Federal Implementation Progress Report 

for the

Action Plan for the Prevention, Care, and

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

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

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

agencies, the Department of Veterans Affairs, the Department of Justice’s Bureau of Prisons, and the 

Department of Housing and Urban Development. Ms. Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy 

Advisor in OHAIDP and Ms. Michelle Moses-Eisenstein, M.P.H., Public Health Analyst, coordinated 

development of this report. Ms. Tanesha Burley, M.P.H., Ms. Alaysia Phillips, M.P.H., Mr. Roy Quini, 

Ms. Deborah Finette of Altarum Institute and Mr. Steve Holman, M.B.A., all working under contract to 

OHAIDP, assisted OHAIDP staff in compiling and formatting the report. 

Wanda K. Jones, PhD.............................Acting Assistant Secretary for Health, HHS

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

Infectious Diseases, HHS 

September 2014
An excerpt from 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

July 25, 2014

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

Federal Implementation Progress Report – 2013
Table of Contents

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

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

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

Priority 2 Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer........5

Priority 3 Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease...13

Priority 4 Eliminating Transmission of Vaccine-Preventable Viral Hepatitis...........................15

Priority 5 Reducing Viral Hepatitis Associated with Drug Use Behaviors ...............................17

Priority 6 Protecting Patients and Workers From Health Care-Associated Viral Hepatitis....22

Appendix A. Relevant Journal Citations of Publications by Priority Area.....................................I

Appendix B. Abbreviations................................................................................................................IX
Background 

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

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

Viral Hepatitis (Action Plan). This national Action Plan detailed more than 150 actions to be 

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

Department of Justice’s (DOJ) Federal Bureau of Prisons (FBOP) and the U.S. Department of 

Veterans Affairs (VA). These actions were designed to improve the prevention, diagnosis, and 

treatment of viral hepatitis in the United States. 

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

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

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

hepatitis was previously addressed by various federal research, prevention, care, and treatment 

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

efforts. Following the Institute of Medicine’s (IOM) 2010 report, Hepatitis and Liver Cancer, 

which recommended steps to reduce the threats posed by HBV and HCV, Assistant Secretary 

for Health Dr. Howard Koh convened an interagency workgroup composed of subject matter 

experts from various HHS agencies to review the IOM recommendations and develop a 

comprehensive strategic Viral Hepatitis Action Plan (VHAP) that would do the following:

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

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

identified and provided with quality care and treatment.

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

collaborations with other government agencies and nongovernmental organizations. 

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

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

Action Plan represented efforts to be undertaken in calendar years 2011–2013. Some actions 

outlined in the Plan could be accomplished using existing resources through improved 

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

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

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

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

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

representatives from across HHS and other federal departments and is chaired by Dr. Ronald 

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

have met repeatedly during the 3 years of implementing the Action Plan and have served as 

representatives within their respective agencies and offices on matters related to viral hepatitis. 

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

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

Federal Implementation Progress Report – 2013
Introduction

This third progress report features select highlights of progress made in implementing the Action 

Plan for the Prevention, Care, and Treatment of Viral Hepatitis during 2013. Compiled by the 

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

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

reported by the federal partners engaged in implementing the Action Plan but are only a 

sampling of the numerous activities that the partners undertook during 2013. 

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

and practice at every level. Throughout 2013, federal partners again made important 

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

viral hepatitis and shared this information through articles published in peer-reviewed literature 

along with the development of reports and other technical documents. These contributions, 

many of which are featured in this report, help to advance efforts to develop and implement 

evidence-based programs, clinical services, and policies.

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.

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

Federal Implementation Progress Report – 2013
Federal Partners in Implementing the Action Plan for the 

Prevention, Care, and Treatment of Viral Hepatitis 

HHS

• Agency for Healthcare Research and

Quality (AHRQ)

• Centers for Disease Control and Prevention

(CDC)

• Centers for Medicare & 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 

o National Vaccine Program Office 

(NVPO)

o Office of Disease Prevention and 

Health Promotion (ODPHP)

o Office of HIV/AIDS and Infectious 

Disease Policy (OHAIDP) 

o Office of Minority Health (OMH)

o Office of Population Affairs (OPA)

o Office of the Surgeon General

o Office on Women’s Health (OWH)

o 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)

Department of Justice (DOJ) 

• Federal Bureau of Prisons (FBOP) 

VA

• Office of Public Health, Veterans Health Administration (VHA), U.S. Department of Veterans 

Affairs (VA)

White House

• Office of National Drug Control Policy (ONDCP)

• White House Initiative on Asian Americans and Pacific Islanders (WHIAAPI)

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

Federal Implementation Progress Report – 2013
Viral Hepatitis Implementation Group 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 (DVH) 

National Center for HIV/AIDS, Viral Hepatitis, STD 

and TB Prevention (NCHHSTP)

Centers for Medicare & Medicaid Services

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

Medical Advisor

Quality Improvement Group

Center for Clinical Standards and Quality

Department of Housing and Urban 

Development

Marlisa Grogan

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.

Lieutenant, U.S. Public Health Service

HIV/Hepatitis C Program Manager

Health Services Division

Federal Bureau of Prisons

Department of Veterans Affairs

David Ross, M.D., Ph.D., M.B.I.

Director

HIV, Hepatitis, and Public Health Pathogens 

Programs

Office of Public Health 

Food and Drug Administration

Jonca Bull, M.D.

Director 

Office of Minority Health 

Health Resources and Services Administration 

Sarah Linde-Feucht, M.D.

CAPT U.S. Public Health Service, Chief Public 

Health Officer

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

Clinical Advisor 

Division of Policy and Data

HIV/AIDS Bureau

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

National Vaccine Program Office

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

Public Health Analyst

Office of Disease Prevention and Health 

Promotion

Dale Hu, M.D., M.P.H.

Medical Officer

Division of Healthcare Quality

Office of Minority Health

Sonsiere Cobb-Souza 

Director 

Division of Program Operations

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

Federal Implementation Progress Report – 2013
Office of the National Coordinator for Health 

Information Technology 

Amy Helwig, M.D., M.S.

Medical Officer 

Office of the Chief Medical Officer

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 of Women’s Health

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

Regional Women’s Health Liaison

Regional Health Offices

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

F.A.C.M.I.

Regional Health Administrator, Region X

Representing Regional Health Offices 

Substance Abuse and Mental Health Services 

Administration 

Elinore McCance-Katz, M.D., Ph.D.

Chief Medical Officer 

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

Director

Division of Pharmacologic Therapies

Center for Substance Abuse Treatment

Chana Rabiner, Ph.D. 

Senior Public Health Advisor 

Office of Policy, Planning, and Innovation

White House Initiative on Asian Americans and 

Pacific Islanders

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

HHS Liaison 

Interagency Implementation Team

This list reflects members as of the release of this report. 

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

Federal Implementation Progress Report – 2013
Priority 1 Educating Providers and Communities to 

Reduce Health Disparities

Goals

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

hepatitis and provide care and treatment to infected persons.

1.2 Decrease health disparities by educating communities about the benefits of 

viral hepatitis prevention, care, and treatment.

The lack of provider awareness and knowledge of current screening, management, and treatment for

viral hepatitis remains a barrier to effectively identifying and caring for patients with chronic HBV and 

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

key component of efforts to address viral hepatitis, because of the large proportion of individuals who 

are undiagnosed and unaware of their infections. Additionally, the dynamic public health and clinical 

landscape has led federal partners, in collaboration with other stakeholders, to support the 

development and dissemination of updated recommendations for viral hepatitis testing, care, and 

treatment. This will maximize the benefits afforded by new scientific advances, as well as 

opportunities presented by the Affordable Care Act. 

State and local community efforts are critical to addressing viral hepatitis health disparities but are 

often limited by resource constraints. Past efforts to reach disproportionately affected communities 

and the providers at all levels of the health systems that serve them, have also been hampered by 

low levels of awareness among community leaders and a dearth of culturally competent materials. 

Federal efforts have focused on developing evidence-based materials and partnering with 

organizations serving affected communities to educate and increase awareness of opportunities for 

viral hepatitis prevention, care, and treatment. By increasing awareness in communities and patients 

at risk for viral hepatitis, including Asian-Americans and Pacific Islanders (AAPI), African-Americans, 

HIV-infected persons, persons who inject drugs (PWID), men who have sex with men (MSM), and 

baby boomers (persons born during 1945–1965), in tandem with health care provider education 

efforts, we can improve the identification, management, and treatment of people who have chronic 

viral hepatitis in the United States.

In 2013, the following were among the actions undertaken by federal partners to educate 

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

Expanding national hepatitis education activities and campaigns. In 2013, the National 

Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) continued developing 

and implementing two national educational campaigns to inform the general public, persons at 

risk, and health care providers about the serious consequences of unrecognized viral hepatitis. 

The campaigns encourage testing of persons at risk and linkage to care for persons who test 

positive for viral hepatitis. CDC continued promotion and dissemination of campaign messages 

and tools for the Know More Hepatitis campaign, which launched in 2012 and encourages adults 

born during 1945–1965 to get tested for hepatitis C. The targeted multimedia campaign, which 

comprises news media outreach, print and broadcast ads, transit ads, radio public service 

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

Federal Implementation Progress Report – 2013
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Facebook and Twitter, enhanced its outreach to baby boomers, for whom one-time HCV screening 

is recommended by both CDC and the U.S. Preventive Services Task Force. In June 2013, CDC 

launched a new national public awareness campaign, Know Hepatitis B, the first national 

multilingual, multiyear communications campaign encouraging screening for hepatitis B among 

Asian Americans and Pacific Islanders (AAPIs), a population disproportionately affected by HBV 

infection. Know Hepatitis B is a partnership between CDC and Hep B United, a nationwide 

coalition of community organizations working to increase hepatitis B awareness and testing. Hep 

B United receives support from the Office of Minority Health (OMH). The Know Hepatitis B

campaign delivers culturally relevant messages in multiple languages, including English, Chinese, 

Korean, and Vietnamese, through a wide range of channels. The official launch of the new 

hepatitis B campaign was held at HHS headquarters in June 2013 and featured remarks by Dr. 

Howard Koh, Assistant Secretary for Health; Dr. John Ward, Director of DVH; Deputy Assistant 

Secretary for Minority Health Dr. Nadine Gracia; Ms. Kiran Ahuja, Executive Director of the White 

House Initiative on Asian-Americans and Pacific Islanders; and Hep B United leaders Ms. Joan 

Block and Mr. Jeff Caballero. 

Raising awareness in highly affected communities. The HHS Regional Health Administrators 

(RHAs) in Public Health Regions II, V, VII, VIII, IX, and X supported or participated in various activities 

across the nation that promoted the Action Plan and helped increase public awareness about viral 

hepatitis, particularly within communities that are highly impacted by the disease. For example, RHA

staff in Region IX met with clinic and hospital consortia in an effort to improve HBV screening rates 

among AAPIs and build public awareness around viral hepatitis in correctional facilities. Several RHAs 

and HIV/AIDS Regional Resource Coordinators actively engaged in partnering with community-based 

organizations and others to raise public awareness around viral hepatitis. They presented in Detroit, 

Michigan, about the impact of viral hepatitis on minority populations, as well as in Chicago, Illinois, on

the impact of the Affordable Care Act on prevention, care, and treatment of viral hepatitis.

