THE PROGRESS TO CURING HCV

By Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy Advisor, Office of HIV/AIDS and 

Infectious Disease Policy, U.S. Department of Health and Human Services

Chronic HCV infection affects an estimated 3.5 million individuals in the Unites States; over 50% of 

them are unaware that they are infected.1 Chronic HCV has been termed a “silent epidemic”, due 

to the largely asymptomatic nature of the disease. HCV infection can persist for decades without 

causing symptoms. During this time however, liver disease may continue to progress. HCV infection 

can cause significant liver disease, cirrhosis, hepatocellular carcinoma (HCC), and death. Persons 

born between 1945 and 1965 (often referred to as the “baby boomers”) represent approximately 75% 

of those infected. Many of these individuals were infected many years, or even decades, ago. As the 

baby boomer population ages and the duration of their HCV infection increases, the serious clinical 

consequences associated with chronic infection are also expected to increase. Thus, the clinical 

burden of HCV will continue to increase, particularly in this group,2 if we do not redouble our efforts to 

identify individuals currently living with HCV and link them to lifesaving care and curative therapies. 

The coordinated federal response to combat viral hepatitis is only 4 years old, and yet, we have made 

progress both in raising awareness and in understanding gaps in our response to the silent epidemic 

of chronic HCV infection. As we continually work to evaluate progress in efforts toward achieving 

the goals of the Action Plan, it is important to have a consistent set of indicators that we can track 

over time. The HCV continuum of care provides a set of indicators that can be used this way by 

federal partners, state and local health departments, health systems, and advocates. In 2013, CDC 

developed and published the first U.S. HCV continuum of care, based on the Chronic Hepatitis Cohort 

Study (CHeCS) data to help inform our national response3. Philadelphia provides an example of a 

jurisdiction that has evaluated its continuum of care indicators and used the findings to identify gaps 

and strategies to improve their work on HCV4. The authors identified a lack of HCV testing due to 

low provider awareness and lack of patient perception of risk as well as limited access to healthcare 

1 Centers for Disease Control and Prevention. Recommendations for the identification of chronic hepatitis C virus infection 

among persons born during 1945 — 1965. Morbidity and Mortality Weekly Review. 2012;61(RR04):1-18.

2 Davis GL, Alter MJ, El-Serag H, et al. Aging of hepatitis C virus (HCV)-infected persons in the United States: multiple 

cohort model of HCV prevalence and disease progression. Gastroenterology. February 2010;138(2):513-521.

3 Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Current status of hepatitis C in the United States. New 

England Journal of Medicine. 2013;368:1859-1186.

4

 Viner K, Kuncio D, Newbern EC, and Johnson CC. The continuum of hepatitis C testing and care. Hepatology. March 

2015;61(3):783-789.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 10

The HCV Care Continuum: Measure the Progress to Curing HCV

services. Strategies implemented include a change to reporting all HCV confirmatory test results (not 

just those that are positive) coupled with provider training regarding the implementation of routine 

confirmatory testing, and increasing communication and collaboration among HCV surveillance, 

prevention, and clinical personnel. The continuum graph is a visual representation of where we 

must focus efforts and resources to close gaps and increase the proportion of people ultimately 

cured of HCV. 

HCV CONTINUUM OF CARE

Yehia B, Schranz A, Umscheid, C, et al. The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic 

review and meta-analysis. PLoS One. 2014;9(7): e101554

Yehia, et al., conducted a systematic review and meta-analysis to provide more comprehensive, 

updated estimates of the proportion of individuals who successfully complete each step of a proposed 

HCV management cascade5

. With only 50% of those infected with HCV diagnosed, the continuum

of care indicates that efforts at the initial stages are required in order to increase awareness of the 

disease and improve screening rates among persons at risk. We have seen new opportunities and 

resources to improve screening rates in recent years, including: USPSTF/CDC recommendations 

that all persons born between 1945 and 1965 receive a one-time HCV antibody test,1,6,7 availability 

of point-of-care antibody screening8

, and numerous federal, private, and community-led efforts to 

increase awareness of HCV and its clinical consequences. While over 80% of people who have an 
11

initial antibody test are linked to care, just over half have their infections confirmed based on CDC 

HCV testing recommendations.5

 The continuum of care further shows that, of all people who have 

confirmed chronic HCV infection, less than 60% are prescribed HCV treatment and only one-third 

have achieved a cure. 

Given the limited funding dedicated to HCV prevention, awareness, and care, continued creativity and 

innovation will be key to increasing all the indicators along the HCV continuum of care. Opportunities 

in this area include:

◊	 Leveraging and expanding upon existing resources by identifying best practices and 

building on existing programs.

◊	 Harnessing the power of technology by using electronic medical record tools, engaging 

social media, and developing web-based education and tools.

◊	 Highlighting successes and wins by describing the HCV continuum of care within a 

jurisdiction, e.g., Philadelphia, or health system and advances such as the USPSTF/CDC 

aligned screening recommendations and new curative therapies.

◊	 Referring to the national roadmap by using both the 2011 Action Plan which laid a 

foundation for advancing efforts to address HCV and the updated Action Plan which provides a 

framework for identifying national goals and actions for all stakeholders invested in ending the 

HCV epidemic.

Efforts to improve outcomes along the continuum are progressing in states, counties, and cities 

across the nation, through effective partnerships, innovative resource utilization, and strong 

leadership. Expanding these efforts will help the U.S. reach the ultimate goal of achieving an HCV 

continuum of care with high levels of diagnosis, access to care, and cure for Americans with HCV.

5

 Yehia B, Schranz A, Umscheid, C, et al. The treatment cascade for chronic hepatitis C virus infection in the United 

States: a systematic review and meta-analysis. PLoS One. 2014;9(7):e101554.

6

 Chou R, Cottrell E, Wasson N, et al. Screening for hepatitis C virus infection in adults: a systematic review for the U.S. 

Preventive Services Task Force. Ann Intern Med. 2013;158(2):101-108.

7

 U.S. Preventive Services Task Force. Hepatitis C Screening Recommendation. June 2013. 

http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/hepatitis-c-screening.

8

 US Food and Drug Administration. FDA approves rapid test for antibodies to hepatitis C virus. 2010. 

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm217318.htm 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

The HCV Care Continuum: Measure the Progress to Curing HCV
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 12

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

PRIORITY 2:

IMPROVING TESTING, CARE, AND TREATMENT TO 

PREVENT LIVER DISEASE AND CANCER

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

disease.

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

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

with viral hepatitis.

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

and treatment for infected persons.

Providers at every level in the health care system play 

a critical role in meeting the needs of the millions of 

people at risk for or living with viral hepatitis. However, 

not all providers and systems are prepared to address 

these needs; missed opportunities to prevent, diagnose, 

treat, and care for persons with viral hepatitis result 

in preventable morbidity and mortality. These missed 

opportunities highlight the need for taking full advantage 

of existing tools, and developing additional innovative 

strategies. By identifying targets for improvement 

throughout the healthcare system, we can close the gaps 

that prevent individuals from receiving the care needed to 

improve hepatitis-related health outcomes.

In 2014, the following were among the actions undertaken by federal partners to improve testing, 

care, and treatment to prevent liver disease and cancer:
13

TESTING, DIAGNOSIS, AND LINKAGE TO CARE 

Supporting development and dissemination of updated U.S. Preventive Services Task 

Force (USPSTF) HBV screening recommendations. In May 2014, USPSTF issued an updated 

recommendation for screening for hepatitis B infection in persons at high risk for infection in 

non-pregnant adolescents and adults. AHRQ provides administrative, research, technical, and 

communication support to the Task Force, which is an independent group of national experts that 

works to improve the health of all Americans by making evidence-based recommendations on clinical 

preventive services such as screenings, counseling services, or preventive medicines. The new 

USPSTF recommendation statement on HBV screening, which was given a “B” grade, supports the 

need to identify chronically-infected individuals who may benefit from treatment and reduce HBV 

transmission. Among those considered at high risk for HBV in the United States are persons born 

in countries with a high prevalence (≥2%) of HBV, HIV-positive persons, persons who inject drugs 

(PWID), and men who have sex with men (MSM). 

Increasing HBV testing capacity. In 2014, CDC provided $900,000 of grant funding to improve 

the capacity of health care providers and other stakeholders to provide HBV testing and care in 

cities with large populations of persons born in countries with intermediate-to-high HBV prevalence. 

In three areas, funding was awarded to coalitions of key stakeholders (i.e. community-based 

organizations, health departments, specialists in HBV care, and primary-care providers) to support 

efforts to screen and diagnose people with chronic HBV and provide linkage to high-quality HBV care. 

Funded organizations included Saint Barnabas Medical Center (NJ) in partnership with Charles B. 

Wang Community Health Center (NY), Asian Health Coalition (IL), and Regents of the University of 

California at Davis (CA). The funded coalitions collaborated to implement screening and case-finding 

activities; conduct community outreach, patient navigation, case management, and other support 

services; implement training of primary-care staff to enhance screening, monitoring, management and 

referral practices; and implement activities to increase community and health professional awareness 

of hepatitis B. 

Developing guidance for effective HCV outreach testing. In 2014, CDC developed a Guide to 

Comprehensive Hepatitis C Counseling and Testing — a manual to enhance counseling and testing 

for individuals at risk for, or potentially infected with, hepatitis C. Released in April 2015, the manual 

is available for use in public health settings and for use in primary care practices. It was developed 

in part by CDC-funded State Viral Hepatitis Prevention Coordinators and field-tested by primary 

care providers. The manual includes a sample risk assessment, testing algorithms, sample HCV 

test counseling conversations, and recommended alcohol education for individuals whose HCV test 

results are positive.

Expanding coverage for HCV testing for Medicare recipients. In June 2014, CMS expanded 

Medicare coverage to include screening for HCV infection, consistent with the 2013 grade B 

recommendation by the USPSTF. The tests must be ordered by the beneficiary’s primary care 

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physician or practitioner within the context of a primary care setting, performed by an eligible 

Medicare provider for beneficiaries who are at high risk for HCV infection, and use the appropriate 

FDA-approved laboratory tests. A single screening test is covered for Medicare beneficiaries who do 

not meet the high-risk definition, but who were born from 1945 through 1965. “High risk” is defined 

as persons with a current or past history of illicit injection drug use and persons who have a history 

of receiving a blood transfusion prior to 1992. Repeat screening for high-risk persons is covered 

annually only for persons who have had continued illicit injection drug use.

Providing quality viral hepatitis testing and linkage to care for federal inmates. FBOP 

continues risk-based hepatitis screening of inmates and additional screening as clinically indicated. 

FBOP offers prenatal hepatitis B screening for pregnant females in FBOP custody to prevent motherto-child transmission and provides hepatitis A and hepatitis B vaccination to appropriately-indicated 

adult inmates according to the FBOP National Preventative Health Care Clinical Practice Guidelines. 

FBOP inmates identified as HCV- or HBV-positive are enrolled in Chronic Care Clinics for appropriate 

care and management of their disease. Inmates receiving HCV treatment are monitored by a network 

of regional hepatitis clinical pharmacist consultants, in addition to receiving care management from 

their local health services team.

Supporting viral hepatitis prevention and testing in public health. In 2014, CDC provided $5.2M 

in funding to support health department jurisdictions that conduct core viral hepatitis prevention 

activities including integration of testing into public health clinical settings. These funds provided 

support to State Viral Hepatitis Prevention Coordinators (VHPCs) in over 50 jurisdictions around the 

country, including 48 states and several major cities. VHPCs evaluate local data to tailor prevention 

activities for their jurisdictions and then seek local partnerships and resources to implement these 

activities where they are most needed. These activities include integrating viral hepatitis prevention 

vaccination, testing, and linkage to care within existing public health, clinical care, and community 

settings. 

Enhancing the integration of viral hepatitis screening in primary care. HRSA’s BPHC, in 

collaboration with CDC, and in support of both HIV and viral hepatitis services, funded Partnerships 

for Care (P4C). The three-year contract was awarded in FY2104 utilizing Secretary’s Minority AIDS 

Initiative Funds to support the integration of high-quality HIV services into primary care through 

innovative partnerships between health centers and state health departments in four states. Given the 

high levels of hepatitis co-infection among people living with HIV, this project also includes support for 

hepatitis B and C screening and referrals to care.

Developing and disseminating electronic tools to improve hepatitis C testing and 

management. IHS continued dissemination of the HCV Screening Reminder for people born from 

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1945 to 1965. IHS also developed and released a Microsoft Excel-based registry tool that assists 

clinicians in assessing patients and setting priorities for treatment. IHS conducted training on the 

registry at 10 sites in 2014.

Expanding screening and vaccination in family 

planning settings. In 2013, OPA provided Title X 

funds to 95 grantees that delivered family planning 

and related preventive health services through more 

than 4,000 service sites to more than 4.5 million 

individuals. Released in 2014, “Providing Quality 

Family Planning Services: Recommendations of 

CDC and the U.S. Office of Population Affairs” 

includes recommending screening for HCV in 

males and females and offering routine hepatitis B 

vaccination to all individuals under age 19 as well as all adults who are unvaccinated and do not have 

a documented history of hepatitis B infection.

Developing improved diagnostics for viral hepatitis. FDA is working with manufacturers to 

develop visually readable, rapid devices for diagnosing viral hepatitis that may be used to prevent 

transmission, such as in emergency screening of blood donors (e.g., in combat zones). FDA is also 

working with manufacturers to develop more sensitive and precise hepatitis C genotype testing, and 

to consolidate the intended uses of existing hepatitis C tests such that a single test could be used 

both to diagnose HCV and assess treatment response (i.e., determine genotype). 

Expanding the use of health information technology (HIT) to improve viral hepatitis services. 

In 2014, the following federal partners developed tools and evaluated HIT strategies to address viral 

hepatitis:

◊ Using a community-based participatory approach, the National Institute on Minority Health and 

Health Disparities supports ongoing needs assessments and focus groups. It is developing 

pilot testing of culturally proficient HIT intervention strategies to improve HBV vaccination, 

screening rates, and linkages to care among underserved Asian Americans visiting a 

community clinic. This study was initiated in January 2013 with a planned completion date of 

December 2016. 