Educating the public about viral hepatitis via the Internet and social media. Many federal 

partners engaged in public and provider outreach via websites, blogs, and social media to raise 

awareness of the benefits of viral hepatitis prevention, screening, care, and treatment. For example,

the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP), which administers AIDS.gov, shared 

45 viral hepatitis-related blog posts via blog.aids.gov on a variety of topics including: viral hepatitisrelated health disparities among racial and ethnic minority populations; efforts by state health 

departments to address viral hepatitis; observances, including Hepatitis Awareness Month, Hepatitis 

Testing Day, and World Hepatitis Day; and guest posts from federal partners, including FDA, CMS, 

and NIH, and several nonfederal community partners. To expand dissemination to additional 

audiences, CDC, OHAIDP, OMH, Office of Women’s Health (OWH), and several Regional Health 

Offices used Twitter and Facebook to share new guidelines, publicize informational resources, and to

promote events and observances.

Training health professionals in viral hepatitis. Several agencies and offices led trainings or 

created other opportunities to educate health care professionals and improve quality of care for 

persons with viral hepatitis. The table below summarizes the trainings, webinars, briefings, and 

resources from partners across government.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 2

Federal Implementation Progress Report – 2013
Priority 1: Educating Providers and Communities to Reduce Health Disparities

Agency 

or Office Health Professional Training Product

CDC In 2013, CDC continued working with academic partners, the University of 

Washington, Seattle (UW) and the University of Alabama, Birmingham (UAB). UW 

continued to update and maintain www.HepWebstudy.org, which houses case 

studies, slide libraries and glossary. UW also produced Hepatitis C Online, a 

comprehensive online training for clinicians on HCV covering topics from screening 

and diagnosis to treatment of special populations and special situations. UAB 

continued to produce webinars for frontline workers and also worked on developing 

competency-based hepatitis curricula for the entire spectrum of medical education,

both housed at www.KnowHepatitis.org. 

HRSA HRSA’s Bureau of Primary Health Care developed a Grantee Spotlight on a health 

center that serves a predominately AAPI population in Seattle, Washington, titled 

“Using Video Storytelling and Community Health Workers To Provide Health 

Education Across 52 Languages.” The Spotlight highlights their provider’s innovative 

approach to educating the multilingual community on hepatitis B and their work within 

the health center to develop clinical guidelines and train staff on managing chronic 

hepatitis B. 

The National LGBT Health Education Center and the National Association of 

Community Health Centers, both National Cooperative Agreement partners of HRSA,

developed a toolkit titled “Taking Routine Sexual Histories: A System-Wide Approach 

for Health Centers.” The toolkit is designed to develop and implement systems for 

collecting routine sexual histories of patients and opportunities to educate and 

counsel patients about HIV, STDs, and viral hepatitis. It includes resources to 

connect patients to treatment and care.

The National Center for Health in Public Housing and the National Center for Health 

and the Aging, both National Cooperative Agreement partners of HRSA, hosted 

webinars on viral hepatitis related to their respective target audiences.

The National Health Care for the Homeless Council, also a HRSA National 

Cooperative Agreement partner, on March 14-16, 2013, hosted two trainings on 

hepatitis C at the National Health Care for the Homeless Conference and Policy 

Symposium: “Investigating Patient Attitudes Towards Hepatitis C (HCV) to Guide 

Implementation of Primary Care-Based HCV Treatment” and “Talking About Hep C: 

How To Give Clear, Compassionate, and Up-to-Date Information.” 

The National Association of Community Health Center’s Annual Policy and Issues 

Forum included two training sessions: “Board Members: Learning About Health Care 

for LGBT People and National Strategies on HIV and Hepatitis,” hosted by the 

National LGBT Health Education Center; and “The Health Center Response to 

Hepatitis C, the New Public Health Crisis.”

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 3

Federal Implementation Progress Report – 2013
Priority 1: Educating Providers and Communities to Reduce Health Disparities

Agency 

or Office Health Professional Training Product

OWH In collaboration with OMH, NVPO, and OHAIDP, OWH led a webinar on hepatitis and 

Hispanics. OWH led a webinar with OHAIDP on hepatitis in women. The webinars 

are available on the OWH YouTube channel.

RHAs

RHAs briefed selected state health officers on priority public health issues, including 

the VHAP.

The Regional Resource Network Programs (RRNP) in Regions I and II led the 

development and coordination of the first RRNP viral hepatitis national webinar 

series in partnership with RRNP in Regions V, IX and X and the Latino Commission 

on AIDS. The Latino Commission on AIDS hosted the webinar series as part of 

Hepatitis Awareness Month and National Hispanic Hepatitis Awareness Day. This 

four-part webinar series, “Viral Hepatitis Today: Taking Action To Overcome the 

Challenges of Communities of Color,” was launched in May 2013. The series 

featured webinars focused on the VHAP, racial and ethnic communities, and 

vulnerable populations, and reached more than 800 participants. 

In July 2013, the Region VIII Federal National HIV/AIDS Strategy Workgroup hosted 

a webinar to further inform advocates of the latest developments in screening, 

testing, and treatment for viral hepatitis. Partners included Hep C Connection, 

Denver Health, the Colorado Department of Public Health and Environment, 

SAMHSA, and OHAIDP. As a result of this webinar, the focus of the 2014 RRNP 

regional meeting was viral hepatitis.

SAMHSA The Center for Substance Abuse Prevention (CSAP) produced webinars, technical 

assistance trainings, and conference calls for grantees. CSAP’s Minority AIDS 

Initiative programs provided preventive services in communities disproportionately 

affected by HIV/AIDS, viral hepatitis, and other infectious diseases. Webinars 

highlighted the benefits of HIV/HCV prevention efforts, including counseling, 

treatment, and vaccination. 

VA VA organized monthly calls on national HIV/HCV issues for frontline VA providers, as 

well as a live meeting lecture series on viral hepatitis featuring experts and offering 

continuing education units.. Lecture series topics included emerging clinical issues 

and psychosocial issues around transplantation.

In 2013, VA funded postdoctoral fellowships in clinical psychology at nine VA Medical 

Centers. The fellowships emphasize the behavioral health, mental health, and 

substance use treatment of Veterans with HIV/HCV infection and include weekly 

national didactic seminars that are open to the entire VA healthcare system.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 4

Federal Implementation Progress Report – 2013
Priority 2 Improving Testing, Care, and Treatment to 

Prevent Liver Disease and Cancer

GOALS

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

disease.

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

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

viral hepatitis.

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

and treatment for infected persons.

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

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

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

Many federal partners are working to improve health outcomes through policies and programs to

reduce viral hepatitis-related health disparities experienced by baby boomers, African Americans, 

AAPI, MSM, PWID, HIV-infected persons, and other populations. Further evaluation and 

dissemination of effective models of care are critical to achieving the Action Plan goals.

In 2013, the following were among the actions undertaken by federal partners to improve 

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

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

Force (USPSTF) HCV screening recommendations. In June 2013, USPSTF issued a new 

recommendation for screening for hepatitis C infection in persons at high risk for infection as 

well as offering one-time screening for HCV infection to adults born between 1945 and 1965. 

The Task Force is an independent group of national experts that works to improve the health of 

all Americans by making evidence-based recommendations about clinical preventive services 

such as screenings, counseling services, or preventive medicines. AHRQ is authorized to 

convene the Task Force and provides it with ongoing scientific, administrative, and 

dissemination support. The new USPSTF recommendation statement on HCV screening aligns 

with the CDC’s Recommendations for the Identification of Chronic Hepatitis C Virus Infection 

Among Persons Born During 1945–1965, issued in 2012. Creating more standard, consistent 

federal recommendations on hepatitis C testing was one of the strategies articulated in the 

VHAP. These aligned recommendations from USPSTF and CDC send a clear signal to health 

care professionals, policymakers, and the public that screening for HCV is effective and should 

be offered to patients. This alignment of recommendations is a step toward reducing confusion 

among health care providers, increasing awareness of the importance of hepatitis C screening,

improving testing rates and ultimately identifying millions of Americans previously unaware of 

their infection status, and preventing the associated liver disease and deaths attributable to 

undiagnosed chronic HCV infection. 

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

Federal Implementation Progress Report – 2013
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Many federal agencies and offices worked to adopt and raise awareness of the new USPSTF 

HCV screening recommendation after it was issued, revising policies or sharing information with 

providers and the public via blog posts, web pages, social media, training opportunities, and 

other means. For example, in November 2013, the VHA’s Preventive Medicine Field Advisory 

Committee voted to approve a new Clinical Preventive Services Guideline recommending birth 

cohort HCV testing. The VHA National Center for Health Promotion and Disease Prevention

released guidance on this recommendation in January 2014. These recommendations 

encourage one-time testing for all veterans within the 1945–1965 birth cohort, in addition to all 

veterans who have known HCV risk factors. Additionally, in 2013, SAMHSA’s medical director

sent a letter to agency grantees notifying them of the updated screening recommendations. In 

July, the medical director of IHS sent a “Dear Colleague” letter regarding the new HCV 

screening recommendations to all clinical directors within the Indian Health Service care

system.

Supporting development of recommendations for healthcare providers on HCV testing, 

management, and treatment. In 2013, investigators from NIH, in collaboration with CDC, 

participated in the development of clinical Recommendations for Testing, Managing, and 

Treating Hepatitis C. The guidelines, developed by a panel of HCV experts convened by the 

American Association for the Study of Liver Diseases and the Infectious Diseases Society of 

America, were published online in January 2014. The recommendations cover four broad 

topics: HCV testing and linkage to care, initial treatment of HCV infection in patients starting 

treatment, retreatment of persons in whom prior therapy has failed, and unique patient 

populations. CDC led the development of guidelines for screening, testing, and linkage to care. 

The recommendations will be expanded and updated on an ongoing basis as warranted by new 

findings and developments in the field. In late 2013, VHA convened a panel of nationally 

recognized VHA experts in the treatment of hepatitis C. They developed Chronic HCV 

Treatment Considerations, which are based on the available medical evidence. These 

Treatment Considerations are updated as new medications are approved by the FDA and as 

new data become available. They are nationally recognized and available to the public.

Exploring opportunities to expand coverage for viral hepatitis testing. In September 2013, 

CMS initiated a national coverage determination (NCD) for HCV screening after the release of 

the USPSTF recommendation. An NCD is a national policy statement granting, limiting, or 

excluding Medicare coverage for a specific medical item or service. CMS is authorized to add 

coverage of “additional preventive services” that have been recommended with a grade of A or 

B by the USPSTF and are found, through the NCD process, to be reasonable and necessary 

and appropriate for the Medicare population. The final NCD was issued in June 2014 

expanding coverage for screening for HCV in primary care settings for beneficiaries who are at 

high risk and who were born from 1945 through 1965.

Increasing HCV screening and hepatitis awareness in minority communities. OMH 

funded six grantees located in several diverse communities across the nation with 

disproportionately high rates of hepatitis to support hepatitis awareness and access to testing,

care, and treatment. Activities included piloting the offering of rapid HCV screening onsite and 

at public events and venues, facilitating access to care for people who tested positive for HCV, 

engaging local officials in hepatitis awareness activities, and hosting a bilingual Twitter chat on 

Latinos and viral hepatitis. OMH supported the following grantees: Dominican Sisters Family 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 6

Federal Implementation Progress Report – 2013
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Health Service, Inc. in Bronx, New York; Community Education Group in Washington, District of 

Columbia; Latino Commission on AIDS in New York, New York; FACES NY, Inc. in New York, 

New York; Long Island Association for AIDS Care, Inc. in Long Island, New York; and Hep B 

United in Oakland, California.