By December of 2014, IHS 

had screened 33% of patients 

born during 1945 — 1965 for 

HCV, an increase of 44% over 

2013 screening levels among 

individuals seen at federally 

supported IHS sites.

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◊ Under an inter-agency agreement with CDC, the Office of the National Coordinator for Health 

Information Technology (ONC) worked to develop electronic specifications of three American 

Medical Association — Physician Consortium for Performance Improvement (AMA-PCPI) 

measures: 

AMA-PCPI measure 9a: Screening for HCV patients at high risk.

AMA-PCPI measure 9b: Annual HCV screening for patients who are active injection-drug 

users.

AMA-PCPI measure 9c: Referral to treatment for patients identified with HCV infection.

In addition to developing these electronic Clinical Quality Measures (eCQMs), ONC is developing 

electronic clinical decision support (CDS) tools designed to help healthcare providers better screen 

and care for HCV patients. To support more widespread dissemination and use, the CDS tools are 

included in the HL7 balloted Knowledge Artifact Sharing draft standard. The eCQMs and CDS tools 

have been developed, and publication is expected by mid-to-late 2015.

Increasing viral hepatitis testing among homeless veterans. Collaborating with the VA’s 

Healthcare for the Homeless Program, the Office of Public Health (OPH) funded 25 small grants in 

2014 to increase HIV and HCV testing for veterans through multiple homeless outreach programs. 

More than 400 homeless veterans were tested for HCV through this program.

TREATMENT AND CURE

Enabling access to new HCV therapies. In 2014, FDA approved three new regimens for the 

treatment of chronic hepatitis C.

◊ Harvoni® (ledipasvir and sofosbuvir), the first combination pill, was approved in October 2014. 

Harvoni® was the first approved regimen to treat chronic HCV genotype 1 infection that does 

not require administration with interferon or ribavirin. Harvoni® was a new drug that received 

the FDA’s breakthrough therapy designation, which is intended to expedite the development 

and review of drugs for serious or life-threatening conditions. It was reviewed under the FDA’s 

priority review program.

◊ Olysio® (simeprevir) in combination with Sovaldi® (sofosbuvir) was approved for treatment 

of chronic HCV genotype 1 infection in November 2014. Each component drug was initially 

approved in 2013. This regimen was reviewed under the FDA’s priority review program.

◊ Viekira PakTM (ombitasvir, paritaprevir and ritonavir tablets co-packaged with dasabuvir 

tablets), another treatment option for patients with chronic HCV genotype 1 infection, was 

approved in December 2014. Viekira PakTM was also a new drug with breakthrough therapy 

designation and was reviewed under the FDA’s priority review program; it is the only once-daily 

oral regimen available.

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

Innovating to improve the HCV continuum of 

care. Federal partners conducted the following 

activities to improve the HCV continuum of care for 

targeted populations: 

◊ CDC provided funding ($4.3M) to increase 

capacity of primary-care providers 

to diagnose and cure HCV among 

disproportionately affected populations in 

three communities. In each community, a 

coalition of key stakeholders (i.e., health 

departments, specialists in HCV care, 

and primary-care providers) was funded 

to develop and implement these services. 

Funds were awarded to the University of 

Chicago, the Maryland Department of Health 

and Mental Hygiene, and Public Health—

Seattle & King County. Project activities 

include expanding the use of electronic 

health records to enhance HCV testing 

and care; assessing community impact of 

services; and increasing health department 

capacity to gather and follow-up on reports 

of current HCV cases in target populations.

◊ Through OMH’s HIV/AIDS Health Improvement for Re-entering Ex-offenders Initiative 

(HIRE) program, clients are linked to care within 30 days of testing positive for HIV, and are 

also screened for hepatitis C and linked to medical treatment as necessary. Grantees have 

established partnerships with organizations providing comprehensive healthcare services, 

substance use and mental disorder treatment programs, family services, education/GED 

programs, job placement/training programs, housing assistance and public assistance 

programs. Additionally, through the Health and Social Service Resource (HSSR) Network, 

Linkage to Life (L2L) grantees utilized a systems navigation approach to link clients with and 

retain them in comprehensive primary care, HIV/AIDS treatment, and social and supportive 

services including viral hepatitis screening and follow-up through each HSSR Network. 

Integrating viral hepatitis into HIV demonstration projects for at-risk individuals. Through 

SAMHSA’s Minority AIDS Initiative Continuum of Care (MAI-CoC) pilot program, grantees are 

required to use 5 percent of funding for viral hepatitis activities and report those activities to SAMHSA. 

To capture testing rates, positivity, vaccination, and referral to care, SAMHSA has updated its Rapid 

HIV and Hepatitis Testing Form. 

From September 2013- August 

2014, a total of 1,095 HIRE 

participants were screened and 

tested for viral hepatitis; 116 

individuals tested positive and 

90 clients attended a routine 

viral hepatitis medical care 

visit within three months of 

HIV diagnosis. L2L grantees 

screened and tested 1,888 

participants during the same 

period; 205 clients tested 

positive and 143 clients 

attended a routine viral 

hepatitis medical care within 

three months of HIV diagnosis. 

The Linkage to Life Program 

ended August 31, 2014.
Redesigning the HCV system of care for veterans. In September 2014, VA hosted a conference 

to address the system redesign of HCV care across the system. This meeting was attended by 

representatives from each of the 21 Veterans Integrated Service Networks (VISNs). Out of this 

meeting, VISN Hepatitis C Innovation Teams (HITs) were formed in 19 out of 21 VISNs. HITs were 

tasked with creating broad based regional teams with a focus on system redesign. Their goals are to 

assess current HCV clinical care and variability in facility treatment capacity and practice across their 

regions, identify gaps in care, and implement broad-based, redesigned strategies to align with future 

state goals for HCV testing and treatment.

VA has several field-based quality improvement initiatives including: 

1) The use of a “Hepatocellular Carcinoma (HCC) Tracker”, a web-based tool to identify and follow 

patients with HCC. This tracker augments care coordination and case management to create a 

Cancer Care Tracking System for HCC to detect and treat liver cancer earlier.

2) A model for VISN-wide multidisciplinary and multi-facility liver cancer teams and tumor boards 

which have been shown to improve both access to and the quality of liver cancer care that has 

expanded to three VISNs.

3) The HCV Dashboard Collaborative Project, which brings together VISN and facility teams who 

have developed HCV dashboards to share best practices and mentor other teams to use this 

technology to improve HCV clinical care.

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The figures below depict the geographic distribution of these and other important quality improvement 

initiatives, which include the Liver Disease and HIV psychology fellowship sites and HIV and HCV 

testing initiatives in VA homeless and outreach and care programs. 

HCC Tracker Locations

Tumor Board Locations

HIV/Liver Disease Psychology Fellowship Locations

HIV/HCV Testing in Homeless Programs

Funded VISN HIT Teams

No VISN HIT funding

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Responding to public concern about access to hepatitis C treatment. In December 2014, 

OHAIDP convened an HHS listening session with clinical and community leaders on the important 

issue of improving access to curative HCV treatment. The advent of more effective, 

second-generation, direct-acting HCV antiviral drugs represents a tremendous scientific 

accomplishment with huge potential for public health benefits. During the session, which was 

attended by senior HHS staff (Acting Assistant Secretary for Health Karen DeSalvo, Principal Deputy 

Assistant Secretary for Health Wanda Jones, and Deputy Assistant Secretary for Health, Infectious 

Diseases, Ronald Valdiserri), community leaders and other stakeholders raised concerns about 

barriers to treatment access as described in a letter sent to Secretary Burwell in September 2014. 

It had been signed by more than 700 organizations, healthcare providers, and individuals. The 

meeting provided an opportunity for stakeholders to share concerns about restrictions to treatment 

access that, in their opinion, do not appear to be medically justified. These include restrictions based 

on degree of liver fibrosis, alcohol and drug use/abuse, and prescriber qualifications. In this rapidly 

evolving arena, HHS continues to collaborate with stakeholders to implement the Action Plan and 

improve the diagnosis, treatment, and prevention of viral hepatitis.

Understanding viral hepatitis progression and liver cancer markers. NIH worked in 2014 to 

support and conduct research focusing on the progression of HBV and HCV and detection measures 

for liver disease and cancer. 

◊ The availability of a small-animal model would provide an enormous benefit to research the 

pathogenesis, prevention and treatment of hepatitis B and C. Several such models have been 

developed by investigators funded by the National Cancer Institute (NCI), National Institute of 

Allergy and Infectious Diseases (NIAID) and National Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK) and are being used in studies of both viral infections. Mice with 

humanized livers can be infected with HBV or HCV, which allows the study of the early events 

that occur in the liver during infection that lead to cell injury, recovery, or chronic infection. 

◊ Intramural investigators from NCI are supporting ongoing studies of the mechanisms of cancer 

stem cells and viral hepatitis-mediated hepatocarcinogenesis in liver cancer. Molecular 

profiling and gene expression array studies that compare signatures of chronic liver diseases 

with hepatocellular carcinoma revealed a molecular signature that separates patients for their 

risk of developing advanced disease.

◊ NCI is also currently supporting a project for the serial collection of serum and plasma from 

patients with cirrhosis who are predominantly HCV-positive and progress to liver cancer. A 

biorepository containing serum and plasma samples from cirrhotic patients who developed 

liver cancer will provide an important resource for the prospective validation of biomarkers for 

the early detection of liver cancer.

◊ Intramural researchers at NIAID, NIDDK, NCI and the NIH Clinical Center are conducting 

ongoing translational research studies on the molecular mechanisms of pathogenesis of 

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21

acute and chronic liver disease (with a focus on viral hepatitis, cirrhosis and hepatocellular 

carcinoma) aimed at investigating the role of hepatitis viruses in liver carcinogenesis. Other 

ongoing studies include elucidating the role of host and viral factors in hepatitis virus infections, 

identifying new diagnostic and prognostic biomarkers for HCC, and using large patient cohorts 

to validate previously-discovered predictive markers for the progression of hepatitis C to 

cirrhosis.

Advancing approaches to HBV testing and treatment. NIH also supports research focusing on 

hepatitis B vaccination, screening, and treatment.

◊ NIDDK supports ongoing studies through the Hepatitis B Research Network, which has the 

goal to advance understanding of disease processes and natural history of chronic hepatitis 

B, as well as to identify effective approaches to treatment with currently available therapies. 

The Network brings together clinical centers from throughout the U.S. and Canada. Through 

partnerships with industry and CDC, this multi-center Network has initiated two prospective 

cohort studies (with over 1700 patients enrolled) and three clinical trials with several supportive 

ancillary studies. A study, ancillary to the Hepatitis B Research Network, has recently been 

initiated to follow a cohort of adult patients with HBV and HIV co-infection that will allow for 

analysis of the separate contribution of HIV infection to the course and outcome of chronic 

hepatitis B, and help define the optimal means of managing hepatitis B in patients with HIV 

infections. A recent publication summarized baseline clinical characteristics of adults enrolled 

in the Hepatitis B Research Network. Funding will continue for the Network through 2020.

◊ NIMHD supports a community-based participatory study in a Korean church that examines the 

effectiveness of two dissemination strategies for implementing the evidence-based hepatitis B 

intervention in-person training and technical assistance (IPT/TA) and e-training and technical 

assistance of community health workers to increase hepatitis B screening and vaccination 

rates among Korean-American workers. This study was initiated in July 2013, with a planned 

completion date of February 2016.

Expanding HCV therapy research. In 2014, NIH continued efforts to expand options for hepatitis C 

treatment. 

◊ NIH researchers at NIAID and NIDDK have initiated several clinical research studies of oral 

regimens of therapy for acute and chronic hepatitis C. These studies are focused on high-risk 

patients in vulnerable populations who are usually not included in industry-supported studies 

that lead to drug licensure. These populations include the uninsured, recent emigrants from 

Africa and Asia, racial/ethnic minority populations, persons with advanced liver disease and 

cirrhosis, and persons co-infected with HIV. Special groups include patients with genotypes 2, 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 22

3 and 4, patients with drug-resistant HCV mutations, and patients who are co-infected with HIV 

(SWIFT-C, A5327).

◊ NIH researchers in the NIDDK’s Intramural Research Program have an ongoing collaboration 

with National Center for Advancing Translational Sciences (NCATS) performing highthroughput screening to identify novel targets and molecules for HCV therapy. One of the 

identified molecules is undergoing a phase 1 study in NIDDK’s intramural Liver Diseases 

Branch, with results expected in 2015. 

Examining perinatal HCV transmission & infection. A multi-center observational study by the 

Maternal-Fetal Medicine Units Network, supported by the NIH’s NICHD, is examining risk factors for 

HCV transmission from mother to baby and risk factors associated with HCV infection in pregnant 

women. The study will also describe the outcomes of pregnant women with HCV as well as the 

outcomes of their infants up to 18 months of age. To date, the study has enrolled 309 of the planned 

1800 pregnant women with HCV infection and 370 of the planned 1800 uninfected pregnant women 

control group. This study was initiated in October 2012, with a planned completion date of April 2019. 

Identifying effective hepatitis D therapy. The hepatitis delta virus (HDV) is a rare but important 

cause of severe liver disease and cirrhosis in individuals co-infected with HBV, for which there 

is currently no effective treatment. NIH researchers in NIDDK’s Intramural Research Program 

have completed a pilot trial of a farnesyl transferase inhibitor (lonafarnib) that showed its efficacy 

in reducing levels of HDV RNA in the blood, and improving liver tests with minimal side effects 

when given for 28 days (NCT01495585). A more ambitious, multicenter, multinational randomized 

controlled trial of 6 months of therapy is being designed; it is due to start enrollment in 2015.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 23

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

PRIORITY 3:

STRENGTHENING SURVEILLANCE TO DETECT

VIRAL HEPATITIS TRANSMISSION AND DISEASE

GOAL 3.1 — Monitor viral hepatitis-associated health disparities, transmission, and 

disease. 