Demonstrating effective HBV and HCV testing and linkage to care model programs. 

Beginning in 2012 and throughout 2013, CDC funded 34 viral hepatitis testing and linkage-tocare demonstration sites. Ten sites focused on testing individuals at risk for HBV and 24 sites

were supported to test persons for HCV. From October 2012 through March 2014, three sites 

that participated in an initiative to identify foreign-born persons with HBV infection and link them 

to care tested a total of 4,727 persons, of whom 310 (6.6 percent) were HBV surface antigen 

(HBsAg)-positive. These findings show that community-based and refugee clinic-based HBV 

testing initiatives can identify substantial numbers of persons with chronic HBV infection, inform 

them of their HBV infection, and provide preventive counseling.

In 2013, three additional demonstration sites were funded by the CDC Foundation’s Viral 

Hepatitis Action Coalition to test persons for viral hepatitis and refer them to care. One site in 

Birmingham, Alabama, focused on HCV testing and linkage to care for baby boomers. With a 

relatively modest investment of approximately $239,000, the program began HCV testing in 

September 2013. After the first 6 months of operation, a total of 3,600 baby boomers had been 

tested for HCV. Of those, 444 (12.3 percent) had a positive antibody result; and of those, 354 

persons were tested further to determine whether they had active (chronic) HCV infection. 

Results of this testing showed that 251 persons (or 71 percent of those who received a 

confirmatory test) have active HCV infection. This revealed that more than one of every 15 baby 

boomers tested learned of their infection as a result of this project, providing them the 

information needed to seek lifesaving care and treatment.

Using electronic health record tools to improve HCV screening for American Indians and 

Alaska Natives. IHS has been innovative in using computer technology to capture clinical data 

while improving patient care since the emergence of electronic health records (EHR). In 2013, 

IHS disseminated an EHR clinical reminder module that prompts clinicians to screen babyboomer patients for HCV. Mid-year analysis covering July–December 2013 showed that at 

participating sites, 23 percent of active patients in the baby-boomer cohort were screened for 

HCV. This was a significant improvement from the pilot year, in which only 11 percent of 

eligible patients were screened.

Using health information technology (HIT) to monitor and improve viral hepatitis services 

in health centers. HRSA-support health centers provide comprehensive, culturally competent, 

quality primary health care services to medically underserved communities and vulnerable 

populations. In 2013, two national organizations that receive support from HRSA to provide 

technical assistance to health centers undertook activities to improve the use of health 

information technology to address viral hepatitis-related health disparities: 

• The Association for Asian Pacific Community Health Organizations (AAPCHO) received a 3-

year grant totaling more than $700,000 from NIH to develop new HIT strategies that increase 

screening for chronic hepatitis B and reduce the impact of hepatitis B among high-risk AAPI 

populations. To pilot and assess the HIT strategies designed to improve HBV outcomes for 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 7

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underserved AAPIs receiving care in community health centers, AAPCHO is partnering with 

International Community Health Services, a community health center located in Seattle, 

Washington.

• The International Association of Providers of AIDS Care, in partnership with the Alliance of 

Chicago Community Health Services and the National Association of Community Health 

Centers, developed an EHR-based approach to integrating hepatitis C clinical management 

into community health center settings. The hepatitis C EHR module will be piloted across the 

11-state EHR system network maintained by the Alliance, which manages almost 400,000 

patients annually.

Expanding health care provider capacity to effectively manage and treat HCV. Project 

ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 by the 

University of New Mexico’s Health Sciences Center. Project ECHO seeks to build primary care 

capacity to treat HCV among rural, underserved populations through videoconferencing and 

case-based learning in telehealth clinics. The model program has been proven to improve HCV 

treatment outcomes of patients managed by primary care providers in community settings, with 

outcomes equal to—in some cases better than—those achieved by hepatitis C specialists at 

academic medical centers. In 2013, federal partners supported further development of HCV 

telehealth networks.

Beginning in September 2012 and throughout 2013, CDC funded Project ECHO programs in 

Arizona and Utah to improve patient access to primary care providers with the capacity to 

manage and treat HCV infection. In both states, Project ECHO was successfully implemented, 

training 66 primary care clinicians, predominantly from rural settings. Nearly all (93 percent) of 

the participating clinicians had no prior experience in care and treatment of HCV infection. For 

both states combined, 129 (46 percent) of 280 HCV-infected patients seen in teleECHO clinics 

received antiviral treatment, more than doubling the proportion of patients receiving HCV 

treatment in these clinics in the years prior to the introduction of the HCV telehealth program.

In 2013, the HRSA HIV/AIDS Bureau funded nine grant supplements for AIDS Education and 

Training Centers to expand hepatitis C and behavioral health treatment support in the Telehealth 

Training Centers Program (TTCP) demonstration program. The TTCP program expands access 

to and improves health care and health outcomes through telehealth technology by expanding 

support for providers who see a low volume of HIV patients. These efforts are targeted to rural 

areas to improve the management of hard-to-reach, HIV-positive persons residing in historically 

underserved communities.

The VA's Office of Specialty Care Services partnered with the Office of Primary Care, Office of 

Telehealth, Office of Nursing Service, Pharmacy, Office of Rural Health, Office of Public Health,

and others to develop Specialty Care Access Networks (SCAN) across five regional sites,

nationwide. Hepatitis C is one of the focus areas for the National SCAN Extension of 

Community Healthcare Outcomes (SCAN-ECHO). SCAN-ECHO uses video teleconferencing 

technology to simultaneously link mentoring specialists in hepatology to multiple primary- and 

specialty-care providers. SCAN-ECHO transforms health care delivery to veterans by 

enhancing communication between medical specialists and generalists. It also demonstrates 

the force-multiplier effects of shared specialist knowledge, skills, and resources locally, 

regionally, and across the country, which helps care systems responsibly manage fiscal 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 8

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resources and generate cost-savings across the system. To date, there are six active Hepatitis 

C SCAN-ECHO centers that have mentored providers from 136 community-based outpatient 

clinics and VA Medical Centers in 18 of 21 Veterans Integrated Service Networks. As the 

program continues to evolve, it will increasingly focus on expanding access to specialty care 

among rural and highly rural veterans with HCV.

Facilitating development, review, and approval of new drugs to treat viral hepatitis. In 

2013, the FDA engaged in several activities supporting advances in research to enhance care 

and treatment for persons living with HCV infection. 

• Providing guidance for the clinical development of Direct-Acting Antivirals (DAA) for 

hepatitis C. The FDA released its draft “Guidance for Industry Chronic Hepatitis C Virus 

Infection: Developing Direct-Acting Antiviral Drugs for Treatment” in October 2013. This 

revised draft guidance assists pharmaceutical sponsors in the clinical development of DAA 

drugs for the treatment of chronic hepatitis C. HCV DAA drugs are defined as drugs that 

interfere with specific steps in the HCV replication cycle through direct interaction with the 

HCV genome, its polyprotein, or its polyprotein cleavage products, representing significant 

advances in therapeutic efficacy. Although the guidance discusses the development of 

DAAs with and without interferon, the main focus is on the development of DAA drugs that 

can be used as part of interferon-free regimens.

• Expediting safe hepatitis C DAA research and development. The FDA’s Antiviral 

Information Management System database is a pooled database of de-identified clinical 

trial data from multiple pharmaceutical sponsors to be used for regulatory research. This 

pooled data was used in the research leading to establishment of sustained viral 

response to treatment regimens at 12 weeks after therapy instead of 24 weeks, as the 

primary efficacy endpoint for HCV clinical trials. In 2013, these findings decreased the 

HCV drug development timeline by 3 months, thus facilitating earlier access to safe and 

effective drugs.

• Approving new drugs to treat hepatitis C. In 2013, the FDA Center for Drug Evaluation and 

Research (CDER) approved two new DAAs for the treatment of chronic HCV infection. In 

November 2013, the FDA approved simeprevir, a protease inhibitor that blocks a specific 

protein needed by HCV to replicate, as a component of a combination antiviral regimen. 

Simeprevir (sold under the brand name OlysioR

) was reviewed under the FDA’s priority 

review program, which provides for an expedited review of drugs that, if approved, would 

provide safe and effective therapy when no satisfactory alternative therapy exists, or offer 

significant improvement compared to available therapies. In December 2013, CDER 

approved a second new HCV treatment, sofosbuvir. Also a DAA, sofosbuvir (sold under 

the brand name SovaldiR

) was the first drug approved after demonstrating safety and 

efficacy to treat certain types of HCV infection without the need for co-administration of 

interferon. This was also the first regimen to be approved to prevent HCV recurrence posttransplant in a subgroup of the pretransplant population as well as the first approved 

regimen for HCV/HIV-1 co-infected population. Sovaldi is the third drug with breakthrough 

therapy designation to receive FDA approval. The FDA can designate a drug as a 

breakthrough therapy at the request of the sponsor if preliminary clinical evidence indicates 

the drug may demonstrate a substantial improvement over available therapies for patients 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 9

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

with serious or life-threatening diseases. Sovaldi was also reviewed under the FDA’s 

priority review program.

Advancing the development of new therapeutic agents for viral hepatitis. NIH supported a 

number of research activities on potential HBV and HCV therapies, including a randomized 

controlled trial of tenofovir with or without peginterferon in patients with immune active chronic 

hepatitis B. The study is funded as a cooperative agreement with participation from CDC. NIH 

researchers are engaged in an ongoing collaboration to identify novel targets and molecules for 

HCV therapy. Researchers in two NIH Intramural Research Programs have several ongoing 

clinical research studies of combinations of oral, direct-acting antiviral agents, with or without 

peginterferon and ribavirin, in patients with chronic hepatitis C. These studies are focused on 

high-risk patients in vulnerable populations, including uninsured and minority populations as well 

as persons with advanced disease and cirrhosis. In addition, the NIH supports clinical research 

studies of oral direct-acting agents in patients affected with both HIV and HCV.

Advancing the science to improve prevention, care, and treatment of chronic viral hepatitis 

and liver cancer. A project in the NIH funding announcement (FOA), “Biomarkers of InfectionAssociated Cancers” includes a project that is investigating circular microRNAs as potential 

biomarkers to monitor people infected with hepatitis C virus for the development of liver cancer. A 

small animal model that is susceptible to hepatitis B and/or C would provide an enormous benefit 

for research into the pathogenesis, prevention, and treatment of hepatitis B and C. Extramural 

NIH-supported investigators have developed several new humanized mouse models of HCV 

infection by providing mice with the human genes responsible for entry of the HCV into liver cells. 

These mouse lines that are susceptible to HCV infection can be used to study immunity, recovery, 

and treatment of hepatitis C. A similar approach is being used to develop a mouse model for 

hepatitis B. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 10

Federal Implementation Progress Report – 2013
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Improving Testing, Care, and Treatment to Prevent Liver Disease

By John Ward, MD, Director, Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, 

STD and TB Prevention, Centers for Disease Control and Prevention

An estimated 3 million persons in the United States are living with HCV infection, of which about

three-quarters1 are baby boomers. However, at least 50 percent of HCV-infected persons in the 

United States are estimated to be unaware of their HCV infection.2 Of the persons tested and 

aware of their infection status, only 32 to 38 percent are referred for care, 7 to 11 percent are 

treated, and 5 to 6 percent achieve virologic cure.

3 These data highlight gaps in the health care 

delivery system. In the absence of 

new interventions, the burden of HCV 

is projected to continue to increase in 

the United States.4

Priority area two of the VHAP focuses 

on reducing the burden of cirrhosis 

and liver disease caused by HCV, 

with detection of HCV infection 

through testing as the critical first step 

toward reducing HCV-related 

morbidity and mortality. In recent 

years, CDC, like other federal 

partners engaged in the Action Plan, 

has undertaken efforts to improve HCV prevention, testing, and linkage to care and treatment. 

For example, in Fiscal Year 2012, CDC awarded $6.6 million in Prevention and Public Health

Funds to demonstration sites, including community health, primary care, and substance abuse 

and prevention clinics to test persons for hepatitis B and C and to refer infected persons to 

appropriate care.5 With that funding, CDC supported 35 sites in 19 states, the District of 

Columbia, and Puerto Rico. In 2013, three additional sites received support as a result of a 

public-private partnership under the auspices of the CDC Foundation’s Viral Hepatitis Action 

Coalition (VHAC). The majority of the demonstration projects met targets for the number of 

persons receiving HCV testing and linkage to care for infected persons, but those at the 

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 Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and 

medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination 

Survey 2001–2008. Hepatology. 2012;55:1652–1161. 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

Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the 

United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. February 

2010;138(2):513–521.e6. doi:http://dx.doi.org/10.1053/j.gastro.2009.09.067. 5 Centers for Disease Control and Prevention. Viral hepatitis, early identification and linkage to care for persons 

with chronic HBV and HCV infections. Atlanta, GA: Centers for Disease Control and Prevention; 2013.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 11

Federal Implementation Progress Report – 2013

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

University of Alabama at Birmingham6 and The Johns Hopkins University in Baltimore, 

Maryland,

7 have been particularly successful. For example, in September 2013, UAB began 

offering HCV screening to all baby boomers seen in the hospital’s emergency department. A 

total of 6,521 baby boomers were screened for HCV, of whom 691 (10.6 percent) had a positive 

test for HCV antibody. Of those who tested positive, 530 were given an additional test to 

determine whether they had current HCV infection, of whom 394 (74.2 percent) were confirmed 

to have chronic infection. One hundred ninety (48.3 percent) of the individuals with chronic 

infection were successfully contacted by phone and 91 (47.9 percent) of those contacted were 

linked to HCV care with an appointment. These data reveal that the prevalence of HCV in this 

population of ED patients was 6 percent or higher, far exceeding the expected 3 percent

prevalence of HCV among baby boomers participating in national health surveys.8 This project, 

which is the first CDC-funded HCV testing program implemented in the ED settings, 

demonstrates the potential of the ED to be a best practice setting for HCV testing and linkage to 

care.

The important work of the UAB project, as well as many other CDC research projects and 

programs, would not have been possible without the support of the private sector. The White 

House highlighted the importance of public-private partnerships as one of its priorities.

9 The 

VHAC is a success story for leveraging public- and private-sector partnerships to further

progress toward achieving national public health goals for viral hepatitis. In addition to these

demonstration projects, the VHAC provided funding to support the first U.S. longitudinal cohort 

study of individuals with chronic HCV, evaluation of the birth cohort HCV testing guidelines, and

support for the increasingly important efforts to address HCV issues globally.

The collective actions of partners and stakeholders helped to disseminate CDC 

recommendations for HCV, evaluate strategies to implement testing in various care settings, 

increase awareness of viral hepatitis in key communities, and expand provider capacity to 

effectively manage and treat HCV. While these efforts show great promise, we cannot lose 

sight of how much more work remains: up to 60 percent of people living with viral hepatitis are 

still unaware of their status, reports of both incidence and mortality are increasing, and only 

about 5 percent of chronically infected persons have been successfully treated. We must 

continue to improve viral hepatitis testing, as well as care and treatment, if we are to stop new 

infections and prevent more people from becoming ill with or dying from liver disease. With 

commitment of governmental and non-governmental partners, the nation can markedly reduce 

HCV transmission and disease, setting the country on a course toward the elimination of 

hepatitis C. 

6 Galbraith JW, Franco RA, Rodgers JS, et al. Screening in emergency department identifies a large cohort of 

unrecognized chronic hepatitis C virus infection among baby boomers. Presented at the 64th Annual Meeting of 

the American Association for the Study of Liver Diseases, Washington, DC; November 1–5, 2013. Abstract LB-6. 7 Falade-Nwulia O, Mehta S, Sulkowski M, Lasola J, Ghanem K, Chaulk P, Thomas D. Impact of rapid hepatitis C 

testing on receipt of hepatitis C results in an STD clinic. Presented at the 22nd International Conference on 

Retroviruses and Opportunistic Infections, Boston, MA; March 3–6, 2014. 8 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. 9 The White House, Community Partnerships Interagency Policy Committee. Building partnerships: a best practices 

guide. Washington, DC: Government Printing Office; 2013.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 12

Federal Implementation Progress Report – 2013

 
Priority 3 Strengthening Surveillance to Detect Viral 

Hepatitis Transmission and Disease

GOALS

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

monitor viral hepatitis transmission and disease.

3.2 Monitor viral hepatitis-associated health disparities.

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

services.

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

hepatitis surveillance.

Historically, the impacts of the viral hepatitis epidemic have not been well-quantified or wellunderstood. Surveillance data provides estimates of the prevalence and incidence of disease

and can highlight trends in the burden of disease and disparities in health. Experts in the field 

are working to enhance existing methods and utilize novel data sources and analysis methods 

to improve surveillance and better target limited prevention and service resources. In the 

rapidly evolving health care field, with the increase in EHR use and the focus on data to monitor 

changes in health care use and outcomes, there are unprecedented opportunities to improve 

what we know about viral hepatitis to inform our national response. 

In 2013, the following were among the actions undertaken by federal partners to strengthen 

surveillance to detect viral hepatitis transmission and monitor disease:

Enhancing surveillance to better inform local viral hepatitis policy and community 

impact. CDC released the report Viral Hepatitis Surveillance United States, 2011 in August 

2013. The report includes incidence data for 2011 and an analysis of changes from 2000 to 

2011. Data are reported by age, sex, race or ethnicity, and state and are useful to a variety of 

policymakers, community advocates, and other stakeholders. Data reveal that deaths among 

persons diagnosed with HCV were highest among persons aged 55 to 64 years, American 

Indians and Alaskan Natives, and males.

This surveillance report was the first in which CDC used its revised and improved methods to 

estimate new viral hepatitis infections from cases reported to the CDC National Notifiable 

Diseases Surveillance System. CDC researchers adapted a model previously used to estimate 

the number of people who had pandemic influenza in 2009. Their revised model considers who 

developed symptoms, who sought care, and who was reported in hepatitis surveillance. This 

change in CDC’s surveillance strategy will let state and local health authorities more accurately 

estimate acute cases of viral hepatitis on a jurisdiction level to inform their prevention activities.

CDC also published a paper on improving estimating methods related to infectious disease 

surveillance. “Estimating the Number of Persons Who Inject Drugs in the United States by 

Meta-analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections” describes a 

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

Federal Implementation Progress Report – 2013
Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease

meta-analysis from four national probability surveys and deriving population size estimates from 

Census data.

Monitoring advanced liver disease in veterans with chronic hepatitis. All veterans in VA 

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

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

information on HCV care in the VA. VA CCR reports showed that out of 174,302 veterans with 

chronic hepatitis C in VA care, the incidence of patients newly diagnosed with cirrhosis remains 

stable at 2-to-3 percent over 2 years; the prevalence of cirrhosis among veterans with chronic 

hepatitis C in VA care in 2013 was 17 percent. In 2013, of veterans with chronic hepatitis C in 

VA care, 1,654 (0.9 percent) were newly diagnosed with hepatocellular carcinoma.

Providing guidance for hepatitis C testing procedures and policies. In 2013, CDC 

published “Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians”

in the Morbidity and Mortality Weekly Report. This critical update provided a simplified 

algorithm for HCV testing which was needed because of changes in the availability of certain 

commercial HCV antibody tests and evidence that many persons identified as reactive by an 

HCV antibody test might not subsequently be evaluated to determine whether they have current 

HCV infection. In addition, demand for HCV screening is expected to rise because of revised 

HCV screening recommendations as well as significant advances in the development of antiviral 

agents with improved efficacy against HCV. 

Improving surveillance through the development of new technologies. In 2013, CDC 

engaged in a number of activities to develop and implement new technologies and lab 

procedures to improve viral hepatitis surveillance. These included significant laboratory 

capacity improvement for accurate, rapid, and cost-effective detection of disease transmission,

especially during outbreak investigations. The application of powerful next-generation 

sequencing technologies capable of rapid identification and control of outbreaks, the 

development of novel computational approaches to viral hepatitis surveillance, and the 

development of multiplexing technologies for simultaneous detection of viral and immune 

markers of infection are being realized through laboratory capacity improvement .

Advancing liver cancer surveillance. Intramural investigators from NIH are studying 

mechanisms of viral hepatitis-mediated hepatocarcinogenesis and cancer stem cells in liver 

cancer. Molecular profiling and gene expression array studies comparing signatures of chronic 

liver diseases with hepatocellular carcinoma, revealed a molecular signature that separates

patients for their risk of developing advanced disease. In addition, NIH, through the Early 

Detection Research Network, has a project for the surveillance and serial collection of serum 

and plasma from cirrhotic patients who are predominantly HCV positive. This biorepository will 

serve as an important resource for the future validation of markers for the monitoring and early 

detection of liver cancer.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 14

Federal Implementation Progress Report – 2013
Priority 4 Eliminating Transmission of 

Vaccine-Preventable Viral Hepatitis

GOALS

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

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

vulnerable adults.

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

indications for their optimal use.

Hepatitis A and B are vaccine preventable, and expanded delivery of these vaccines has 

resulted in fewer new infections. From 2000 - 2012, new hepatitis A cases decreased by 88 

percent. During the same period, new hepatitis B infections decreased by 64 percent. Although 

barriers to vaccination exist, the Affordable Care Act provides opportunities for expanding 

immunization access for adults at risk as well as enhancing perinatal hepatitis B prevention 

efforts. Establishing new and strengthening existing partnerships between organizations that 

serve groups at highest risk for viral hepatitis and health care providers who can administer 

vaccines is critical to increasing rates of vaccination, establishing effective programs, and 

ultimately eliminating new HAV and HBV infections in the United States. 

In 2013, the following were among the actions undertaken by federal partners to eliminate the 

transmission of vaccine-preventable viral hepatitis: 

Supporting activities to eliminate mother-to-child transmission of HBV. CDC funds Perinatal 

HBV Prevention Programs (PHBPP) through cooperative agreements with health department 

immunization programs. These programs are required to identify HBsAg-positive pregnant women 

and ensure that their infants receive post exposure prophylaxis by providing case management in 

50 states, 6 cities, 5 territories, and the freely associated states. In 2013, CDC collaborated on a 

cost-effectiveness analysis of the PHBPP and worked with PHBPPs in Michigan and New York 

City to assess the rates of prenatal evaluation of HBV-infected women for care and treatment, 

evaluate novel strategies to increase identification of HBsAg-positive pregnant women, and 

determine the annual reporting of HBV birth dose coverage by birthing facilities in these 

jurisdictions. To further support the PHBPP, CDC collaborated with three large commercial 

laboratories to develop and implement a Special Laboratory Report. The report, which will be 

regularly provided to PHBPPs, lists confirmed HBsAg-positive test results from women who are 

likely to be pregnant with the objective of facilitating identification of pregnant women whose 

infants will require case management for prevention of mother-to-child HBV transmission.