GOAL 3.2 — Monitor provision and impact of viral hepatitis prevention, care, and 

treatment services.

GOAL 3.3 — Develop and implement new technologies and laboratory procedures to 

improve viral hepatitis surveillance.

We must identify and collect accurate and timely information to improve and evaluate our efforts 

to address viral hepatitis. Surveillance and other health data can play an important role in making 

decisions on how resources can best be allocated to meet the needs of populations at risk for, or 

infected with, viral hepatitis. 2014 saw further expansion and innovation among federal efforts on 

surveillance through collaborations with new partners, exploration of new data collection strategies, 

and the development of new tools. This new data can help guide future efforts to ensure maximum 

impact on the prevention, care, and treatment of viral hepatitis across the health care spectrum. 

In 2014, the following were among the actions undertaken by federal partners to strengthen 

surveillance to detect viral hepatitis transmission and monitor disease:

Supporting enhanced HCV surveillance. CDC continued to support seven state and local health 

departments (San Francisco, Florida, Massachusetts, Michigan, New York State, Philadelphia, and 

Washington State) in conducting more active surveillance for hepatitis A, B, and C. In Philadelphia, 

CDC supported a project to measure “matching” of cases of HCV infection documented in electronic 

health records with the state registry of HCV cases. CDC also established a collaborative relationship 

with New York State Public Health Laboratories to develop web-based processing of HCV sequences 

for transmission linkage analyses, and a collaborative relationship with Indiana Public Health 

Laboratory to conduct research and surveillance of early HCV infection in incarceration centers.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 24

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

Responding to viral hepatitis outbreaks. In 2014, CDC supported outbreak or cluster 

investigations of six food-handler-related hepatitis A consultations, one nursing home hepatitis B 

investigation, and ongoing efforts around hepatitis C related to inadequate syringe hygiene in a 

medical clinic. 

Understanding viral hepatitis health disparities. Beginning in late 2014, CDC examined several 

public-use or large CDC databases to assess viral hepatitis-related health disparities. Using data from 

the National Health and Nutrition Examination Survey (NHANES), the Chronic Hepatitis Cohort Study 

(CHeCS), and the National Health Interview Survey (NHIS) CDC documented health care disparities 

among Asians/Asian-Americans and Africans/African Americans among hepatitis B and for African 

Americans and uninsured persons with hepatitis C. 

Monitoring testing and care for HCV. CDC established a “care continuum” for HCV — screening, 

confirmatory lab work, referral to specialty care, work-up for treatment, provision of antiviral therapy, 

and cure — and has measured progress along this continuum of HCV-infected persons in the Chronic 

Hepatitis Cohort Study. In findings published in 2014, less than two-thirds of patients who had positive 

HCV antibody tests had subsequently undergone an RNA test to confirm current infection. The 

authors recommended the implementation of rapid-reflex RNA testing to improve the identification 

of individuals who could benefit from HCV therapy.1 In addition, CDC developed and expanded a 

collaboration with Quest Diagnostics, the largest single provider of laboratory testing in the U.S., to 

analyze anonymous data from its national lab test results database. CDC’s analysis revealed modest 

increases in HCV screening following CDC and USPSTF recommendations for universal one-time 

screening of the 1945 to 1965 birth cohort. CDC also started a similar collaboration with LabCorp. 

In an effort to improve health care quality and delivery by identifying and addressing clinical 

performance gaps in testing and care, CMS implemented quality measures in the Physician Quality 

Reporting System. They are related to screening of at-risk patients, HCV initial testing and RNA 

confirmatory testing, testing after initial treatment, and vaccination against HAV and HBV. 

In 2014, VA continued to maintain a robust surveillance program for hepatitis C, which includes: 

◊ Tracking the number of veterans in the 1945 to 1965 birth cohort tested for hepatitis C,

◊ Tracking compliance with the standard of routine reflex confirmatory testing to determine which 

patients with positive antibody results have chronic hepatitis C,

1 Spradling PR, Tong X, Rupp LB, Moorman AC, Lu M, Teshale EH, Gordon SC, Vijayadeva V, Boscarino JA, Schmidt MA, 

Holmberg SD; Chronic Hepatitis Cohort Study (CHeCS) Investigators. Trends in HCV RNA testing among HCV antibodypositive persons in care, 2003-2010. Clin Infect Dis. 2014;59(7):976-981.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 25

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

◊ Maintenance of facility-level and national electronic hepatitis C Clinical Case Registries (CCR), 

which supports preparation of an annual report generated from the CCR on the population 

of patients with hepatitis C in VA care, including demographics, clinical comorbidities, and 

antiviral treatment metrics. CCR data are also used to generate weekly, monthly, and ad hoc 

reports for operational purposes. 

Additionally, the State of Care for Veterans with Hepatitis C, 2014, the summative multi-year 

analysis of hepatitis C care within VA, was completed. This report presents data from 2002-2013 

and describes the population of veterans with HCV infection in VHA care, assesses trends in 

complications of HCV infection, and examines access and quality of care metrics.

Monitoring viral hepatitis testing & diagnoses in health centers. HRSA collects data related to 

hepatitis from all HRSA-supported health centers.

Health Center Service Reports on Hepatitis B and C

Hepatitis B Hepatitis C

In 2012, health centers reported providing 

services to: 

a. 21,890 patients with a diagnosis of 

hepatitis B with 48,080 patient visits 

(averaging 2.20 visits per patient), and 

b. 294,400 patients screened for 

 hepatitis B.

In 2012, health centers reported providing 

services to: 

a. 132,078 patients with a diagnosis of 

hepatitis C with 303,713 patient visits 

(averaging 2.30 visits per patient), and 

b. 255,775 patients screened for 

 hepatitis C.

In 2013, health centers reported providing 

services to:

a. 23,759 patients with a diagnosis of 

hepatitis B with 50,295 patient visits 

(averaging 2.12 visits per patient), and

b. 317,647 patients screened for 

 hepatitis B.

In 2013, health centers reported providing 

services to: 

a. 145,309 patients with a diagnosis of 

hepatitis C with 321,011 patient visits 

(averaging 2.21 visits per patient), and 

b. 296,349 patients screened for 

 hepatitis C.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 26

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

Exploring improved HCV diagnostics. CDC validated the performance of an HCV antigen assay 

using panels comprising blood samples from U.S. patients. HCV antigen assays are more sensitive 

than currently available tests. They could be used to improve detection of acute HCV infection and 

to reduce the costs of confirmatory testing following an initial HCV antibody test. Findings were 

published in the Journal of Clinical Virology.2 FDA is encouraging the development of tests for HCV 

antibodies/antigens similar to those developed for HIV. This would benefit STD clinics and providers 

working with people who inject drugs by improving diagnostic capability. 

Analyzing HBV genotypes. CDC completed an analysis of HBV-genotype distribution among U.S. 

residents with acute and chronic HBV infection. Based on the analysis, HBV vaccination efforts in the 

U.S. should be scaled up for persons at risk.3 CDC also identified U.S. blood donors with incubationphase HBV infections and characterized them according to if they are infected with strains of HBV 

that are not prevented by vaccines due to mutations of the virus.

Improving understanding of tools to detect HCV transmission. To improve our understanding 

of HCV transmission and inform future epidemiologic activities, CDC conducted a comparative 

evaluation of protocols to detect the HCV genome in dried blood spots4 and established protocols 

based on deep sequencing of the HCV genome to infer transmission linkages.

2 Mixson-Hayden T, Dawson GJ, Teshale E, Le T, Cheng K, Drobeniuc J, Ward J, Kamili S. Performance of ARCHITECT 

HCV core antigen test with specimens from US plasma donors and injecting drug users. J Clin Virol. 2015;66:15-18.

3 Ramachandran S, Purdy MA, Xia GL, Campo DS, Dimitrova ZE, Teshale EH, Teo CG, Khudyakov YE. Recent population 

expansions of hepatitis B virus in the United States. J Virol. 2014;88(24):13971-13980.

4 Tejada-Strop A, Drobeniuc J, Mixson-Hayden T, Forbi JC, Le NT, Li L, Mei J, Terrault N, Kamili S. Disparate detection 

outcomes for anti-HCV IgG and HCV RNA in dried blood spots. J Virol Methods. 2015;212:66-70.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 27

Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

PRIORITY 4:

ELIMINATING TRANSMISSION OF

VACCINE-PREVENTABLE VIRAL HEPATITIS

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

GOAL 4.2 — Achieve universal hepatitis A and B vaccination for vulnerable adults and 

youth.

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

indication for their optimal use.

Elimination of mother-to-child transmission of hepatitis B is possible with the tools available to us. 

Federal partners can further reduce the burden of hepatitis A and B in the U.S. by focusing on efforts 

to increase the number of persons who receive hepatitis A and B vaccination. Increased awareness 

among healthcare providers, communities, and those at risk, coupled with the availability of more 

efficacious therapies, can move us closer to the goals outlined in the Viral Hepatitis Action Plan. 

In 2014, the following were among the actions undertaken by federal partners to eliminate the 

transmission of vaccine-preventable viral hepatitis: 

Improving identification of pregnant women with chronic HBV. CDC Special Laboratory Reports

for identification of hepatitis B-infected pregnant women were implemented by four major commercial 

laboratories: ARUP Laboratories, LabCorp, Mayo Medical Laboratories, and Quest Diagnostics. 

The reports aid in the identification of hepatitis B-infected pregnant women and timely postexposure prophylaxis for their infants. The reports have helped CDC-supported Perinatal Hepatitis 

B Prevention Programs in most states identify an increased number of hepatitis B-infected pregnant 

women, and support the provision of care for the mothers and their infants. 

CDC’s DVH analyzed discrepant hepatitis B surface antigen (HBsAg) results for pregnant women screened 

for hepatitis B virus, and determined that the majority of results were false positives. However, true 

positives did occur, and testing for total hepatitis B core antibody was useful for resolving discrepancies.1
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 28

Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

Preventing perinatal HBV transmission. Perinatal hepatitis B prevention programs in Michigan and 

New York City collaborated with CDC to close the gap between the expected and identified number of 

births to hepatitis B-infected mothers. They compared outcomes of infants born to infected mothers, 

and examined the reliability of a facility-based National Quality Forum measure regarding hepatitis B 

vaccine coverage among newborn infants. 

CDC DVH analyzed data from the Enhanced Perinatal Hepatitis B Prevention Program from 2008-

2013 and determined that 95% of uninfected infants born to Hepatitis B-infected mothers responded 

to the primary Hepatitis B vaccine series. The proportion of responding infants decreased as the 

interval between the final dose of vaccine and post vaccination testing increased.2

CDC DVH analyzed the cost-effectiveness of the U.S. Perinatal Hepatitis B Prevention Program and 

concluded that it increased quality-adjusted life years and led to reductions in the number of perinatal 

and childhood infections, thereby representing a cost-effective use of resources.3

CDC’s DVH developed models to estimate the annual number of perinatal Hepatitis B virus infections. 

An estimated 952 infections occurred in 2009, suggesting that a substantial number of infections are 

not identified by the Perinatal Hepatitis B Prevention Program.4

Understanding and expanding the use of HBV therapies to prevent perinatal transmission. 

NIH’s NICHD, in collaboration with the CDC, has funded a research group to conduct a randomized, 

placebo-controlled trial of maternal tenofovir (in addition to standard infant HBV immune globulin and 

vaccine) for prevention of transmission of hepatitis B from HBeAg-positive women to their infants in 

Thailand since 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. Between January 2013 and August 

2015, the study completed its target enrollment of 328 women. Results are expected in late 2016. 

This study is funded by NICHD in collaboration with the CDC in a cooperative agreement. More 

information about this study is available here.

CDC DVH analyzed MarketScan® data to describe antiviral treatment during pregnancy for women 

infected with hepatitis B. MarketScan® databases include data on over 200 million patients (since 1995) 

1 Veselsky SL, Walker TY, Fenlon N, Teo CG, Murphy TV. Discrepant hepatitis B surface antigen results in pregnant 

women screened to identify hepatitis B virus infection. J Pediatr. 2014;165(4):773-778. 

2 Ko SC, Schillie SF, Walker T, Veselsky SL, Nelson NP, Lazaroff J, Crowley S, Dusek C, Loggins K, Onye K, Fenlon N, Murphy TV. 

Hepatitis B vaccine response among infants born to hepatitis B surface antigen-positive women. Vaccine. 2014;32(18):2127-2133.

3 Barbosa C, Smith EA, Hoerger TJ, Fenlon N, Schillie SF, Bradley C, Murphy TV. Cost-effectiveness analysis of the 

national Perinatal Hepatitis B Prevention Program. Pediatrics. 2014;133(2):243-253.

4 Ko SC, Fan L, Smith EA, Fenlon N, Koneru AK, Murphy TV. Estimated annual perinatal hepatitis B virus infections in the 

United States, 2000 — 2009. J Ped Infect Dis. 2014; doi:10.1093/jpids/piu115.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 29

Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

including publicly- and privately-insured individuals. The data captures patient level data, treatment patterns, 

and costs. Antiviral treatment was prescribed for fewer pregnant women than non-pregnant women (12.6 

percent and 20.0 percent, respectively). Tenofovir was the most commonly prescribed agent.5

Understanding the cost of perinatal HBV prevention. CDC’s DVH analyzed the cost-effectiveness 

of testing hepatitis B-infected pregnant women for hepatitis B e antigen or viral load and concluded 

that testing, followed by maternal antiviral prophylaxis for mothers who are hepatitis B e antigen 

positive or have high viral loads, is cost-effective.6

Planning optimal use of HBV vaccine. In 2014, and following 2011 recommendations from the 

National Vaccine Advisory Committee (NVAC), NVPO began development of the National Adult 

Immunization Plan (NAIP). Created with input from hundreds of stakeholders across every sector of 

the adult immunization landscape, the NAIP will be a 5-year national plan channeling the collective 

efforts of federal and nonfederal stakeholders. NVPO’s ultimate vision for the NAIP is to protect public 

health and achieve optimal prevention of infectious diseases (including HAV and HBV) and their 

consequences through vaccination of all adults.