Validating a hepatitis B birth dose vaccination electronic clinical quality measure. Clinical 

quality measures are tools that help measure and track the quality of health care services 

provided within the health care system. In 2013, CMS continued its partnership with CDC to 

convert CDC’s quality measure “Hepatitis B Vaccine Coverage Among All Live Newborn Infants 

Prior to Hospital or Birthing Facility Discharge” (NQF 0475) into an electronic clinical quality 

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

Federal Implementation Progress Report – 2013
Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

measure format (e-specification). CMS used its existing Interagency Agreement with the HHS 

Office of the National Coordinator for Health Information Technology to e-specify the hepatitis B 

birth dose vaccination measure, which is now being piloted and evaluated in clinical settings to 

determine its feasibility for use in the Medicaid EHR Incentive Program.

Increasing awareness of and access to hepatitis A & B vaccines. In 2013, NVPO 

supported viral hepatitis prevention efforts via its website, www.vaccines.gov, showcasing HAV 

and HBV vaccine information and featuring a homepage billboard during May’s observance of 

Hepatitis Awareness Month. NVPO also maintains Vaccine Finder, an online locator that 

enables individuals seeking protection from vaccine preventable diseases to search by ZIP code 

for health care providers and pharmacies that can provide HAV and HBV vaccine as well as flu 

and other vaccines.

VA’s Office of Public Health expanded its scope of responsibility to include hepatitis B (as well 

as hepatitis C) through a formal directive, and drafted information for VHA clinicians on hepatitis 

B, particularly the importance of identifying candidates for immunization against hepatitis B.

Supporting activities to achieve universal hepatitis A and hepatitis B vaccination for 

vulnerable adults. In 2013, CDC engaged in a number of activities to further the goal of 

achieving universal hepatitis A and B vaccination for vulnerable adults, including the following:

• Collaborated with the DVH Laboratory Branch and American Red Cross in an ongoing 

project to determine the characteristics of hepatitis B virus vaccine breakthrough (when 

HBV infection occurs after an individual has been vaccinated for the disease) and occult 

HBV infection (the presence of HBV infection even when HBsAg is undetectable) by 

identifying cases through the screening of blood donors. 

• Developed a project to conduct a prospective clinical trial determining the kinetics of 

hepatitis A vaccination seroconversion and immunogenicity among adults aged 40 years

and up. The results will inform recommendations on the age limits for hepatitis A 

vaccination as post-exposure prophylaxis for hepatitis A exposure and support policy 

recommendations for providing vaccine or hepatitis A immunoglobulin in post-exposure 

situations.

• Published CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus 

Protection and for Administering Postexposure Management in the CDC Morbidity and 

Mortality Weekly Report, providing updated guidance for evaluating health care 

personnel for hepatitis B protection for administering post-exposure prophylaxis.

Supporting new vaccine development. CDC is evaluating published data on novel hepatitis 

B vaccines for future consideration by the Advisory Committee on Immunization Practices 

(ACIP), a group of medical and public health experts that develops recommendations on how to 

use vaccines to control diseases in the United States, including whether and how to include 

newly approved vaccines in CDC’s recommended immunization schedules.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 16

Federal Implementation Progress Report – 2013
Priority 5 Reducing Viral Hepatitis Associated with

Drug Use Behaviors

GOALS

5.1 Ensure that people who inject drugs (PWID) have access to viral hepatitis prevention, 

care, and treatment services. 

5.2 Mobilize community resources to prevent viral hepatitis associated with injection 

drug use.

5.3 Provide people who inject drugs (PWID) with access to care and substance abuse 

treatment to prevent transmission and progression of disease.

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

correctional settings.

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

drugs.

In 2011, after years of decreasing or stable rates of new infections, acute HCV infection rates in 

the US increased by 45 percent. Injection drug use continues to be the most common mode of 

transmission for HCV in the United States. The rise of new HCV infections is considered to be 

linked to the U.S. prescription opioid drug use epidemic, because individuals who become 

dependent on oral opioids very often transition to injecting drugs, thus creating opportunities for 

HCV transmission. To address this emerging trend, it is necessary to collaborate across 

sectors and form new partnerships to develop effective education and prevention programs;

identify those infected and refer them into care; and explore opportunities afforded by new, 

more effective therapies.

In 2013, the following were among the actions undertaken by federal partners to reduce viral 

hepatitis associated with drug using behaviors: 

Supporting viral hepatitis testing in behavioral healthcare settings. In 2013, SAMHSA 

supported its grantees’ expansion of HCV screening in substance abuse treatment programs. 

Included among these are 87 substance abuse treatment grantees under SAMHSA’s Targeted 

Capacity Expansion-HIV (TCE-HIV) grant program, which supports substance abuse treatment 

for racial and ethnic minority populations at risk for HIV infection. SAMHSA awarded 35 new 

TCE-HIV grants in 2013. All 87 TCE-HIV grantees have the option to use up to 5 percent of 

their funds for hepatitis testing. In 2013, more than 60 percent of those grantees provided 

onsite HCV testing or referred the clients for hepatitis testing and treatment. In addition, 

SAMHSA’s 2013 grant awards under the TCE-HIV minority women program funded 35 

substance abuse treatment grantees that also have the option to use as much as 5 percent of 

their funds for hepatitis testing. During the first 6 months of those projects, most of those 

treatment facilities trained their staff on hepatitis testing and counseling and 2,020 HCV tests 

were provided, with an 11.5 percent HCV antibody positivity rate. Finally, SAMHSA’s 2013 HCV 

Screening and Referral grant provided supplemental funding to nine SAMHSA-certified nonprofit 

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

Federal Implementation Progress Report – 2013
Priority 5: Reducing Viral Hepatitis associated with Drug-Use Behaviors

opioid treatment program grantees focused on providing an HCV screening test and, if results 

are antibody positive, referral for confirmatory testing and treatment. In the first 6 months of this 

grant program, more than 700 clients received HCV testing and 18 percent were screened 

antibody positive for hepatitis C. 

Convening national consultation on HCV infections among young persons who inject 

drugs. In response to the emerging epidemic of HCV infection among young PWID

documented in recent years in both rural and suburban settings, OHAIDP, CDC, NIDA, and 

SAMHSA collaborated to plan and convene a multidisciplinary technical consultation to discuss 

the existing evidence and to identify and define priorities for a comprehensive public health 

response. During the consultation, federal agency representatives, state health department 

officials, researchers, care providers, staff of community-based organizations, and other experts 

in the field shared presentations on key facts about the epidemiology of HCV infection among 

this population, the state of current research, and examples of innovative community responses

to address this emerging issue. The participants explored factors fueling the epidemic and 

made recommendations about priorities for epidemiology and surveillance initiatives, prevention 

and care interventions, and research questions designed to curb the rising rate of HCV among 

young PWID in the United States. To further heighten awareness of this evolving epidemic and 

engage partners from across all sectors of society, OHAIDP produced and disseminated a 

summary of the presentations and the groups’ recommendations for key public health actions. 

Expanding efforts to address new HCV cases among young PWID. CDC began a study in 

rural Wisconsin to better understand emerging clusters of HCV infections among young PWID in 

rural settings. This project expands CDC’s efforts and research findings from a similar 

investigation in upstate New York, in which DVH assisted both the New York State Department 

of Health and the Cortland County Health Department in the investigation of an increase in new 

HCV infections in Cortland County, New York, among young PWID. In addition, CDC continued

to provide funding to the Philadelphia Department of Health for a prospective follow up of new 

cases of HCV infection among young adults.

Continued and expanded support of HIV/HCV psychology postdoctoral fellowships. The 

VHA’s HIV, Hepatitis, and Public Health Pathogens Programs, in collaboration with its Office of 

Academic Affiliations, funded additional postdoctoral fellowships in clinical psychology at five VA 

Medical Centers in 2013, in Long Beach, California; Miami, Florida; Providence, Rhode Island;

Washington, District of Columbia; and West Haven, Connecticut. These joined the existing four 

sites at Houston, Texas; Jackson, Mississippi; San Francisco, California; and Seattle, 

Washington. This fellowship emphasizes the behavioral, mental health and substance use 

treatment of veterans with HIV and/or hepatitis C infection and the training of psychologists in 

this increasingly critical area to support the growing need within the VA to successfully treat 

veterans with HCV and care for veterans with HIV, as well as expand available mental health 

expertise within the system. Addressing the significant psychiatric needs of these patient 

populations promotes health, wellness, successful treatment, and disease management. 

Fellows receive specialty training in management of mental health aspects of HIV, HCV, and 

substance use disorders, as well as up to 20 percent protected time for research (depending on 

the site). 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 18

Federal Implementation Progress Report – 2013
Priority 5: Reducing Viral Hepatitis associated with Drug-Use Behaviors

Treating prisoners for hepatitis C in federal prisons. In 2013, FBOP continued its HCV 

treatment initiative approving 250 patients for HCV treatment with boceprevir or telaprevir. 

Clinical pharmacy consultants reviewed treatment requests, monitored ongoing treatment, and 

collected data on patient outcome results. In addition, to inform policy and practice, FBOP 

collected and analyzed retrospective data on HCV treatment outcomes for patients with 

genotype 1 who were given dual therapy (peginterferon and ribavirin) in 2011 and began 

preparing the data and a manuscript for publication in a peer-reviewed journal.

Funding research to improve HCV services for PWID. In 2013, NIDA continued to support 

four major research studies on HCV among PWID. These research studies focus on clinical 

and treatment issues for PWID. Additionally, NIDA funded laboratory research on developing 

screening tests for HCV, which is critical for identifying HCV-positive PWID who are unaware of 

their status. NIDA also funded research using mathematical modeling of HIV/HCV co-infection 

that is being used to generate evidence to support optimal screening and treatment guidelines 

for PWID. Lastly, NIDA supported clinical studies examining the efficacy and practicality of 

providing rapid HCV, syphilis, and HIV testing kits at point-of-care clinics to improve medical 

care for PWID.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 19

Federal Implementation Progress Report – 2013
Priority 5: Reducing Viral Hepatitis associated with Drug-Use Behaviors

Progress Addressing the Action Plan’s Fifth Priority Area

By Elinore McCance-Katz, M.D., Ph.D., Chief Medical Officer, Substance Abuse and 

Mental Health Services Administration, U.S. Department of Health and Human Services

Viral hepatitis is a major comorbidity among persons who inject drugs. It has been 

estimated that 11 percent of PWID are infected with hepatitis B and 64 percent are infected 

with hepatitis C.1 It is also important to note the evolving epidemiology of hepatitis C in the 

United States, which includes increased HCV in young people who inject heroin and who 

initiated opioid use with prescription opioid analgesics.22 In addition, other drug and alcohol 

use behaviors are also associated with viral hepatitis infection due to related high-risk 

behaviors. In the context of intoxication, risky behaviors, such as injection by those who do 

not regularly inject or engaging in high-risk sexual behaviors that can also result in viral 

hepatitis transmission, underscore the need to enhance our outreach, prevention, 

screening, and treatment efforts with all drug users.