Developing an HCV vaccine. FDA published findings on T-cell memory phenotypes induced by 

vaccination against HCV. This is important in establishing biomarkers for predicting success for 

experimental vaccines during clinical trials. HCV clearance correlates with HLA-DR expression on 

proliferating CD8+ T-cells in immune-primed chimpanzees.7

NIAID is conducting a double-blinded, randomized, Phase I/II trial to evaluate the safety, 

immunogenicity, and initial efficacy of a vaccine to prevent acute and chronic hepatitis C infection in 

high-risk people. The Phase I component of the trial has been completed, and Phase II is currently 

enrolling participants. The study is expected to enroll approximately 450 participants and is slated for 

completion in October 2016. 

Ensuring vaccine safety. In response to concerns about vaccine safety, NVPO and AHRQ released 

a review of vaccine safety: Safety of Vaccines used for Routine Immunization in the United States

on July 1, 2014 in the journal Pediatrics. A summary of the evidence review is also available. The 

report found scientific evidence that addresses several common concerns about a variety of vaccines. 

For example, the report found strong scientific evidence that there is not a link between hepatitis B 

vaccines and childhood leukemia.

5 Fan L, Owusu-Edusei K Jr, Schillie SF, Murphy TV. Antiviral treatment among pregnant women with chronic hepatitis B. 

Infect Dis Obstet Gynecol. 2014:546165. 

6 Fan L, Owusu-Edusei K Jr, Schillie SF, Murphy TV. Cost-effectiveness of testing hepatitis B-positive pregnant women for 

hepatitis B e antigen or viral load. Obstet Gynecol. 2014;123(5):929-937.

7 Zubkova I, Duan H, Wells F, Mostowski H, Chang E, Pirollo K, Krawczynski K, Lanford R, Major M. Hepatitis C virus 

clearance correlates with HLA-DR expression on proliferating CD8+ T cells in immune-primed chimpanzees. Hepatology. 

2014;59(3):803-813.
PRIORITY 5:

REDUCING VIRAL HEPATITIS

CAUSED BY DRUG USE BEHAVIORS

GOAL 5.1 — Ensure that persons who inject drugs have access to viral hepatitis 

prevention, care, and treatment services.

GOAL 5.2 — Develop and mobilize community resources to prevent viral hepatitis caused 

by injection drug use.

GOAL 5.3 — Expand access to and delivery of hepatitis prevention, care, and treatment 

services in correctional settings.

GOAL 5.4 — Advance research to improve prevention of viral hepatitis among persons 

who use drugs.

A growing cross-section of public and private sector partners are alarmed by the emergence of an 

epidemic of hepatitis C infection among young persons who inject drugs (PWID). This trend is being 

seen among both males and females, primarily in rural and suburban settings, who begin using 

prescription opioids before transitioning to injecting prescription opioids and/or heroin. There is an 

urgent need for research, surveillance, and prevention strategies to stop the spread of viral hepatitis 

associated with drug use. These strategies must address a diverse set of challenges, including 

successfully engaging vulnerable populations who often face significant barriers in access to 

health care.

In 2014, the following were among the actions undertaken by federal partners to reduce viral hepatitis 

associated with drug using behaviors: 

Promoting viral hepatitis prevention and screening in behavioral health care settings. 

Through the Center for Substance Abuse Treatment’s (CSAT) Targeted Capacity Expansion-HIV 

grant program, SAMHSA provided an estimated $850,000 to 34 grantees to assist in the attenuation 

of the transmission of vaccine-preventable viral hepatitis by achieving universal hepatitis A and B 

vaccination for vulnerable adults. In 2014, for the first time, a SAMHSA grant required — rather than 

offering — use of grant funds for viral hepatitis activities (e.g., screening, testing, education, linkage 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 5: Reducing Viral Hepatitis Caused by Drug Use Behaviors

30
to care). Through the new Minority AIDS Initiative-Continuum of Care (MAI-CoC) Pilot program, five 

percent of the awarded funds must be used for viral hepatitis activities, including hepatitis A and B 

vaccination for vulnerable adults. SAMHSA awarded $16.8 million to 34 grantees through the MAICoC Pilot program, which fosters integration of HIV services, behavioral health services, and primary 

care. On July 25, 2014, SAMHSA’s Chief Medical Officer released an annual Dear Colleague Letter

that discussed the need for HCV screening and testing among persons with substance use and 

mental health disorders. This letter was delivered to over 53,000 individuals including state Mental 

Health Commissioners, state Alcohol and Drug Abuse Directors, SAMHSA grantees, etc. It described 

the rationale for HCV testing in behavioral health populations, discussed the recent USPSTF 

endorsement of hepatitis C screening, and provided contact information for State Viral Hepatitis 

Prevention Coordinators who can assist with implementation of screening and testing programs. 

SAMHSA CSAT administers and manages the HCV Screening Grants with resources from the 

Secretary’s Minority AIDS Initiative Fund. Under this pilot initiative, 9 SAMHSA Opioid Treatment 

Program (OTP) grantees received HCV screening grants to implement HCV screening/testing 

in their facilities from July 2013 through June 2014. During that one-year period, a total of 2,101 

HCV screening tests were administered. Four grantees received a no-cost extension in order to 

reach the proposed testing target. Overall, 19% of clients tested positive for HCV. Fifty-two percent 

of all individuals tested were PWID; among them, 28% tested positive for hepatitis C. Only 10% 

of individuals who were not PWID tested positive for HCV. Most of the clients screened for HCV 

received referrals for counseling and other health services. The vast majority of individuals who 

tested positive for HCV antibodies were provided with referrals for confirmatory testing, education and 

counseling services. Several grantees reported that, during the grant period, providing HCV training 

to local facility staff proved instrumental in making the OTP clients more receptive to testing. As a 

result of implementing this grant project, some grantees are making efforts to provide routine HCV 

screening to all clients with substance use disorders.

Expanding workforce capacity to address HCV in behavioral health care settings. 

The SAMHSA-funded Addiction Technology Transfer Center (ATTC) Network’s charge is to respond 

to the emerging needs of the addictions’ professional workforce; consequently, it was critical to 

develop a curriculum specifically designed to educate providers that work with PWID. Recognizing 

the urgency of educating staff, the 10 ATTC regional centers developed a new website, HCV Current 

Initiative; a face-to-face training curriculum, “Increasing Hepatitis C Knowledge for Behavioral Health 

and Medical Providers”; an online HCV course and a training calendar for HCV-specific ATTC 

Network trainings. The nationwide network of trainers will be available to provide hepatitis C training 

for health center staff, and others who work with PWID.

Expanding HCV treatment access in corrections. NIH’s National Institute on Drug Abuse (NIDA) 

is examining ways to adapt the "Seek, Test, and Treat" paradigm to those infected with HCV who are 

in the criminal justice system — a setting with numerous opportunities to identify individuals with HCV 

infection and provide linkage to treatment, given the high prevalence of HCV among the incarcerated. 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 5: Reducing Viral Hepatitis Caused by Drug Use Behaviors

31
32

Originally developed to address HIV, the seek, test, treat, and retain (STTR) model of care involves 

reaching out to high-risk, hard-to-reach drug-abusing groups who have not been recently tested for 

HIV (seeking); engaging them in HIV testing (testing); initiating, monitoring, and maintaining HIV 

treatment for those testing positive (treating); and retaining patients in care (retaining). This model of 

care is based on previous research demonstrating that expanding HIV testing and reducing viral load 

among HIV-positive individuals through highly active antiretroviral therapy can be effective in reducing 

the HIV transmission at a population level. 

Providing access to treatment for 

substance use disorders and HCV in 

corrections. Since a substantial proportion 

of people in jails and prisons are there 

because of crimes related to substance 

abuse, the inmate population includes many 

persons living with chronic HCV infection. 

The DOJ/FBOP provides inmates who have 

acquired HCV as a result of prior injection 

drug use with access to substance abuse 

treatment as well as HCV care to prevent 

transmission and progression of disease. 

FBOP provides these services through a 

robust drug education program provided at 

intake during the admissions and orientation 

process and through various subsequent 

drug abuse programs. In 2014, FBOP 

expanded access to HCV medications 

available for treatment of inmates to include 

newly approved sofosbuvir- and simeprevirbased regimens. 

OMH promoted continuity of viral hepatitis 

care and substance use disorder treatment 

of inmates who were released from 

incarceration and are reentering the 

mainstream population through two grant 

programs, HIRE and Linkage to Life. Both 

programs support community-based efforts 

to ensure that people living with HIV, as well 

as those who are co-infected with HIV and 

HCV, successfully transition from state or 

federal incarceration back into communities. 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 5: Reducing Viral Hepatitis Caused by Drug Use Behaviors

Efforts to reduce HCV transmission 

associated with injection drug use are also 

aided by preventing drug use initiation 

and treating substance use disorders. 

During 2014, the Federal Government 

continued to implement the Prescription 

Drug Abuse Prevention Plan, to help 

prevent and reduce misuse of prescription 

medications. The plan focuses actions in 

four major areas: education of the public 

and healthcare providers, expansion of 

prescription drug monitoring programs, 

proper disposal of unused prescription 

medication, and enforcement. Efforts 

also include evidence-based strategies, 

such as the provision of medicationassisted treatment for individuals with 

opioid use disorders, implementation 

of syringe services programs (SSPs) 

to reduce disease transmission among 

people who inject drugs and help them 

access treatment, promotion of access 

to naloxone to prevent overdose deaths, 

and integration of screening and treatment 

services to address the intersection of 

substance use disorders and viral hepatitis 

infections.
Advancing research on HCV to better serve PWID. CDC launched a treatment-as-prevention 

modeling study to assess whether targeted treatment to PWID can have an effect on reducing HCV 

incidence when combined with evidence-based prevention interventions. The overarching goal of 

the three-year effort is to collect and use epidemiologic data on risk behaviors, drug use patterns, 

and injection networks. The data are meant to support the development and implementation of 

an integrated approach to supporting people through the HCV continuum of care from prevention 

and screening to treatment among young, non-urban, PWID. CDC awarded a total of $600,000 in 

FY2014 to two organizations: University of New Mexico Health Sciences Center (NM) and University 

of Cincinnati (OH).

In addition to providing hepatitis C virus testing, awardees will provide testing for the presence of 

HBV and HIV. This research will guide and improve the understanding of patterns of HCV, HBV and 

HIV in non-urban PWID. This project will develop and provide linkages to appropriate prevention 

services; care and treatment including access to clinical interventions; harm reduction strategies; 

drug treatment interventions; and treatment of hepatitis C, hepatitis B, and HIV infection, when 

warranted. Awardees will assess access to recommended hepatitis C treatment regimens, record the 

basis for decisions to defer or begin all-oral therapy, and assess hepatitis C infection status at least 

once during the 12 months following enrollment or completion of all-oral hepatitis C therapy. Rates of 

hepatitis C infection or re-infection will be evaluated through follow-up assessment. 

In 2014, Region VIII’s Federal Regional National HIV/AIDS Strategy workgroup — comprised 

of active members from OMH, OWH, OPA, HRSA, Administration for Community Living (ACL), 

SAMHSA, Office for Civil Rights (OCR), and outside of HHS with HUD, USDA, and the Social Service 

Administration — spearheaded an effort with the State Viral Hepatitis Prevention Coordinators from 

each of the six states in the region, to further explore how to integrate viral hepatitis into regional 

collaboration. In April 2014, 68 stakeholders from four of the six states met at a day-long meeting in 

Denver to closely examine the Action Plan’s six priority areas and to assess what the region’s work 

in each area has been, the resources available, and the recommendations for future collaboration.

From discussions at the forum, participants created a toolkit that was disseminated to approximately 

400 contacts throughout the region. Increases in new HCV infections among PWID in specific 

geographic pockets were identified as an area of concern for many stakeholders. In response, a 

series of webinars on the alignment of HCV prevention, substance use disorder treatment resources, 

and harm reduction efforts were developed and launched in early 2015. 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 33

Priority 5: Reducing Viral Hepatitis Caused by Drug Use Behaviors
34

NIH undertook a series of activities in 2014 to contribute to the research of substance use and hepatitis.

◊ PWID are at high risk of acquiring HIV and/or HCV infection through exposure to blood and 

other bodily fluids during unsafe injection practices. They also have limited access to HCV 

care. Engaging PWID in substance use disorder treatment programs reduces viral hepatitis 

transmission. A recent study showed that providing opioid agonist therapy to young adult 

injection drug users significantly reduced the incidence of new HCV infections compared to 

those who received non-opioid forms of treatment.1

◊ NIH’s NIDA funds laboratory research on developing improved rapid HCV screening tests. 

This type of test is useful in outreach settings and when working with PWID, because rates 

of infection are high and many face barriers to healthcare. Providing rapid testing has been 

shown to be one strategy to engage PWID in healthcare.2

◊ Recent studies have shown that on-site testing, vaccination, and coordinated linkage to care 

within methadone maintenance treatment programs are feasible and efficacious for identifying, 

treating, and preventing viral hepatitis transmission; however, widespread implementation of 

this care model is dependent upon sustainable funding streams.3,4

Using modeling to estimate impact of HCV interventions. FDA Office of Vaccines Research 

Review researchers have established collaborations with members in academia to develop 

mathematical models of HCV transmission in PWID. The model uses empirical data from Chicago 

and can be adapted for populations in other cities. NIH’s NIDA research using mathematical modeling 

of HIV/HCV co-infection is being used to generate evidence to support optimal screening and 

treatment guidelines.

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

Priority 5: Reducing Viral Hepatitis Caused by Drug Use Behaviors

1 Larney S, G Beckwith C, D Zaller N, T Montague B, Rich J. “Seek, test, treat and retain” for hepatitis C in the United 

States criminal justice system. Int J Prison Health. 2014;10(3):164-171.

2 Assoumou SA, Huang W, Horsburgh CR Jr, Drainoni ML, Linas BP. Relationship between hepatitis C clinical testing site 

and linkage to care. Open Forum Infect Dis. 2014;1(1):ofu009.

3 Tsui JI, Evans JL, Lum PJ, Hahn JA, Page K. Association of opioid agonist therapy with lower incidence of hepatitis C 

virus infection in young adult injection drug users. JAMA Intern Med. 2014;174(12):1974-1981.

4 Perlman DC, Jordan AE, McKnight C, Young C, Delucchi KL, Sorensen JL, Des Jarlais DC, Masson CL. Viral hepatitis 

among drug users in methadone maintenance: associated factors, vaccination outcomes, and interventions. J Addict Dis. 

2014;33(4):322-331.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 35

Priority 6: Protecting Patients and Workers from Health Care-Associated Viral Hepatitis

PRIORITY 6:

PROTECTING PATIENTS AND WORKERS FROM 

HEALTH CARE-ASSOCIATED VIRAL HEPATITIS

GOAL 6.1 — Reduce transmission of viral hepatitis to patients resulting from misuse of 

medical devices and drugs.

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

tissues. 

GOAL 6.3 — Reduce occupational transmission of viral hepatitis.

GOAL 6.4 — Enhance understanding of the preventable causes of viral hepatitis 

transmission in health care settings.

Quality health care is safe health care. Neither patients nor providers should be at risk for acquiring 

HBV, HCV, or other blood- borne infections during health care encounters. Healthcare interventions, 

by their very nature, carry a risk of exposure to blood or other contaminated materials. To combat 

these risks, ongoing efforts to reduce health care-associated transmission of viral hepatitis and 

ensure safety are critical.

In 2014, the following were among the actions taken by federal partners to protect patients and health 

workers from health care-associated viral hepatitis:

Expanding our understanding of health care associated HCV risks. CDC completed modeling 

studies of per-exposure and cumulative risks of HCV transmission by health care providers who 

tamper with injectable anesthetic opioids. The results of these analyses suggested that many cases 

of HCV infection from nosocomial outbreaks were attributable to providers tampering with anesthetic 

opioids; that transmission risk from tampering is substantially higher than from surgery. These 

findings suggest that existing care and management recommendations and guidelines for providers 

infected by blood-borne viruses should consider the findings of this model. To reduce the risk of harm 

to patients from providers who tamper with anaesthetic opioids, the following prevention activities are 

suggested:
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 36

Priority 6: Protecting Patients and Workers from Health Care-Associated Viral Hepatitis

◊ Periodic opioid screening of providers,

◊ Raising greater awareness among healthcare staff about provider substance abuse and 

provider diversion of controlled drugs,

◊ Educating healthcare staff on how colleagues abusing narcotics might be identified,

◊ Adopting computerized dispensing and charting systems to monitor controlled drug access, 

and

◊ Enabling staff recruitment agencies and bodies that credential and license healthcare 

professionals to verify past criminal history and reports of adverse actions taken by regulatory 

authorities and employers.1

Ensuring the safety of the blood supply. NIH conducted a series of research-based activities 

to support the protection of the blood supply in the U.S. and guard against transfusion-related 

transmission of viral hepatitis, including the following: 

◊ Scientists in the NIH Clinical Center’s Department of Transfusion Medicine (DTM) continue to 

prospectively monitor blood recipients for evidence of post-transfusion hepatitis. This study, 

designated TRIPS, has now prospectively followed approximately 1,600 blood recipients 

and has detected zero transmissions of either HBV or HCV. This indicates that current donor 

screening measures, which include both antibody and nucleic acid testing (NAT) for these 

agents, are highly effective. Additionally, NIH recently determined that donor prevalence 

for antibodies to HEV is approximately 16%. Despite this high donor exposure rate, no 

donors have been found to be HEV RNA positive, and no evidence has been found of HEV 

transmission to the more than 400 recipients prospectively followed. Thus, HEV blood 

transmission is a theoretical problem in the U.S., but does not yet reach a threshold that would 

require routine donor screening. 

◊ There are at least 15 clinically relevant pathogens that can be transmitted by blood, and in 

2014, scientists in the NIH Clinical Center’s DTM worked to develop technology to detect all 

of them from a single small-volume sample. They explored both Next-Gen Sequencing and 

micro-array analyses, and the detection of HBV, HCV, and HEV; HAV also possibly will be 

included in this multi-pathogen approach. 

◊ In addition to supporting investigator-initiated research on issues related to hepatitis and blood 

safety, the NIH’s National Heart Lung and Blood Institute (NHLBI) supported the Retrovirus 

Epidemiology Donor Study — II (REDS-II) and the Recipient Epidemiology and Donor 

Evaluation Study — III (REDS-III), which continue to find new ways to enhance transfusion 

safety and the practice of blood banking domestically and internationally. For example, the 

REDS-II Transfusion-Transmitted Retrovirus and Hepatitis Virus Rates and Risk Factors Study 

1 Hatia, R. I., Dimitrova, Z., Skums, P., Teo, E. Y.-L. and Teo, C.-G. Nosocomial hepatitis C virus transmission from 

tampering with injectable anesthetic opioids. Hepatology. 2015;62:101-110. 
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 37

Priority 6: Protecting Patients and Workers from Health Care-Associated Viral Hepatitis

provided updated data for incidence, prevalence, and donor risk factors for known transfusiontransmissible infections (TTI) and demonstrated the feasibility of establishing a nationallycoordinated, representative donor surveillance effort. The REDS-III Blood Donation Rules 

Opinion Study (BloodDROPS) provided insight into non-compliance with certain current donor 

deferral policies, the motivations of at-risk individuals who donate, and attitudes and behaviors 

toward the donation screening process.

Promoting safe organ transplantation. In order to promote transplant patient safety, as of February 

1, 2014, HRSA’s Organ Procurement and Transplantation Network requires an Organ Procurement 

Organization (OPO) to use a new guideline for medical-social evaluation questions to determine if a 

potential deceased donor is at increased risk for HIV, HBV, or HCV transmission. OPOs must screen 

all deceased organ donors with Nucleic Acid Testing (NAT) methodology for HCV effective August 

10, 2015. Living Donor Recovery Hospitals must also use the new guideline for medical-social 

evaluation questions to determine if a potential living donor is at increased risk for HIV, HBV, or HCV 

transmission. 

Protecting health care providers from vaccine-preventable viral hepatitis. CDC analyzed 

the cost-effectiveness of pre- and post-exposure approaches for ensuring previously vaccinated 

healthcare personnel are protected from HBV infection. Incremental cost-effectiveness ratios 

may inform healthcare institutions as they determine which approach will be utilized for protecting 

healthcare personnel. Also in 2014, IHS revised the Indian Health Manual to provide updated 

guidance for employee hepatitis B immunization, screening, and prophylaxis.
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 38

THE END OF THE BEGINNING

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

Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. 

Department of Health and Human Services

As reflected in the project highlights described in this report, much was accomplished during 2014 by 

federal partners to improve our national response to viral hepatitis. 

Among those many accomplishments was the updating and release of the Viral Hepatitis Action Plan 

for 2014—2016. We worked with federal and community partners to develop and broadly disseminate 

the update of the nation’s first comprehensive cross-governmental action plan to combat chronic viral 

hepatitis in April 2014. Since then, the plan has served as a roadmap for our federal response, as 

reflected in this progress report. 

We also encouraged nonfederal stakeholders to consider using the updated Action Plan as a 

blueprint for their own activities. Indeed, the updated Action Plan emphasizes that achieving our 

nation’s life-saving viral hepatitis goals will require contributions from partners across all sectors 

of society. This includes people living with HBV and HCV; clinicians; members of the scientific 

community; industry representatives; public health and community leaders; colleagues from state, 

local and federal government; and many, many others. Together, we are helping to break the silence 

around a public health problem that has too long been neglected.

The potential for progress toward these goals is greater than ever before, as these activities are 

unfolding during a truly remarkable time in our response to both hepatitis B and hepatitis C. We know 

more than ever before about how to prevent, diagnose, and treat these diseases—and, in the case of 

HCV, even how to cure it! So while it is appropriate to acknowledge and celebrate our successes, we 

must acknowledge that there is a great deal more to be done. 

There’s a famous quote from Winston Churchill, delivered during the years of the Second World 

War that, to my mind, describes where we are today with our efforts to confront and respond to viral 

hepatitis. Prime Minister Churchill reminded the citizens of England, “(Now) this is not the end. It is 

not even the beginning of the end. But it is, perhaps, the end of the beginning.”

Truly we are at the “end of the beginning” of our response to viral hepatitis, but important challenges 

remain: 

2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

The End of the Beginning
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis 39

The End of the Beginning

◊ Although we have a highly effective intervention to prevent the perinatal transmission of 

hepatitis B, there are still close to 1,000 babies born every year in the U.S. who are infected 

with hepatitis B.

◊ Many of us are alarmed by the resurgence of hepatitis C associated with injection drug use 

arising from America’s epidemic of prescription opioid drug abuse.

◊ And sadly, far too many people who are chronically infected with hepatitis B or hepatitis C have 

not yet been diagnosed.

So yes, there is much more work left to do. While we recognize and appreciate the progress achieved 

in 2014 and the foundation it has laid for our continued work, we won’t stop now. I hope readers will 

join my colleagues and I from across the federal government in re-dedicating themselves to the vision 

of becoming a nation resolved to combat the silent epidemic of viral hepatitis and achieving the goals 

of the Viral Hepatitis Action Plan.
APPENDIX A – REFERENCES 

PRIORITY AREA 1 - EDUCATING PROVIDERS AND COMMUNITIES TO 

REDUCE HEALTH DISPARITIES

Backus LI, Belperio PS, Loomis TP, Mole LA. Impact of race/ethnicity and gender on HCV 

screening and prevalence among U.S. Veterans in Department of Veterans Affairs Care. 

American Journal of Public Health. 2014;104(S4):S555-S561.

Chartier M, Blais R, Steinberg T, Catella S, Dehon E, Ross D, Zeiss RA. A psychology postdoctoral 

fellowship program in integrated HIV and hepatitis C clinical care: rationale, progress, and 

future directions. Training and Education in Professional Psychology. 2015;9(2):77-84.

El-Serag HB, Kramer J, Duan Z, Kanwal F. Racial differences in the progression to cirrhosis and 

hepatocellular carcinoma in HCV-infected veterans. American Journal of Gastroenterology. 2014; 

109(9):1427-1435. 

White House Initiative on Asian Americans and Pacific Islanders. Building a Legacy for the Asian 

American and Pacific Islander Community. Federal Agency Accomplishments. February 2015.

PRIORITY AREA 2 – IMPROVING TESTING, CARE, AND TREATMENT TO 

PREVENT LIVER DISEASE AND CANCER 

Backus LI, Belperio PS, Loomis TP, Han S, Mole LA. Screening for and prevalence of hepatitis B 

virus infection among high-risk veterans under the care of the U.S. Department of Veterans 

Affairs: A case report. Annals of Internal Medicine. 2014;161(12):926-928.

Backus LI, Belperio PS. Effectiveness research in the evolving HCV landscape. Digestive 

Diseases & Sciences. 2014;59(12):2845-2847.

Backus LI, Belperio PS, Shahoumian TA, Cheung R, Mole LA. Comparative effectiveness of the 

hepatitis C virus protease inhibitors boceprevir and telaprevir in a large US cohort. Alimentary 

Pharmacology & Therapeutics. 2014;39(1):93-103.

Backus LI, Belperio PS, Shahoumian TA, Mole LA. Impact of provider type on hepatitis C 

outcomes with boceprevir and telaprevir based regimens. Journal of Clinical Gastroenterology. 

2015;49(4):329-335.

A - 1
Belperio PS, Backus LI, Ross D, Neuhauser MM, Mole LA. A population approach to disease 

management: Hepatitis C direct acting antiviral use in a large healthcare system. Journal of 

Managed Care Pharmacy. 2014;20(6):533-540. 

Buchanan PM, Kramer JR, El-Serag HB, Asch SM, Assioun Y, Bacon BR, Kanwal F. The quality of 

care provided to patients with varices in the department of Veterans Affairs. American Journal 

of Gastroenterology. 2014;109(7):934-940.

Burton MJ, Penman A, Sunesara I, McGuire BM, Hook EW 3rd. A pilot study examining the safety 

and tolerability of valacyclovir in veterans with hepatitis C virus/herpes simplex virus type 2 

coinfection. American Journal of the Medical Sciences. 2014;348(6):455-459.

Butt AA, Yan P, Shaikh OS, Freiberg MS, Lo Re V 3rd, Justice AC, Sherman KE; the ERCHIVES 

(Electronically Retrieved Cohort of HCV Infected Veterans) Study Team. Virologic response and 

haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical 

settings. Journal of Viral Hepatitis. 2014;22(9):691-700.

Campo DS, Skums P, Dimitrova Z, Vaughan G, Forbi JC, Teo CG, Khudyakov Y, Lau DT. Drug 

resistance of a viral population and its individual intra-host variants during the first 48 hours 

of therapy. Clinical Pharmacology and Therapeutics. 2014;95(6):627-635.

Cho NJ, Lee C, Pang PS, Pham EA, Fram B, Nguyen K, Xiong A, Sklan EH, Elazar M, Koytak ES, 

Kersten C, Kanazawa KK, Frank CW, Glenn JS. Phosphatidylinositol 4,5-bisphosphate is an HCV 

NS5A ligand and mediates replication of the viral genome. Gastroenterology. 2015;148(3):616-

625.

Chowdhury AY, Tavis JE, George SL. Human pegivirus (GB virus C) NS3 protease activity 

inhibits induction of the type I interferon response and is not inhibited by HCV NS3 protease 

inhibitors. Virology. 2014;456-457:300-309.