To achieve the goals of the VHAP, we must reduce viral hepatitis associated with drug use 

behaviors as detailed in the Action Plan’s fifth priority area. Prominent themes in priority 

area five include the development and implementation of prevention interventions to 

reduce the incidence of viral hepatitis and working to ensure that people who use drugs 

have access to treatment for both viral hepatitis and substance use disorders. The 

overarching goal of this priority area is to bring together federal and community partners 

and other key stakeholders to develop new, effective strategies for addressing viral 

hepatitis among drug users. Federal agencies have come together to develop new 

approaches, to construct a foundation that can be built upon, going forward, for viral 

hepatitis prevention, screening, testing, and treatment where necessary. 

This foundation begins with improving the science and our understanding of what works to 

prevent, diagnose, care for, treat, and cure viral hepatitis in people who use drugs. To that 

end, colleagues at NIH, with NIDA leading the charge, are advancing research to inform 

improvements in HCV services for this important population. 

An effective model, integrated care has been shown to have promise in providing for the 

multiple needs of patients in a single clinical setting. As part of the VHAP, SAMHSA, 

HRSA, and CDC have undertaken programs that integrate treatment of mental and 

substance use disorders with primary care. Building on this, SAMHSA developed a new 

model of collocation, where primary and HIV care are integrated into substance abuse and 

community mental health treatment programs. This pilot requires that a mandatory 

percentage of funds be utilized for viral hepatitis screening, testing, and vaccination, 

emphasizing the importance of viral hepatitis care in populations with substance use 

1

Rosenberg SD, Goodman LA, Osher FC, et al. Prevalence of HIV, hepatitis B, and hepatitis C in people with severe 

mental illness. American Journal of Public Health. 2001;91:31–37.

2

Klevens RM, Hu DJ, Jiles R, et al.: Evolving epidemiology of hepatitis C virus in the United States. Clinical Infectious 

Diseases. 2013;55(Suppl 1):S3–S9.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 20

Federal Implementation Progress Report – 2013

 
Priority 5: Reducing Viral Hepatitis associated with Drug-Use Behaviors

disorders and HIV. Another exciting outgrowth of integrated care is the development of 

new training materials for behavioral health providers on viral hepatitis, including treatment 

options. Similarly, clinical training programs developed by SAMHSA, and implemented by 

HRSA, CDC, and IHS will provide physicians with the knowledge/training needed to obtain 

a DOJ Drug Enforcement Administration waiver to provide office-based treatment of opioid 

dependence using buprenorphine. 

These projects demonstrate only a few of the many innovative approaches being 

developed and implemented through ongoing partnerships between stakeholders and 

federal agencies in the service of those who have great clinical need but have traditionally 

been marginalized and unable to access essential treatment services. Through these and 

other initiatives, we aim to reduce the spread of viral hepatitis associated with drug use 

behaviors and realize the VHAP’s goals.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 21

Federal Implementation Progress Report – 2013
Priority 6 Protecting Patients and Workers from

Health Care-Associated Viral Hepatitis

GOALS

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

devices and drugs.

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

tissues.

6.3 Reduce occupational transmission of viral hepatitis.

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

health care settings.

Health care-associated viral hepatitis infections are much less common today than in decades 

past, before the routine screening of blood and the implementation of universal precautions. 

However, there remain opportunities to further reduce health care-associated transmission of 

viral hepatitis and ensure safety. Collaboration between the public and private sectors is critical 

to the success of educational campaigns, the consistent and comprehensive implementation of 

infection control practices, and the identification and investigation of suspected outbreaks as we 

strive to eliminate the risk of health care-associated viral hepatitis for patients and health care 

providers.

In 2013, the following were among the actions taken by federal partners to protect patients and 

workers from health care-associated viral hepatitis.

Educating and promoting safe injection practices. Throughout 2013, efforts continued to 

ensure patients are protected each and every time that they receive a medical injection. These 

include the One & Only Campaign, a public health effort to eliminate unsafe medical injections 

by raising awareness of safe injection practices. The campaign was developed by the Safe 

Injection Practices Coalition, a partnership of health care-related organizations, patient 

advocacy organizations, industry partners, and other public health partners led by CDC. From 

June 2011 to June 2013, the Campaign offered a Medscape continuing medical education 

activity titled “Unsafe Injection Practices: Outbreaks, Incidents, and Root Causes,” which 

garnered more than 89,000 page views and served more than 58,000 learners and nearly 

26,000 test takers. In 2013, the One & Only Campaign enhanced provider education by urging 

all health care professionals to know the difference between single-dose and multiple-dose 

vials. The Campaign created a dynamic infographic that guides health care providers through 

the safe use of vials from various perspectives—providers, office managers, and patients—and 

concludes with a brief quiz to test the knowledge of medication vials. 

Enhancing blood transfusion safety. In the past year, FDA has encouraged the development 

of increasingly sensitive tests for hepatitis B and C in blood donations to further reduce 

transfusion transmitted hepatitis. These tests are expected to become available in the coming 

years.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 22

Federal Implementation Progress Report – 2013
Priority 6: Protecting Patients and Workers from Health Care-Associated Viral Hepatitis

Issuing updated guideline for reducing HIV, HBV, and HCV through organ 

transplantation. In June 2013, HHS issued the updated U.S. Public Health Service (PHS) 

“PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis 

C Virus Transmission Through Organ Transplantation.” Published in Public Health Reports, the 

updated guideline recommends use of more sensitive tests so that patients can be informed of 

risks to the greatest extent possible and protected from unintentional infections caused by 

transplanted organs. The updated guideline is the result of the deliberations of an HHS-wide 

multidisciplinary workgroup. That group included transplant and infection prevention experts 

who conducted a systematic review of the best available evidence on reducing HIV, HBV, and 

HCV infection transmitted through organ transplantation. Subsequent to the release of this 

updated guideline, under direction of HRSA Division of Transplantation in fall 2013, the Organ 

Procurement and Transplantation Network (OPTN) began developing recommendations for 

revisions to current OPTN policies related to testing organ donors to be consistent with updated 

PHS guideline. OPTN’s goal is to promote transplant patient safety through updated policies 

that are consistent with PHS recommendations for testing organ donors and transplant 

candidates and recipients for hepatitis and HIV. This policy revision process will continue in 

2014. 

Enhancing understanding of the preventable causes of health care-associated viral 

hepatitis. In 2013, CDC updated their website with new resources: Healthcare-Associated 

Hepatitis B and C Outbreaks Reported to the Centers for Disease Control and Prevention 

(CDC) in 2008–2013 to share information on known outbreaks and a health care investigation 

guide for use by state and local health departments to investigate possible health careassociated viral hepatitis transmission events, particularly those involving a single patient.

Investigation of these single cases is an important public health response, as it can result in the 

identification of an outbreak or unsafe clinical practices that are putting additional patients at 

risk. Additionally, a Patient Notification Toolkit was developed and made available on the CDC 

website in 2013. This resource is intended to be used after a health department or health care 

facility decides to notify patients of their potential exposure to infectious organisms due to an 

unsafe practice or infection control breach. It offers resources and template materials to 

facilitate the notification process as well as essential tips and strategies.

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 23

Federal Implementation Progress Report – 2013
Looking Forward to a Promising Future 

Ronald O. 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

This report reflects only a sample of the myriad activities undertaken by federal stakeholders in 

2013 to help advance the Viral Hepatitis Action Plan’s national goals. Together with a host of 

important efforts pursued by nonfederal stakeholders, these activities have strengthened the 

foundation for continued efforts to improve viral hepatitis prevention, diagnosis, care, and 

treatment across the United States. 

Perhaps the most significant 2013 accomplishment was the decision by all federal partners

engaged in the Viral Hepatitis Action Plan to re-commit to another 3 years of focused 

collaborative activity and the subsequent work to draft an updated action plan. Over the course 

of 2013, federal partners reflected on the progress of their agencies and offices and began 

considering strategic actions they could undertake from 2014 through 2016, independently and 

in partnership with other federal and nonfederal stakeholders, to move closer toward achieving 

the national goals. Importantly, we gathered critical feedback from nonfederal stakeholders that 

informed the development of a host of recommended actions for the coming years. 

By the end of 2013, the updated Viral Hepatitis Action Plan was nearly complete and 

stakeholders turned their attention to the initial plans for rolling out the updated Action Plan, with 

an eye toward fostering even greater opportunities for engagement of nonfederal stakeholders. 

To this end, the Stakeholder’s Workbook was developed to help all stakeholders identify actions 

they could take to join our national response to the epidemic of viral hepatitis (read more about 

the updated Viral Hepatitis Action Plan and the Stakeholder’s Workbook at 

www.aids.gov/hepatitis).

This is an exciting time in the field of viral hepatitis. The updated Viral Hepatitis Action Plan 

(2014-2016) was released in April 2014. It seeks to take full advantage of the confluence of 

emerging opportunities for even greater progress resulting from the growing awareness of viral 

hepatitis—particularly among disproportionately impacted populations and those who serve 

them. The plan reflects the promise of effective hepatitis C treatments, and new 

recommendations regarding screening for hepatitis B and hepatitis C, as well as the expansion 

of access to viral hepatitis prevention, care, and treatment offered by the Affordable Care Act.

Much has been accomplished since the 2011 release of Combating the Silent Epidemic of Viral 

Hepatitis: Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, the nation’s 

first comprehensive plan to respond to viral hepatitis. Through partnerships inside and outside 

of government, we are finally breaking the silence on viral hepatitis. 

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 24

Federal Implementation Progress Report – 2013
Appendix A. Citations of Publications by Priority Area

Priority 1

Klevens RM, Moorman AC. Hepatitis C virus: an overview for dental health providers. Journal of 

the American Dental Association. 2013;144:1340–1347.

U.S. Department of Health and Human Services, Office of the Assistance Secretary for Health, 

Office of HIV/AIDS and Infectious Disease Policy. 2012 interagency implementation progress 

report for the action plan for the prevention, care & treatment of viral hepatitis. Washington, DC: 

U.S. Department of Health; September 2013.

Priority 2

Belperio PS, Hwang EW, Thomas IC, Mole LA, Cheung RC, Backus LI. Early

virologic responses and hematologic safety of direct-acting antiviral therapies

in veterans with chronic hepatitis C. Clinical Gastroenterology and Hepatology. August 

2013;11(8):1021–1027. doi:10.1016/j.cgh.2013.03.006.

Centers for Disease Control and Prevention. Locations and reasons for initial testing for 

hepatitis C infection—Chronic Hepatitis Cohort Study, United States, 2006–2010. Morbidity and 

Mortality Weekly Report. 2013;62(32):645–648.

Centers for Disease Control and Prevention. Testing for HCV infection: an update of guidance 

for clinicians and laboratorians. Morbidity and Mortality Weekly Report. May 10, 2013;62(18):

362–365.

Chan K, Lai MN, Groessl EJ, et al. Cost effectiveness of direct-acting antiviral therapy for 

treatment-naive patients with chronic HCV genotype 1 infection in the Veterans Health 

Administration. Clinical Gastroenterology and Hepatology. November 2013;11(11):1503–1510.

Chen J, Florian J, Carter W, et al. Earlier sustained virologic response end points for regulatory 

approval and dose selection of hepatitis C therapies. Gastroenterology. June 2013;144(7):

1450–1455.e2. doi:10.1053/j.gastro.2013.02.039. PMID: 23470616.

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

in adults. Rockville, MD: Agency for Healthcare Research and Quality; November 2012.

Available at: 

http://effectivehealthcare.ahrq.gov/ehc/products/285/1284/CER69_ScreeningHepatitisC_Executi

veSummary_20121015.pdf. Accessed July 15, 2014.