Clark JA, Gifford AL. Resolute efforts to cure hepatitis C: understanding patients’ reasons for 

completing antiviral treatment. Health (London). 2014. doi: 10.1177/1363459314555237.

Coats SJ, Garnier-Amblard EC, Amblard F, Ehteshami M, Amiralaei S, Zhang H, Zhou L, Boucle SR, 

Lu X, Bondada L, Shelton JR, Li H, Liu P, Li C, Cho JH, Chavre SN, Zhou S, Mathew J, Schinazi 

RF. Chutes and ladders in hepatitis C nucleoside drug development. Antiviral Research. 

2014;102:119-147.

Cusi K. The relationship between hepatitis C virus infection and diabetes: time for a divorce?

Hepatology. 2014;60(4):1121-1123.

A - 2
David N, Yaffe Y, Hagoel L, Elazar M, Glenn JS, Hirschberg K, Sklan EH. The interaction between 

the hepatitis C proteins NS4B and NS5A is involved in viral replication. Virology. 2015;475:139-

149. 

Department of Veterans Affairs, Veterans Health Administration. Under Secretary for Health’s 

Information Letter: Prevention, diagnosis, and treatment of hepatitis B virus infection. 

December 30, 2014. 

Dieperink E, Fuller B, Isenhart C, McMaken K, Lenox R, Pocha C, Thuras P, Hauser P. Efficacy of 

motivational enhancement therapy on alcohol use disorders in patients with chronic hepatitis 

C: a randomized controlled trial. Addiction. 2014;109(11):1869-1877. 

Dieperink E, Pocha C, Thuras P, Knott A, Colton S, Ho SB. All-cause mortality and liver-related 

outcomes following successful antiviral treatment for chronic hepatitis C. Digestive Diseases 

and Sciences. 2014;59(4):872-880.

El-Serag HB, Kanwal F, Davila JA, Kramer J, Richardson P. A new laboratory-based algorithm to 

predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis. 

Gastroenterology. 2014;146(5):1249-1251.

Elazar M, Glenn JS. HCV NS5A inhibitors: the devil is in the details. Gastroenterology. 

2014;147(2):273-277. 

Emerson D, Endicott K, Amdur R, Trachiotis G. Cardiac surgery in patients chronically infected 

with hepatitis C virus: long-term outcomes and comparison to historical controls and human 

immunodeficiency virus infection. Journal of Cardiovascular Surgery (Torino). 2014.

Erqou S, Mohanty A, Murtaza Kasi, Butt AA. Predictors of mortality among United States 

Veterans with human immunodeficiency virus and hepatitis C virus coinfection. ISRN 

Gastroenterology. 2014;2014:764540.

Gerbi GB, Xing J, Rupp LB, Ko SC, Moorman AC, Holmberg SD, Xu F. Reported reasons for 

testing among hepatitis B virus-infected patients. The chronic hepatitis cohort study (CHeCS), 

United States, 2006-2010 [letter]. Liver International. 2014;34(6):e162-e163. 

Gidwani R, Barnett PG, Goldhaber-Fiebert JD, Asch SM, Lo J, Dally SK, Owens DK. Uptake and 

utilization of directly acting antiviral medications for hepatitis C infection in U.S. veterans. 

Journal of Viral Hepatitis. 2015;22(5):489-495. 

A - 3
Giugliano S, Kriss M, Golden-Mason L, Dobrinskikh E, Stone AE, Soto-Gutierrez A, Mitchell A, 

Khetani SR, Yamane D, Stoddard M, Li H, Shaw GM, Edwards MG, Lemon SM, Gale M Jr, Shah VH, 

Rosen HR. Hepatitis C virus infection induces autocrine interferon signaling by human liver 

endothelial cells and release of exosomes, which inhibits viral replication. Gastroenterology. 

2015;148(2):392-402. 

Goldberg DS, French B, Forde KA, Groeneveld PW, Bittermann T, Backus LI, Halpern SD, Kaplan 

DE. Association of distance from a transplant center with access to waitlist placement, 

receipt of liver transplantation and survival. Journal of the American Medical Association. 

2014;311(12):1234-1243.

Golden-Mason L, Hahn YS, Strong M, Cheng L, Rosen HR. Extracellular HCV-core protein 

induces an immature regulatory phenotype in NK cells: implications for outcome of acute 

infection. PLoS One. 2014;9(7):e103219.

Gopal P, Yopp AC, Waljee AK, Chiang J, Nehra M, Kandunoori P, Singal AG. Factors that affect 

accuracy of α-fetoprotein test in detection of hepatocellular carcinoma in patients with 

cirrhosis. Clinical Gastroenterology and Hepatology. 2014;12(5):870-877. 

Hagan LM, Sulkowski MS, Schinazi RF. Cost analysis of sofosbuvir/ribavirin versus sofosbuvir/

simeprevir for genotype 1 hepatitis C virus in interferon-ineligible/intolerant individuals. 

Hepatology. 2014;60(1):37-45.

He S, Lin B, Chu V, Hu Z, Hu X, Xiao J, Wang AQ, Schweitzer CJ, Li Q, Imamura M, Hiraga 

N, Southall N, Ferrer M, Zheng W, Chayama K, Marugan JJ, Liang TJ. Repurposing of the 

antihistamine chlorcyclizine and related compounds for treatment of hepatitis C virus 

infection. Sci Transl Med. 2015;7(282):282ra49.

Hermos JA, Quach L, Gagnon DR, Weber HC, Altincatal A, Cho K, Lawler EV, Grotzinger KM. 

Incident severe thrombocytopenia in veterans treated with pegylated interferon plus ribavirin 

for chronic hepatitis C infection. Pharmacoepidemiology and Drug Safety. 2014;23(5):480-488.

Hirsch AA, Lawrence RH, Kern E, Falck-Ytter Y, Shumaker DT, Watts B. Implementation and 

evaluation of a multicomponent quality improvement intervention to improve efficiency of 

hepatitis C screening and diagnosis. Joint Commission Journal on Quality and Patient Safety. 

2014;40(8):351-357. 

Hoofnagle JH, Sherker AH. Therapy for hepatitis C—the costs of success. New England Journal 

of Medicine. 2014;370(16):1552-1553.

A - 4
Huckans M, Fuller BE, Olavarria H, Sasaki AW, Chang M, Flora KD, Kolessar M, Kriz D, Anderson 

JR, Vandenbark AA, Loftis JM. Multi-analyte profile analysis of plasma immune proteins: altered 

expression of peripheral immune factors is associated with neuropsychiatric symptom 

severity in adults with and without chronic hepatitis C virus infection. Brain and Behavior. 

2014;4(2):123-142.

Huckans M, Fuller B, Wheaton V, Jaehnert S, Ellis C, Kolessar M, Kriz D, Anderson JR, Berggren 

K, Olavarria H, Sasaki AW, Chang M, Flora KD, Loftis JM. A longitudinal study evaluating the 

effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic 

hepatitis C. Journal of Psychosomatic Research. 2015;78(2):184-192.

Ioannou GN, Beste LA, Green PK. Similar effectiveness of boceprevir and telaprevir treatment 

regimens for hepatitis C virus infection, based on a nationwide study of veterans. Clinical 

Gastroenterology and Hepatology. 2014;12(8):1371-1380.

Jain MK, Adams-Huet B, Terekhova D, Kushner LE, Bedimo R, Li X, Holodniy M. Acute and chronic 

immune biomarker changes during interferon/ribavirin treatment in HIV/HCV co-infected 

patients. Journal of Viral Hepatitis. 2015;22(1):25-36. 

Kanwal F, El-Serag HB. Hepatitis C virus treatment: the unyielding chasm between efficacy and 

effectiveness. Clinical Gastroenterology and Hepatology. 2014;12(8):1381-1383. 

Kanwal F, Hoang T, Chrusciel T, Kramer JR, El-Serag HB, Durfee J, Dominitz JA, Yano EM, Asch SM. 

Association between facility characteristics and the process of care delivered to patients with 

hepatitis C virus infection. Digestive Diseases & Sciences. 2014;59(2):273-281.

Kanwal F, Kramer JR, Ilyas J, Duan Z, and El-Serag HB. HCV genotype 3 is associated with an 

increased risk of cirrhosis and hepatocellular cancer in a national sample of U.S. Veterans 

with HCV. Hepatology. 2014;60(1):98-105.

Kanwal F, Volk M, Singal A, Angeli P, Talwalkar J. Improving quality of health care for patients 

with cirrhosis. Gastroenterology. 2014;147(6):1204-1207.

Kanwal F, White DL, Tavakoli-Tabasi S, Jiao L, Lin D, Ramsey DJ, Spiegelman A, Kuzniarek J, ElSerag HB. Many patients with interleukin 28B genotypes associated with response to therapy 

are ineligible for treatment because of comorbidities. Clinical Gastroenterology and Hepatology. 

2014;12(2):327-333. 

Kayali Z, Schmidt WN. Finally sofosbuvir: an oral anti-HCV drug with wide performance 

capability. Pharmgenomics and Personalized Medicine. 2014;7:387-398. 

A - 5
Koh C, Canini L, Dahari H, Zhao X, Uprichard SL, Haynes-Williams, Winters MA, Subramanya G, 

Cooper SL, Pinto P, Wolff WF, Bishop R, Han MAT, Cotler SJ, Kleiner DE, Keskin O, Idilman R, 

Yurdaydin C, Glenn JS, and Heller T. Oral prenylation inhibition with lonafarnib in chronic 

hepatitis D infection: a proof-of-concept randomized, double-blind, placebo-controlled phase 

2A trial. Lancet Infect Dis. 2015;S1473-S3099(15)00074-2.

Kohler JJ, Nettles JH, Amblard F, Hurwitz SJ, Bassit L, Stanton RA, Ehteshami M, Schinazi RF. 

Approaches to hepatitis C treatment and cure using NS5A inhibitors. Infection and Drug 

Resistance. 2014;7:41-56.

Kruse RL, Kramer JR, Tyson GL, Duan Z, Chen L, El-Serag HB, Kanwal F. Clinical outcomes of 

hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients. 

Hepatology. 2014;60(6):1871-1878.

Lim JK, Tate JP, Fultz SL, Goulet JL, Conigliaro J, Bryant KJ, Gordon AJ, Gibert C, Rimland D, 

Bidwell M, Goetz MB, Klein DA, Fiellin AC, Justice A, Lo Re V, 3rd. Relationship between alcohol 

use categories and noninvasive markers of advanced hepatic fibrosis in HIV-infected, chronic 

hepatitis C virus-infected, and uninfected patients. Clinical Infectious Diseases. 2014;58(10): 

1449-1458.

Liu S, Watcha D, Holodniy M, Goldhaber-Fiebert JD. Sofosbuvir-based treatment regimens 

for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a costeffectiveness analysis. Annals of Internal Medicine. 2014;161(8):546-553.

Liu Y, Lawrence RH, Falck-Ytter Y, Watts B, Hirsch AA. Evaluating a hepatitis c quality gap: 

missed opportunities for HCV-related care. American Journal of Managed Care. 2014; 

20(7):e257-e264. 

Lo Re V, 3rd, Kallan MJ, Tate JP, Localio AR, Lim JK, Goetz MB, Klein MB, Rimland D, RodriguezBarradas MC, Butt AA, Gibert CL, Brown ST, Park L, Dubrow R, Reddy KR, Kostman JR, Strom BL, 

Justice AC. Hepatic decompensation in antiretroviral-treated patients co-infected with HIV 

and hepatitis C virus compared with hepatitis C virus-monoinfected patients: a cohort study. 

Annals of Internal Medicine. 2014;160(6):369-379.

Marks KM, Kitch D, Chung RT, Hadigan C, Andersen J, Tien P, Luetkemeyer A, Alston-Smith 

B, Glesby MJ; A5239 Team. Pilot study of pioglitazone before HCV retreatment in HIV/

HCV genotype 1-infected subjects with insulin resistance and previous nonresponse to 

peginterferon and ribavirin therapy: A5239. Journal of Acquired Immune Deficiency Syndromes. 

2014;65(3):345-349. 

A - 6
Meissner EG, Wu D, Osinusi A, Bon D, Virtaneva K, Sturdevant D, Porcella S, Wang H, Herrmann E, 

McHutchison J, Suffredini AF, Polis M, Hewitt S, Prokunina-Olsson L, Masur H, Fauci AS, Kottilil S. 

Endogenous intrahepatic IFNs and association with IFN-free HCV treatment outcome. Journal 

of Clinical Investigation. 2014;124(8):3352-3363.

Melis M, Diaz G, Kleiner DE, Zamboni F, Kabat J, Lai J, Mogavero G, Tice A, Engle RE, Becker S, 

Brown CR, Hanson JC, Rodriguez-Canales J, Emmert-Buck M, Govindarajan S, Kew M, Farci P. 

Viral expression and molecular profiling in liver tissue versus microdissected hepatocytes 

in hepatitis B virus-associated hepatocellular carcinoma. Journal of Translational Medicine. 

2014;12:230.

Midboe AM, Elwy AR, Durfee JM, Gifford AL, Yakovchenko V, Martinello RA, Ross D, Czarnogorski 

M, Goetz MB, Asch SM. Building strong research partnerships between public health and 

researchers: a VA case study. Journal of General Internal Medicine. 2014;29(Suppl 4):831-834. 

Moorman AC, Xing J, Ko S, Rupp LB, Xu F, Gordon SC, Lu M, Spradling PR, Teshale EH, Boscarino 

JA, Vijayadeva V, Schmidt MA, Holmberg SD; CHeCS Investigators. Late diagnosis of hepatitis 

C virus infection in the Chronic Hepatitis Cohort Study (CHeCS): Missed opportunities for 

intervention. Hepatology. 2015;61(5):1479-1484.

Morasco BJ, Lovejoy TI, Turk DC, Crain A, Hauser P, Dobscha SK. Biopsychosocial factors 

associated with pain in veterans with the hepatitis C virus. Journal of Behavioral Medicine. 

2014;37(5):902-911.

Nelson RE, Hoop R, Korner E, DuVall S, Hayden CL, Knippenberg K, Morgan T, Pandya P, Han J, 

LaFleur J. Predicting discontinuation of pegylated interferon as a result of lack of efficacy in 

United States veterans with chronic hepatitis C on dual therapy. Annals of Pharmacotherapy. 

2014;48(7):826-836.

Osinusi A, Kohli A, Marti MM, Nelson A, Zhang X, Meissner EG, Silk R, Townsend K, Pang PS, 

Subramanian GM, McHutchinson JG, Fauci AS, Masur H, Kottilil S. Re-treatment of chronic 

hepatitis C virus genotype 1 infection after relapse: an open-label pilot study. Annals of Internal 

Medicine. 2014;161(9):634-638.

Osna NA, Kharbanda KK, Sun Y, Simpson RL, Poluektova LE, Ganesan M, Wisecarver JL, Mercer 

DF. Ethanol affects hepatitis C pathogenesis: humanized SCID Alb-uPA mouse model. 

Biochemical and Biophysical Research Communications. 2014;450(1):773-776. 

Pocha C, Knott A, Rector TS, Dieperink E. Are selective serotonin receptor inhibitors associated 

with hepatocellular cancer in patients with hepatitis C? Journal of Clinical Psychiatry. 

2014;75:e1122-e1126.

A - 7
Pothineni NV, Delongchamp R, Vallurupalli S, Ding Z, Dai Y, Hagedorn CH, Mehta JL. Impact of 

hepatitis C seropositivity on the risk of coronary heart disease events. American Journal of 

Cardiology. 2014;114(12):1841-1845. 

Skums P, Dimitrova Z, Campo DS, Vaughan G, Rossi L, Forbi JC, Yokosawa J, Zelikovsky A, 

Khudyakov Y. Efficient error correction for next-generation sequencing of viral amplicons. BMC 

Bioinformatics. 2012;13(Suppl 10):S6.

Reilley, B, Leston, J, Redd, JT, Geiger, R. Lack of access to treatment as a barrier to HCV 

screening: a facility-based assessment in the Indian Health Service. Journal of Public Health 

Management and Practice. 2014;20(4):420-423.

Smith BD, Yartel AK. Comparison of two hepatitis C virus testing strategies: birth cohort 

versus elevated alanine aminotransferase levels. American Journal of Preventive Medicine. 

2014;47(3):233-241.

Smith DB, Simmonds P, Jameel S, Harrison TJ, Meng XJ, Okamoto H, Van der Poel WHM, Purdy, 

MA. Consensus proposals for classification of the family Hepeviridae. Journal of General 

Virology. 2014;(Pt 10):2223-2232.

Southern WN, Drainoni ML, Smith BD, Koppelman E, McKee MD, Christiansen CL, Gifford AL, 

Weinbaum CM, Litwin AH. Physician nonadherence with a hepatitis C screening program. 

Quality Management in Health Care. 2014;23(1):1-9.

Schmidt WN, Nelson DR, Pawlotsky JM, Sherman KE, Thomas DL, Chung RT. Direct-acting 

antiviral agents and the path to interferon independence. Clinical Gastroenterology and 

Hepatology. 2014;12(5):728-737. 

Stone AE, Mitchell A, Brownell J, Miklin DJ, Golden-Mason L, Polyak SJ, Gale MJ Jr, Rosen HR. 

Hepatitis C virus core protein inhibits interferon production by a human plasmacytoid 

dendritic cell line and dysregulates interferon regulatory factor-7 and signal transducer and 

activator of transcription (STAT) 1 protein expression. PLoS One. 2014;9(5):e95627.

Sussman NL, Remien CH, Kanwal F. The end of hepatitis C. Clinical Gastroenterology and 

Hepatology. 2014;12(4):533-536.

Teshale EH, Lu M, Lamerato LE, Rupp LB, Holmberg SD, Moorman AC, Spradling P, Boscarino JA, 

Henkle E, Gordon SC, for the Chronic Hepatitis Cohort Study (CHeCS) Investigators. APRI and FIB4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the chronic hepatitis 

cohort study (CHeCS). Journal of Viral Hepatitis. 2014;21(12):917-920.

A - 8
Thakur P, Lamoke F, Chaffin JM, Bartoli M, Lee JR, Duncan MB. Dysplastic hepatocytes develop 

nuclear inclusions in a mouse model of viral hepatitis. PLoS One. 2014;9(6):e99872.

Waldron PR, Holodniy M. MicroRNA and hepatitis C virus--challenges in investigation 

and translation: a review of the literature. Diagnostic Microbiology and Infectious Disease. 

2014;80(1):1-12. 

Wantuck JM, Nguyen MH. Letter: Response-guided treatment of hepatitis C virus genotype 5 

may be feasible--authors’ reply. Aliment Pharmacology and Therapeutics. 2014;39(11):1338. 

Wheeler AL, Scherzer R, Lee D, Delaney JA, Bacchetti P, Shlipak MG, Sidney S, Grunfeld C, Tien 

PC. Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). HIV/hepatitis C 

virus coinfection ameliorates the atherogenic lipoprotein abnormalities of HIV infection. AIDS. 

2014;28(1):49-58. 

White DL, Liu Y, Garcia J, El-Serag HB, Jiao L, Tsavachidis S, Franco LM, Lee JS, Tavakoli-Tabasi S, 

Moore D, Goldman R, Kuzniarek J, Ramsey DJ, Kanwal , Marcelli M. Sex hormone pathway gene 

polymorphisms are associated with risk of advanced hepatitis C-related liver disease in males. 

International Journal of Molecular Epidemiology and Genetics. 2014;5(3):164-176. 

Xu F, Tong X, Leidner AJ. Hospitalizations and costs associated with hepatitis C virus and 

advanced liver disease continue to increase. Health Affairs. 2014;33(10):1728-1735.

You, A, Kawamoto, J, Smith, JP. A pharmacist-managed telemedicine clinic for hepatitis C care: 

a descriptive analysis. Journal of Telemedicine and Telecare. 2014;20(2):99-101.

Zhang J, Jiang B, Xu M, Dai X, Purdy MA, Meng, J. Identification of specific antigenic epitope at 

N-terminal segment of enterovirus 71 (EV-71) VP1 protein and characterization of its use in 

recombinant form for early diagnosis of EV-71 infection. Virus Research. 2014;189:248-253.

Zubkova I, Duan H, Wells F, Mostowski H, Chang E, Pirollo K, Krawczynski K, Lanford R, Major ME. 

Hepatitis C virus clearance correlates with HLA-DR expression on proliferating CD8+ T-cells in 

immune-primed chimpanzees. Hepatology. 2014;59(3):803-813.

PRIORITY AREA 3 – STRENGTHENING SURVEILLANCE TO DETECT VIRAL 

HEPATITIS TRANSMISSION AND DISEASE 

Boscarino JA, Lu M, Moorman AC, Gordon SC, Rupp LB, Spradling PR, Teshale EH, Schmidt MA, 

Vijayadeva V, Holmberg SD, for the CHeCS Investigators. Predictors of poor mental and physical 

health status among patients with chronic hepatitis C infection: the chronic hepatitis cohort 

study (CHeCS). Hepatology. 2014;61(3):802-811.

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Campo DS, Dimitrova Z, Yamasaki L, Skums P, Lau DT, Vaughan G, Forbi JC, Teo CG, Khudyakov 

Y. Next-generation sequencing reveals large connected networks of intra-host HCV variants. 

BMC Genomics. 2014;15(Suppl 5):S4. 

Collier MG, Khudyakov Y, Selvage D, Adams-Cameron M, Epson E, Cronquist A, Jervis R, Lamba K, 

Kimura A, Sowadsky R, Hassan R, Park SY, Garza E, Rotstein D, Beal J, Kuntz T, Lance S, Dreisch 

R, Wise M, Nelson NP, Suryaprasad A, Drobeniuc J, Holmberg SD, Xu F, Hepatitis A Outbreak 

Investigation Team. Outbreak of hepatitis A in the USA associated with frozen pomegranate 

arils imported from Turkey: an epidemiological case study. Lancet Infectious Diseases. 

2014;14(10):976-981.

Collier MG, Tong X, Xu F. Hepatitis A hospitalizations in the United States, 2002 – 2011. 

Hepatology. 2015;61(2):481-485.

Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM, Holmberg SD.

Chronic hepatitis C virus infection in the United States, National Health and Nutrition 

Examination Survey 2003 to 2010. Annals of Internal Medicine. 2014;160(5):293-300.

Department of Veterans Affairs, Veterans Health Administration. State of Care for Veterans with 

Hepatitis C 2014. September 2014.

Forbi JC, Campo DS, Purdy MA, Dimitrova ZE, Skums P, Xia GL, Punkova LT, Ganova-Raeva 

LM, Vaughan G, Ben-Ayed Y, Switzer WM, Khudyakov YE. Intra-host diversity and evolution of 

hepatitis C virus endemic to Côte d’Ivoire. Journal of Medical Virology. 2014;86(5):765-771. 

Gerbi G, Williams R, Barnabas B, Liu S, Downing R, Drobeniuc J, Saleem K, Xu F, Holmberg SH, 

Teshale E. Hepatitis E as a cause of acute jaundice syndrome in northern Uganda, 2010-2012. 

American Journal of Tropical Medicine & Hygiene. 2015;92(2):411-414.

Ghany MG, Perrillo R, Li R, Belle SH, Janssen HL, Terrault NA, Shuhart MC, Lau DT, Kim WR, 

Fried MW, Sterling RK, Di Bisceglie AM, Han SH, Ganova-Raeva LM, Chang KM, Lok AS; Hepatitis 

B Research Network; Hepatitis B Research Network. Characteristics of adults in the hepatitis 

B research network in North America reflect their country of origin and hepatitis B virus 

genotype. Clinical Gastroenterology and Hepatology. 2015;13(1):183-192.

Husain N, Blais P, Kramer J, Kowalkowski M, Richardson P, El-Serag HB, Kanwal F. Nonalcoholic 

fatty liver disease (NAFLD) in the Veterans Administration population: development and 

validation of an algorithm for NAFLD using automated data. Alimentary Pharmacology & 

Therapeutics. 2014;40(8):949-954.

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Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections 

from nationally reported cases. American Journal of Public Health. 2014;104(3):482-487.

Kodani M, Mixson-Hayden T, Drobeniuc J, Kamili S. Rapid and sensitive approach to 

simultaneous detection of genomes of hepatitis A, B, C, D and E viruses. Journal of Clinical 

Virology. 2014;61(2):260-264.

Lara J, López-Labrador F, González-Candelas F, Berenguer M, Khudyakov YE. Computational 

models of liver fibrosis progression for hepatitis C virus chronic infection. BMC Bioinformatics. 

2014;15(Suppl 8):S5. 

Lara J, Purdy MA, Khudyakov YE. Genetic host specificity of hepatitis E virus. Journal of 

Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases. 2014;24:127-139.

Liu G, Holmberg SD, Kamili S, Xu F. Racial disparities in the proportion of current, unresolved 

hepatitis C virus infections in the United States, 2003-2010. Digestive Diseases and Sciences. 

2014;59(8):1950-1957.

Liu SJ, Iqbal K, Shallow S, Speers S, Rizzo E, Gerard K, Klevens RM. Characterization of chronic 

hepatitis B cases among foreign-born persons in six population-based surveillance sites, 

United States 2001-2010. Journal of Immigrant and Minority Health. 2015;17(1):7-12.

Ly KN, Speers S, Klevens RM, Barry V, Vogt TM. Measuring chronic liver disease mortality using 

an expanded cause of death definition and medical records in Connecticut, 2004. Hepatology 

Research. 2014. doi: 10.1111/hepr.12437.

Ly KN, Xing J, Klevens RM, Jiles RB, Holmberg SD. Causes of death and characteristics of 

decedents with viral hepatitis, United States, 2010. Clinical Infectious Diseases. 2014;58(1):40-

49.

Mahajan R, Xing J, Liu SJ, Ly KN, Moorman AC, Rupp L, Xu, F, Holmberg SD, for the CHeCS 

Investigators. Mortality among persons in care with hepatitis C virus infection--the Chronic 

Hepatitis Cohort Study (CHeCS), 2006-2010. Clinical Infectious Diseases. 2014;58(8):1055-1061.

McCombs J, Matsuda T, Tonnu-Mihara I, Saab S, Hines P, L’Italien G, Juday T, Yuan Y. The risk 

of long-term morbidity and mortality in patients with chronic hepatitis C: results from an 

analysis of data from a Department of Veterans Affairs clinical registry. JAMA Internal Medicine. 

2014;174(2):204-212.

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Mixson-Hayden T, Dawson GJ, Teshale E, Le T, Cheng K, Drobeniuc J, Ward J, Kamili S. 

Performance of ARCHITECT HCV core antigen test with specimens from US plasma donors 

and injecting drug users. Journal of Clinical Virology. 2015;66:15-18. 

Mixson-Hayden T, Lee D, Ganova-Raeva L, Drobeniuc J, Stauffer WM, Teshale E, Kamili S. Hepatitis 

B virus and hepatitis C virus infections in United States-bound refugees from Asia and Africa. 

American Journal of Tropical Medicine and Hygiene. 2014;90(6):1014-1020.

Ramachandran S, Purdy MA, Xia GL, Campo DS, Dimitrova ZE, Teshale EH, Teo CG, Khudyakov 

YE. Recent population expansions of hepatitis B virus in the United States. Journal of Virology. 

2014;88(24):13971-13980.

Roberts HW, Utuama OA, Klevens M, Teshale EH, Hughes E, Jiles R. The contribution of viral 

hepatitis to the burden of chronic liver disease in the United States. American Journal of 

Gastroenterology. 2014;109(3):387-393.