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

in adults: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal 

Medicine. January 15, 2013;158(2):101–108. doi:10.7326/0003-4819-158-2-201301150-00574.

Chou R, Hartung D, Rahman B, Wasson N, Cottrell E, Fu R. Treatment for hepatitis C virus 

infection in adults. Rockville, MD: Agency for Healthcare Research and Quality; November 

2012. PMID: 23304740. Available at: http://www.ncbi.nlm.nih.gov/books/NBK115347/. Accessed 

July 15, 1014.

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

Federal Implementation Progress Report – 2013
Appendix A. Citations of Publications by Priority Area

Chou R, Hartung D, Rahman B, Wasson N, Cottrell EB, Fu R. Comparative effectiveness of 

antiviral treatment for hepatitis C virus infection in adults: a systematic review. Annals of Internal 

Medicine. January 15, 2013;158(2):114–123. 

Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis 

C virus infection: a systematic review. Annals of Internal Medicine. June 4, 2013;158(11):807–

820. doi:10.7326/0003-4819-158-11-201306040-00005. Erratum in: Annals of Internal Medicine. 

August 20, 2013;159(4):308. 

Dorner M, Horwitz JA, Donovan BM, et al. Completion of the entire hepatitis C virus life cycle in 

genetically humanized mice. Nature. September 12, 2013;501(7466):237–241. 

doi:10.1038/nature12427.

Everson GT, Terrault NA, Lok AS, et al. A randomized controlled trial of pretransplant antiviral 

therapy to prevent recurrence of hepatitis C after liver transplantation. Hepatology. 2013;57(5):

1752–1762. doi:10.1002/hep.25976.

Florian J, Jadhav PR, Amur S, et al. Boceprevir dosing for late responders and null responders: 

the role of bridging data between treatment-naïve and -experienced subjects. Hepatology.

March 2013;57(3):903–907. doi:10.1002/hep.25843. PMID: 22610696.

Garcia ML, Reynolds TD, Mothes W, Robek MD. Functional characterization of the putative 

hepatitis B virus core protein late domain using retrovirus chimeras. PLOS ONE. August 29, 

2013;8(8):e72845. doi:10.1371/journal.pone.0072845.

Groessl EJ, Ho SB, Asch SM, Stepnowsky CJ, Laurent D, Gifford AL. The hepatitis C selfmanagement program: sustainability of primary outcomes at 1 year. Health Education & 

Behavior. December 2013;40(6):730–740.

Groessl EJ, Sklar M, Cheung RC, Bräu N, Ho SB. Increasing antiviral treatment through 

integrated hepatitis C care: a randomized multicenter trial. Contemporary Clinical Trials. July 

2013;35(2):97–107.

Holmberg SD, Lu M, Rupp LB, et al. Noninvasive serum markers for screening and staging 

chronic hepatitis C virus patients in a large U.S. cohort. Clinical Infectious Diseases. 2013;57:

240–246.

Hwang EW, Thomas IC, Cheung R, Backus LI. Assessment and utilization of rapid virologic 

response in U.S. veterans with chronic hepatitis C: evaluating provider adherence to practice 

guidelines. Journal of Clinical Gastroenterology. March 2013;47(3):264–270. 

doi:10.1097/MCG.0b013e31827035cf.

Ioannou GN, Beste LA, Green PK. Similar effectiveness of boceprevir and telaprevir treatment 

regimens for hepatitis C virus infection on the basis of a nationwide study of veterans. Clinical 

Gastroenterology and Hepatology. December 17, 2013. doi:10.1016/j.cgh.2013.12.011.

Jewett, A, Al-Tayyib A, Ginnett L, Smith BD. Successful integration of hepatitis C virus point-ofcare tests into the Denver Metro Health Clinic. AIDS Research and Treatment. 2013. 

doi:10.1155/2013/528904.

Kachko A, Loesgen S, Shahzad-ul-Hussan S, et al. Inhibition of hepatitis C virus by the 

cyanobacterial protein MVL: mechanistic differences between the high-mannose specific lectins 

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

Federal Implementation Progress Report – 2013
Appendix A. Citations of Publications by Priority Area

MVL, CV-N, and GNA. Molecular Pharmaceutics. December 2, 2013;10(12):4590–4602. 

doi:10.1021/mp400399b. PMID: 24152340. 

Kim HY, Li X, Jones CT, et al. Development of a multiplex phenotypic cell-based high 

throughput screening assay to identify novel hepatitis C virus antivirals. Antiviral Research.

2013;99(1):6–11. doi:10.1016/j.antiviral.2013.04.020.

Kirk GD, Mehta SH, Astemborski J, et al. HIV, age, and the severity of hepatitis C virus-related 

liver disease: a cohort study. Annals of Internal Medicine. 2013;158(9):658–666.

Koh C, Heller T, Haynes-Williams V, et al. Long-term outcome of chronic hepatitis C after 

sustained virological response to interferon-based therapy. Alimentary Pharmacology & 

Therapeutics. 2013;37(9):887–894. doi:10.1111/apt.12273.

Kong L, Giang E, Nieusma T, et al. Hepatitis C virus E2 envelope glycoprotein core structure. 

Science. 2013;342(6162):1090–1094. doi:10.1126/science.1243876. 

Li Q, Pène V, Krishnamurthy S, Cha H, Liang TJ. Hepatitis C virus infection activates an innate 

pathway involving IKK-α in lipogenesis and viral assembly. Nature Medicine. 2013;19(6):722–

729. doi:10.1038/nm.3190.

Li Y, Masaki T, Yamane D, McGivern DR, Lemon SM. Competing and noncompeting activities 

of miR-122 and the 5’ exonuclease Xrn1 in regulation of hepatitis C virus replication. 

Proceedings of the National Academy of Sciences of the United States of America. January 29, 

2013;110(5):1881–1886. doi:10.1073/pnas.1213515110. 

Liang TJ, Ghany MG. Current and future therapies for hepatitis C virus infection. New England 

Journal of Medicine. 2013;368(20):1907–1917. doi:10.1056/NEJMra1213651. 

Liu J, Jadhav PR, Amur S, et al. Response-guided telaprevir therapy in prior relapsers? The role 

of bridging data from treatment-naïve and experienced subjects. Hepatology. March 2013;57(3):

897–902. doi:10.1002/hep.25764. PMID: 22487907. 

McInnes DK, Solomon JL, Shimada SL, et al. Development and evaluation of an internet and 

personal health record training program for low-income patients with HIV or hepatitis C. Medical 

Care. March 1, 2013;51(3 Suppl 1):S62–S66.

Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. American 

Family Physician. March 15, 2008;77(6):819–824.

Mitruka K, Thornton K, Cusick S, et al. Expanding primary care capacity to treat hepatitis C virus 

infection through an evidence-based care model—Arizona and Utah, 2012–2014. MMWR.

2014;63(18):393–398.

Morgan RL, Baack B, Smith BD, Pitasi M, Falck-Ytter Y. Eradication of hepatitis C virus infection 

and the development of hepatocellular carcinoma: a meta-analysis or observational studies. 

Annals of Internal Medicine. March 5, 2013;158(5):329–337.

Moyer VA, U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in 

adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal 

Medicine. September 3, 2013;159(5):349–357. doi:10.7326/0003-4819-159-5-201309030-

00672. 

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

Federal Implementation Progress Report – 2013
Appendix A. Citations of Publications by Priority Area

Ngo-Metzger Q, Ward JW, Valdiserri RO. Expanded hepatitis C virus screening 

recommendations promote opportunities for care and cure. Annals of Internal Medicine. 

September 3, 2013;159(5):364–365. doi:10.7326/0003-4819-159-5-201309030-00675. 

Osinusi A, Meissner EG, Lee YJ, et al. Sofosbuvir and ribavirin for hepatitis C genotype 1 in 

patients with unfavorable treatment characteristics: a randomized clinical trial. Journal of the 

American Medical Association. 2013;310(8):804–811. doi:10.1001/jama.2013.109309. 

Panigrahi R, Hazari S, Chandra S, et al. Interferon and ribavirin combination treatment 

synergistically inhibit HCV internal ribosome entry site mediated translation at the level of 

polyribosome formation. PLOS ONE. August 23, 2013;8(8):e72791. 

doi:10.1371/journal.pone.0072791. 

Pedersen J, Carlsen TH, Prentoe J, et al. Neutralization resistance of hepatitis C virus can be 

overcome by recombinant human monoclonal antibodies. Hepatology. 2013;58(5):1587–1597. 

doi:10.1002/hep.26524. 

Rongey C, Shen H, Hamilton N, Backus LI, Asch SM, Knight S. Impact of rural

residence and health system structure on quality of liver care. PLOS ONE. December 26, 

2013;8(12):e84826. doi:10.1371/journal.pone.0084826.

Selph S, Chou R. Impact of contacting study authors on systematic review conclusions: 

diagnostic tests for hepatic fibrosis. Rockville, MD: Agency for Healthcare Research and 

Quality; April 2014. Available at: 

http://effectivehealthcare.ahrq.gov/ehc/products/582/1886/hepatic-fibrosis-report-140417.pdf. 

Accessed July 15, 2014.

Sherman AC, Trehanpati N, Daucher M, et al. Augmentation of hepatitis B virus-specific cellular 

immunity with programmed death receptor-1/programmed death receptor-L1 blockade in 

hepatitis B virus and HIV/hepatitis B virus coinfected patients treated with adefovir. AIDS 

Research and Human Retroviruses. 2013;29(4):665–672. 

Skums P, Mancuso N, Artyomenko A, Tork B, et al. Reconstruction of viral population structure 

from next-generation sequencing data using multicommodity flows. BMC Bioinformatics. 2013;

14(Suppl 9):S2. doi:10.1186/1471-2105-14-S9-S2. 

Southern WN, Drainoni M, Smith BD, et al. Physician non-adherence with a hepatitis C 

screening program. Quality Management in Healthcare. 2013;22(4):276–284. 

Sulkowski M, Pol S, Mallolas J, et al. Boceprevir versus placebo with pegylated interferon alfa2b and ribavirin for treatment of hepatitis C virus genotype 2 in patients with HIV: a randomized, 

double-blind, controlled phase 2 trial. Lancet Infectious Diseases. 2013;13(7):597–605. 

Taylor, DR. Evolution of cell culture systems for HCV. Antiviral Therapy. 2013;18(3 Pt B):523–

530. doi:10.3851/IMP2593. PMID: 23792335. 

U.S. Preventive Services Task Force. Final Recommendation Statement: Hepatitis C: 

Screening. October 2014. Available at: 

http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal

/hepatitis-c-screening. Accessed September 28, 2014.

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

Federal Implementation Progress Report – 2013
Appendix A. Citations of Publications by Priority Area

Vaughan G, Xia G, Forbi JC, et al. Genetic relatedness among hepatitis A virus strains 

associated with food-borne outbreaks. PLOS ONE. November 6, 2013;8(11):e74546. 

doi:10.1371/journal.pone.0074546. 

Vogt A, Scull MA, Friling T, et al. Recapitulation of the hepatitis C virus life cycle in engineered 

murine cell lines. Virology. 2013;444(1–2):1–11. doi:10.1016/j.virol.2013.05.036. 

Zhang L, Gwinn M, Hu DJ. Viral hepatitis C gets personal—the value of human genomics to 

public health. Public Health Genomics. 2013;16(4):192–197. doi:10.1159/000352014.