Smith BD, Beckett GA, Holtzman D, Yartel A, Patel N, and Ward JW. Previous Exposure to HCV 

among persons born during 1945-1965: prevalence and predictors, United States, 1999-2008. 

American Journal of Public Health. 2014;104(3):474-481.

Spradling PR, Bulkow L, Teshale EH, Homan, Simons B, McMahon BJ. Prevalence and causes of 

elevated serum aminotransferase levels in a population-based cohort of persons with chronic 

hepatitis B virus infection. Journal of Hepatology. 2014;61(4):785-791.

Spradling PR, Tong X, Rupp L, Moorman AC, Lu M, Teshale EH, Gordon SC, Vijayadeva V, 

Boscarino JA, Schmidt MA, Holmberg SD, Chronic Hepatitis Cohort Study (CHeCS) Investigators. 

Trends in HCV RNA testing among HCV antibody positive persons in care, 2003-2010. Clinical 

Infectious Diseases. 2014;59(7):976-981.

Suryaprasad, A, Byrd, KK, Redd, JT, Perdue, DG, Manos, MM, McMahon, BJ. Mortality caused by 

chronic liver disease among American Indians and Alaska Natives in the United States, 1999–

2009. American Journal of Public Health. 2014;104(Suppl 3):S350-S358.

Tejada-Strop A, Drobeniuc J, Mixson-Hayden T, Forbi JC, Le NT, Li L, Mei J, Terrault N, Kamili S. 

Disparate detection outcomes for anti-HCV IgG and HCV RNA in dried blood spots. Journal of 

Virological Methods. 2015;212:66–70.

Teshale EH, Denniston MM, Drobeniuc J, Kamili S, Teo CG, Holmberg SD. Decline in hepatitis 

E virus antibody prevalence in the United States from 1988-1994 to 2009-2010. Journal of 

Infectious Diseases. 2015;211(3):366-373.

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ur Rehman I, Vaughan G, Purdy MA, Xia GL, Forbi JC, Rossi LM, Butt S, Idrees M, Khudyakov YE. 

Genetic history of hepatitis C virus in Pakistan. Infection, Genetics and Evolution. 2014;27:318-

324.

Vaughan G, Forbi JC, Xia GL, Fonseca-Ford M, Vazquez R, Khudyakov YE, Montiel S, Waterman 

S, Alpuche C, Gonçalves Rossi LM, Luna N. Full-length genome characterization and genetic 

relatedness analysis of hepatitis A virus outbreak strains associated with acute liver failure 

among children. Journal of Medical Virology. 2014;86(2):202-208.

Vaughan G, Goncalves Rossi LM, Forbi JC, de Paula VS, Purdy MA, Xia G, Khudyakov YE. 

Hepatitis A virus: host interactions, molecular epidemiology and evolution. Infection, Genetics 

and Evolution. 2014;21:227-243.

Wong RJ, Kanwal F, Younossi ZM, Ahmed A. Hepatitis C virus infection and coronary 

artery disease risk: a systematic review of the literature. Digestive Diseases and Sciences. 

2014;59(7):1586-1593.

Xu F, Leidener AJ, Tong X, Holmberg SD. Estimating the number of patients infected with 

chronic HCV in the United States who meet highest or high-priority treatment criteria.

American Journal of Public Health. 2015;105(7):1285-1289.

Younossi ZM, Kanwal F, Saab S, Brown KA, El-Serag HB, Kim WR, Ahmed A, Kugelmas M, Gordon 

SC. The impact of hepatitis C burden: an evidence-based approach. Alimentary Pharmacology & 

Therapeutics. 2014;39(5):518-531.

PRIORITY AREA 4 – ELIMINATING TRANSMISSION OF VACCINEPREVENTABLE VIRAL HEPATITIS 

Barbosa C, Hoerger T, Schillie S, Bradley C, Murphy TV. Cost-effectiveness of the national 

perinatal hepatitis B prevention program. Pediatrics. 2014;133(2):243-253.

Bender TJ, Sharapov UM, Utah O, Xing J, Hu DJ, Drobeniuc J, Kamili S, Rybczynska J, Spradling 

PR, Moorman AC. Evaluation of hepatitis B vaccine immunogenicity among assisted living 

facility residents vaccinated during an outbreak response — Virginia, 2010. Vaccine. 

2014;32:852-856.

Fan L, Owusu-Edusei K, Schillie SF, Murphy TV. Cost-effectiveness of testing hepatitis 

B-positive pregnant women for hepatitis B e antigen or viral load. Obstetrics & Gynecology. 

2014;123(5):929-937.

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Fan L, Owusu-Edusei K, Schillie SF, Murphy TV. Antiviral treatment among pregnant women with 

chronic hepatitis B. Infectious Diseases in Obstetrics and Gynecology. 2014:546165.

Jhaveri R, Swamy GK. Hepatitis C virus in pregnancy and early childhood: current 

understanding and knowledge deficits. Journal of Pediatric Infectious Diseases. 2014;3(Suppl 1): 

S13-S18.

Ko SC, Fan L, Smith EA, Fenlon N, Koneru AK, Murphy TV. Estimated annual perinatal hepatitis 

B virus infections in the United States, 2000-2009. Journal of Pediatric Infectious Diseases. 2014. 

doi: 10.1093/jpids/piu115.

Ko SC, Schillie SF, Walker T, Veselsky SL, Nelson N, Lazaroff J, Crowley S, Dusek C, Loggins K, 

Onye K, Fenlon F, Murphy TV. Hepatitis B vaccine response among infants born to hepatitis B 

surface antigen-positive women. Vaccine. 2014;32(18):2127-2133.

Middleman AB, Baker CJ, Kozinetz CA, Kamili S, Nguyen C, Hu DJ, Spradling PR. Duration of 

protection after infant hepatitis B vaccination series. Pediatrics. 2014;133(6):e1500-e1507.

Nelson NP, Murphy TV, McMahon BJ. Hepatitis A vaccination for post-exposure prophylaxis in 

persons aged 40 years and older. Vaccine. 2014;32(25):2939.

Nelson NP, Jamieson DJ, Murphy TV. Prevention of perinatal hepatitis B virus transmission. 

Journal of Pediatric Infectious Diseases. 2014;3(Suppl 1):S7-S12.

Pitasi MA, Bingham TA, Sey EK, Smith AJ, Teshale EH. Hepatitis B virus (HBV) infection, 

immunity and susceptibility among men who have sex with men (MSM), Los Angeles County, 

USA. AIDS and Behavior. 2014;18(Suppl 3):S248-S255.

Veselsky SL, Walker TY, Fenlon N, Teo CG, Murphy TV. Discrepant hepatitis B surface antigen 

results in pregnant women screened to identify hepatitis B virus infection. Journal of Pediatrics. 

2014;165(4):773-778.

Zhang L, Ko S, Lv J, Ji F, Yan B, Xu F, et al. Perinatal hepatitis B prevention program in 

Shandong Province, China: evaluation and progress. Human Vaccination & Immunotherapeutics. 

2014;10(9):2755-2760.

PRIORITY AREA 5 – REDUCING VIRAL HEPATITIS ASSOCIATED WITH 

DRUG USE BEHAVIORS

Collier MG, Bhaurla SK, Cuevas-Mota J, Armenta RF, Teshale EH, Garfein RS. Awareness of HCV 

infection among persons who inject drugs in San Diego, California. American Journal of Public 

Health. 2015;105(2):302-303. A - 14
Frimpong JA, D’Aunno T, Jiang L. Determinants of the availability of hepatitis C testing services 

in opioid treatment programs: results from a national study. American Journal of Public Health. 

2014;104(6):e75-e82. 

Riley DE, Liu L, Cohen B, Robinson S, Groessl EJ, Ho SB. Characteristics and impact of 

methamphetamine use in patients with chronic hepatitis C. Journal of Addiction Medicine. 

2014;8(1):25-32.

Suryaprasad AG, White JZ, Xu F, Eichler B-A, Hamilton J, Patel A, Hamdounia SB, Church D, Barton 

K, Fisher C, Macomber K, Stanley M, Guilfoye SM, Sweet K, Liu S, Iqbal K, Tohme R, Sharpaov U, 

Ward JW, Holmberg SD. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2011. Clinical Infectious Diseases. 

2014;59(10):1411-1419.

Zibbell JE, Hart-Malloy R, Barry J, Fan L, and Flanigan C. Risk factors for HCV infection among 

young adults in rural New York who inject prescription opioid analgesics. American Journal of 

Public Health. 2014;104(11):2226-2232. 

PRIORITY AREA 6 – PROTECTING PATIENTS AND WORKERS FROM 

HEALTH CARE-ASSOCIATED VIRAL HEPATITIS 

Hoerger TJ, Bradley C, Schillie SF, Reilly M, Murphy TV. Cost-effectiveness of ensuring hepatitis 

B protection for previously vaccinated healthcare personnel. Infection Control and Hospital 

Epidemiology. 2014;35(7):845-854.

Ly KN, Roberts H, Williams RE, Masunu-Faleafaga Y, Drobeniuc J, Kamili S, Teshale EH. Hepatitis 

B vaccination for healthcare personnel in American Samoa: pre-implementation survey for 

policy decision. Epidemiology & Infection. 2014;142(12):2610-2615.

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APPENDIX B – ABBREVIATIONS

AAPCHO Association of Asian Pacific Community Health Organizations

AAPI Asian-American and Pacific Islander

AASLD American Association for the Study of Liver Diseases

ACL Administration for Community Living (HHS)

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

AETC AIDS Education and Training Center (HRSA)

AHRQ Agency for Healthcare Research and Quality (HHS)

AI/AN American Indian/Alaska Native

AMA-PCPI American Medical Association — Physician Consortium for 

Performance Improvement 

ASTHO Association of State and Territorial Health Officials 

ATTC Addiction Technology Transfer Center (SAMHSA)

BloodDROPS REDS-III Blood Donation Rules Opinion Study

BPHC Bureau of Primary Health Care (HRSA)

CCR Clinical Case Registries

CDC Centers for Disease Control and Prevention (HHS)

CDS clinical decision support

CHeCS Chronic Hepatitis Cohort Study

CMS Centers for Medicare & Medicaid Services (HHS)

CSAP Center for Substance Abuse Prevention (SAMHSA)

CSAT Center for Substance Abuse Treatment (SAMHSA)

CPD Office of Community Planning and Development (HUD)

DOJ U.S. Department of Justice

DTM Department of Transfusion Medicine (NIH)

DVH Division of Viral Hepatitis (CDC)

ECQM electronic Clinical Quality Measures

FBOP Federal Bureau of Prisons (DOJ)

FDA Food and Drug Administration (HHS)

B - 1
HAV hepatitis A virus 

HBsAg hepatitis B surface antigen

HBV hepatitis B virus

HCC hepatocellular carcinoma

HCV hepatitis C virus

HDV hepatitis delta virus

HEV hepatitis E virus

HHS U.S. Department of Health and Human Services

HIRE Health Improvement for Re-entering Ex-offenders Initiative

HIT health information technology

HRSA Health Resources and Services Administration (HHS)

HSSR Health and Social Service Resource 

HUD U.S. Department of Housing and Urban Development

IDSA Infectious Diseases Society of America

IHS Indian Health Service (HHS)

IOM Institute of Medicine

IPT/TA intervention in-person training and technical assistance

L2L Linkage to Life

LGBT Lesbian, Gay, Bisexual and Transgender 

MAI-CoC Minority AIDS Initiative Continuum of Care

MMWR Morbidity and Mortality Weekly Report

MSM men who have sex with men

NACCHO National Association of City and County Health Officials

NACHC National Association of Community Health Centers

NAIP National Adult Immunization Plan

NASTAD National Alliance of State and Territorial AIDS Directors

NAT Nucleic Acid Testing 

NCATS National Center for Advancing Translational Sciences (NIH)

NCHHSTP National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

NCI National Cancer Institute (NIH)

NHANES National Health and Nutrition Examination Survey

B - 2
NHCHC National Health Care for the Homeless Council

NHIS National Health Interview Survey

NHLBI National Heart Lung and Blood Institute (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)

NIDDK National Institute of Diabetes and Digestive and Kidney Diseases (NIH)

NIMHD National Institute on Minority Health and Health Disparities (NIH)

NIH National Institutes of Health (HHS)

NVAC National Vaccine Advisory Committee

NVPO National Vaccine Program Office (HHS)

OASH Office of Assistant Secretary for Health (HHS)

OCR Office for Civil Rights (HHS)

OHAIDP Office of HIV/AIDS and Infectious Disease Policy (HHS)

OMH Office of Minority Health (HHS)

ONAP Office of National AIDS Policy

ONC Office of the National Coordinator for Health Information Technology

ONDCP White House Office of National Drug Control Policy

OPA Office of Population Affairs

OPH Office of Public Health (VHA)

OPO Organ Procurement Organization

OSG Office of the Surgeon General

OTP Opioid Treatment Program (SAMHSA)

OWH Office on Women’s Health (HHS)

P4C Partnerships for Care (HRSA)

PEPFAR President’s Emergency Plan for AIDS Relief

PHS U.S. Public Health Service

PWID persons who inject drugs

REDS-II Retrovirus Epidemiology Donor Study-II

B - 3
2014 Progress Report - Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis

REDS-III Recipient Epidemiology and Donor Evaluation Study – III

RHA Regional Health Administrator

RRC Regional Resource Coordinator

SAMHSA Substance Abuse and Mental Health Services Administration

TTI transfusion-transmissible infections

USPSTF U.S. Preventive Services Task Force

VA U.S. Department of Veterans Affairs

VHA Veterans Health Administration (VA)

VHAC Viral Hepatitis Action Coalition

VHIG Viral Hepatitis Implementation Group

VHPC State Viral Hepatitis Prevent Coordinator

VISN Veterans Integrated Service Network

VISN HIT VISN Hepatitis C Innovation Team

WHIAAPI White House Initiative on Asian Americans and Pacific Islanders

B - 4