Priority 3

Backus LI, Belperio PS, Loomis TP, Yip GH, Mole LA. Hepatitis C virus screening and 

prevalence among U.S. Veterans in Department of Veterans Affairs care. JAMA Intern 

Medicine. 2013;173(16):1549–1552. doi:10.1001/jamainternmed.2013.8133. 

Center for Disease Control and Prevention. Vital signs: evaluation of hepatitis C virus infection 

testing and reporting—eight U.S. sites, 2005–2011. Morbidity and Mortality Weekly Review. 

May 10, 2013;62(18);357–361.

Duggal P, Thio CL, Wojcik GL, et al. Genome-wide association study of spontaneous resolution 

of hepatitis C virus infection: data from multiple cohorts. Annals of Internal Medicine. 2013;158

(4):235–245. 

Ganova-Raeva LM, Dimitrova ZE, Campo DS, et al. Detection of hepatitis C virus transmission 

by use of DNA mass spectrometry. Journal of Infectious Diseases. March 15, 2013;207(6):999–

1006. doi:10.1093/infdis/jis938. 

Ganova-Raeva LM, Khudyakov YE. Application of mass spectrometry to molecular diagnostics 

of viral infections. Expert Review of Molecular Diagnostics. May 2013;13(4):377–388. 

doi:10.1586/erm.13.24.

Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. 

New England Journal of Medicine. 2013;368:1859–1861. doi:10.1056/NEJMp1302973.

Hu DJ, Xing J, Tohme RA, et al. Hepatitis B testing and access to care among racial and ethnic 

minorities in selected communities across the United States, 2009–2010. Hepatology.

September 2013;58(3):856–862. doi:10.1002/hep.26286.

Mahajan R, Liu SJ, Klevens RM, Holmberg SD. Indications for testing among reported cases of 

hepatitis C infection from enhanced hepatitis surveillance sites in the United States, 2004–2010. 

American Journal of Public Health. 2013;103:1445–1449.

Mahajan R, Moorman A, Liu S, Rupp L, Klevens R, Chronic Hepatitis Cohort Study 

investigators. The use of the International Classification of Diseases, Ninth Revision (ICD-9) 

coding in identifying chronic hepatitis B virus infection in health system data: implications for 

surveillance. Journal of the American Medical Informatics Association. 2013;20:441–445. 

doi:10.1136/amiajnl-2012-001558.

Moorman AC, Gordon SC, Rupp LB, et al. Baseline population characteristics and mortality 

among people in care for chronic viral hepatitis, 2006–2008: the chronic hepatitis cohort study. 

Clinical Infectious Diseases. 2013;56:40–50.

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

Federal Implementation Progress Report – 2013
Appendix A. Citations of Publications by Priority Area

Morano JP, Gibson BA, Altice FL. The burgeoning HIV/HCV syndemic in the urban Northeast: 

HCV, HIV, and HIV/HCV coinfection in an urban setting. PLOS ONE. 2013;8(5):e64321.

Nelson NP, Murphy TV. Hepatitis A: the changing epidemiology of hepatitis A. Clinics in Liver 

Disease. 2013;2:227–230.

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. April 2014;18(Suppl 3):248–255. doi:10.1007/s10461-013-0670-2.

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

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

Infectious Diseases. 2012;55:1047–1055.

Spradling PR, Simons B, Narayanan M, et al. Incidence of diabetes mellitus in a populationbased cohort of persons with chronic hepatitis B virus infection. Journal of Viral Hepatitis. 

2013;20:510–513. 

Spradling PR, Xing J, Phippard A, et al. Acute viral hepatitis in the United States-Mexico border 

region: data from the Border Infectious Disease Surveillance (BIDS) Project, 2000–2009. 

Journal of Immigrant and Minority Health. April 2013;15(2):390–397. doi:10.1007/s10903-012-

9604-8.

Terrault NA, Dodge JL, Murphy EL, et al. Sexual transmission of hepatitis C virus among 

monogamous heterosexual couples: the HCV partners study. Hepatology. 2013;57(3):881–889. 

doi:10.1002/hep.26164.

Tohme RA, Xing J, Liao Y, Holmberg S. Hepatitis C testing, prevalence, and linkage to care 

among racial and ethnic minorities in the United States, 2009–2010. American Journal of Public 

Health. 2013;103:112–119.

Priority 4

Bender TJ, Sharapov U, Utah O, et al. Hepatitis B vaccine immunogenicity among adults 

vaccinated during an outbreak response in an assisted living facility—Virginia, 2010. Vaccine.

February 7, 2014;32(7):852–856. doi:10.1016/j.vaccine.2013.12.018. 

Centers for Disease Control and Prevention. Post-vaccination serologic testing results for 

infants aged ≤24 months exposed to hepatitis B virus at birth—United States, 2008–2011. 

Morbidity and Mortality Weekly Review. 2012;61:768–771. 

Cottrell EB, Chou R, Wasson N, Rahman B, Guise JM. Reducing risk for mother-to-infant 

transmission of hepatitis C virus: a systematic review for the U.S. Preventive Services Task 

Force. Annals of Internal Medicine. January 15, 2013;158(2):109–113.

Deng L, Zhong L, Struble E, et al. Structural evidence for a bifurcated mode of action in the 

antibody-mediated neutralization of hepatitis C virus. Proceedings of the National Academy of 

Sciences of the United States of America. April 30, 2013;110(18):7418–7422. 

doi:10.1073/pnas.1305306110. PMID: 23589879. 

Hoerger TJ, Schillie S, Wittenborn JS, et al. Cost-effectiveness of hepatitis B vaccination in 

adults with diagnosed diabetes. Diabetes Care. 2013;36:63–69.

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

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Appendix A. Citations of Publications by Priority Area

Honegger JR, Kim S, Price AA, et al. Loss of immune escape mutations during persistent HCV

infection in pregnancy enhances replication of vertically transmitted viruses. Nature Medicine. 

2013;19(11):1529–1533. doi:10.1038/nm.3351.

Liang TJ. Current progress in development of hepatitis C virus vaccines. Nature Medicine. 

2013;19(7):869–878. doi:10.1038/nm.3183.

Lu PJ, Byrd KK, Murphy TV. Hepatitis A vaccination coverage among adults 18–49 years 

traveling to a country of high or intermediate endemicity, United States. Vaccine. 2013;31(19):

2348–2357.

Schillie SF, Spradling PR, Murphy TV. Immune response of hepatitis B vaccine among persons 

with diabetes: a systematic review of the literature. Diabetes Care. 2012;35:2690–2697.

Spradling PR, Xing J, Williams R, et al. Immunity to hepatitis B virus (HBV) infection two 

decades after implementation of universal infant HBV vaccination: association of detectable 

residual antibodies and response to a single HBV challenge dose. Clinical and Vaccine 

Immunology. April 2013;20(4):559–561. doi:10.1128/CVI.00694-12.

Vaughan G, Rossi LM, Forbi JC, Purdy MA, Xia G, Khudyakov YE. Hepatitis A: host factors, 

molecular epidemiology, and evolution. Infection, Genetics, and Evolution. November 5, 

2013;21C:227–243. doi:10.1016/j.meegid.2013.10.023.

Zhou Z, Murphy TV. Which newborns missed the hepatitis B birth dose vaccination among U.S. 

children?. Preventive Medicine. November 2013;57(5):613–617. 

doi:10.1016/j.ypmed.2013.08.012.

Priority 5

Martin NK, Vickerman P, Grebely J, et al. Hepatitis C virus treatment for prevention among 

people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals. 

Hepatology. 2013;58(5):1598–1609.

Masson CL, Delucchi KL, McKnight C, et al. A randomized trial of a hepatitis care coordination 

model in methadone maintenance treatment. American Journal of Public Health. 2013;103(10): 

e81–e88.

Smith BD, Jewett A, Burt RD, Zibbell JE, Yartel AK, DiNenno E. “To share or not to share?”

Serosorting by hepatitis C status in the sharing of drug injection equipment among NHBS-IDU2 

participants. Journal of Infectious Disease. December 2013;208(12):1924–1942. 

doi:10.1093/infdis/jit520.

Taylor LE, Swan, T, Matthews GV. Management of hepatitis C virus/HIV coinfection among 

people who use drugs in the era of direct-acting-antiviral-based therapy. Clinical Infectious 

Disease. August 2013;57(Suppl 2):S118–S124.

Zeremski M, Zibbell JE, Martinez AD, Kritz S, Smith BD, Talal AH. Hepatitis C virus control 

among persons who inject drugs requires overcoming barriers to care. World Journal of 

Gastroenterology. November 28, 2013;19(44):7846–7851.

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Appendix A. Citations of Publications by Priority Area

Priority 6

Byrd KK, Lu P-J, Murphy TV. Hepatitis B vaccination coverage among health-care personnel in 

the United States. Public Health Reports. 2013;128:498–509.

Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for 

hepatitis B virus protection and for administering post-exposure management. Morbidity and 

Mortality Weekly Review. December 20, 2013;62(rr10):1–19. 

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

Federal Implementation Progress Report – 2013
Appendix B. Abbreviations

AAPCHO Association for Asian Pacific Community Health Organizations

AETC AIDS Education and Training Center (HRSA)

AHRQ Agency for Healthcare Research and Quality (HHS)

AAPI Asian-American or Pacific Islander

BPHC Bureau of Primary Health Care (HRSA)

CDC Centers for Disease Control and Prevention (HHS)

CDER Center for Drug Evaluation and Research (FDA)

CMCS Center for Medicaid and CHIP Services (CMS)

CMS Centers for Medicare & Medicaid Services (HHS)

CSAP Center for Substance Abuse Prevention (SAMHSA)

DAA direct-acting antiviral

DOJ U.S. Department of Justice

DVH Division of Viral Hepatitis (CDC)

ECHO Extension for Community Healthcare Outcomes

EHR electronic health record

FBOP Federal Bureau of Prisons (DOJ)

FDA Food and Drug Administration (HHS)

HAV hepatitis A virus

HBV hepatitis B virus

HCV hepatitis C virus

HEV hepatitis E virus

HHS U.S. Department of Health and Human Services

HIT health information technology

HRSA Health Resources and Services Administration (HHS)

HUD U.S. Department of Housing and Urban Development

IHS Indian Health Service (HHS)

IOM Institute of Medicine

LGBT Lesbian, Gay, Bisexual and Transgender

MSM men who have sex with men

NCD national coverage determination

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

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Appendix B. Abbreviations

NCHHSTP National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

NIH National Institutes of Health (HHS)

NVPO National Vaccine Program Office (HHS)

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

OMH Office of Minority Health (HHS)

ONDCP White House Office of National Drug Control Policy

OPTN Organ Procurement and Transplantation Network

OWH Office on Women’s Health (HHS)

PHBPP Perinatal HBV Prevention Program (CDC)

PHS U.S. Public Health Service

PWID people who inject drugs

RHA Regional Health Administrator

RRNP Regional Resource Network Program

SAMHSA Substance Abuse and Mental Health Services Administration

SCAN Specialty Care Access Network

TCE-HIV Targeted Capacity Expansion-HIV

TTCP Telehealth Training Centers Program

USPSTF U.S. Preventive Services Task Force

VA U.S. Department of Veterans Affairs

VHA Veterans Health Administration (VA)

VHAC Viral Hepatitis Action Coalition

VHAP Viral Hepatitis Action Plan

VHIG VHAP Implementation Group

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

Federal Implementation Progress Report – 2013
Federal Implementation Progress Report 

for the

Action Plan for the Prevention, Care & 

Treatment of Viral Hepatitis