Interagency Implementation Progress Report 

Year 1 

May 2011–April 2012 
This report was prepared under the direction of the Office of HIV/AIDS and Infectious Disease Policy 

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

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

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

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

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

and Mr. Steve Holman, MBA, all working under contract to OHAIDP, assisted OHAIDP staff in 

compiling and formatting the report. 

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

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

Infectious Diseases, HHS 

September 2012
Preface 

September 2012

Just over a year ago, in May 2011, it was my honor to release Combating the Silent Epidemic of Viral 

Hepatitis: Action Plan for the Prevention, Care, & Treatment of Viral Hepatitis (Action Plan), which 

presented robust and dynamic steps for improving viral hepatitis prevention and the care and treatment 

provided to infected persons. The Action Plan also helps move the nation toward achieving Healthy 

People 2020 goals, the first Healthy People initiative to include an objective for increasing viral hepatitis 

awareness among infected persons. 

In the year since the release of the Action Plan, an impressive array of actions has been undertaken by 

offices and agencies within the U.S. Department of Health and Human Services and by our colleagues 

at the Department of Justice’s Federal Bureau of Prisons and the Department of Veterans Affairs’

Veterans Health Administration. The Action Plan has fostered enhanced engagement and 

unprecedented collaboration of diverse partners across the federal government. Galvanized by the 

Action Plan, these federal partners have brought together expertise and tools to better coordinate our 

fight against this deadly disease. One important outcome is that we have generated significant 

awareness of the silent epidemic of viral hepatitis among both the public and health care providers. 

I want to commend and thank my colleagues from across the participating federal agencies who 

actively responded to the Plan’s ambitious call to action for better education, treatment, and prevention 

and who have all been working to implement the strategies detailed in the Action Plan. In particular, I 

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

representatives of 15 agencies and offices who have been conferring regularly over the past year to 

guide and advance implementation of the Action Plan and serving as advocates for the Action Plan 

within their respective agencies and offices. I would also like to thank Dr. Ronald Valdiserri, Deputy 

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

Infectious Disease Policy at the Department of Health and Human Services for his leadership on the 

efforts to implement the Action Plan. He and his team have been key to the progress that we have 

made during this first year of the Action Plan. 

In coming years, we shall build on the solid foundation established during this first year of Action Plan 

implementation, continuing to strengthen our cross-agency collaborations, sharpening the focus of our 

activities, and working to expand the reach of our programs. While the strategies and steps detailed in 

the Action Plan will continue to guide the federal efforts on viral hepatitis, to be successful in achieving 

our aims, the support and participation of nonfederal stakeholders is critical. State and local health 

departments, nonprofit education and advocacy organizations, pharmaceutical and diagnostics industry 

partners, medical and behavioral health care providers, and community advocates all play an important 

role in addressing viral hepatitis. We know that it will take new partnerships and creative strategies to 

meet the needs of all persons living with or at risk for viral hepatitis. Working together, we truly can be a 

nation committed to combating the silent epidemic of viral hepatitis. 

Sincerely yours, 

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

Assistant Secretary for Health 
Table of Contents

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

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

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

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

provide care and treatment to infected persons. ...................................................................... 1

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

prevention, care, and treatment. ............................................................................................... 7

Priority 2 Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer.................. 11

GOAL 2.1 Identify persons infected with viral hepatitis early in the course of their disease................... 11

GOAL 2.2 Link and refer persons infected with viral hepatitis to care and treatment. ............................ 14

GOAL 2.3 Improve access to and quality of care and treatment for persons infected with viral hepatitis.16

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

infected persons...................................................................................................................... 19

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

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

viral hepatitis transmission and disease. ................................................................................ 24

GOAL 3.2 Monitor viral-hepatitis-associated health disparities. .............................................................. 25

GOAL 3.3 Monitor provision and impact of viral hepatitis prevention, care, and treatment services...... 26

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

hepatitis surveillance............................................................................................................... 27

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

GOAL 4.1 Eliminate mother-to-child transmission of hepatitis B............................................................. 28

GOAL 4.2 Achieve universal hepatitis A and B vaccination for vulnerable adults................................... 29

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

their optimal use...................................................................................................................... 31

Priority 5 Reducing Viral Hepatitis Caused by Drug Use Behaviors..................................................... 33

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

treatment services................................................................................................................... 33

GOAL 5.2 Mobilize community resources to prevent viral hepatitis caused by injection drug use......... 35

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

prevent transmission and progression of disease. ................................................................. 36

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

correctional settings. ............................................................................................................... 36

GOAL 5.5 Advance research to improve prevention of viral hepatitis among persons who use drugs. . 37

Priority 6 Protecting Patients and Workers From Health Care-Associated Viral Hepatitis ................ 39

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

and drugs................................................................................................................................. 39

GOAL 6.2 Reduce iatrogenic transmission of viral hepatitis associated with blood, organs, and tissues.42

GOAL 6.3 Reduce occupational transmission of viral hepatitis............................................................... 43

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

care settings. ........................................................................................................................... 44

Appendix List of Abbreviations....................................................................................................................... i
Excerpt from Presidential Proclamation on World Hepatitis Day 2011 

My Administration has also released a comprehensive Action Plan 

for the Prevention, Care, and Treatment of Viral Hepatitis. The plan 

brings together expertise and tools across government to 

coordinate our fight against this deadly disease. Our goal is to 

reduce the number of new infections, increase status awareness 

among people with hepatitis, and eliminate the transmission of 

hepatitis B from mothers to their children. 

The first step toward achieving these goals is raising public 

awareness of this life-threatening disease. We must work to reduce 

the stigma surrounding hepatitis and to ensure that testing, 

information, counseling, and treatment are available to all who 

need it. The hard work and dedication of health care professionals, 

researchers, and advocates will help bring us closer to this goal .... 

I encourage citizens, government agencies, nonprofit 

organizations, and communities across the Nation to join in 

activities that will increase awareness about hepatitis and what we 

can do to prevent it. 

—President Barack Obama 

World Hepatitis Day Proclamation 

July 28, 2011 
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis I

Interagency Implementation Progress Report - Year 1

Background 

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

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

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

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

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

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

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

States, where as many as 5.3 million persons are living with chronic hepatitis B or C infection 

and millions more are at risk of infection. While viral hepatitis has been addressed by various 

federal research, prevention, care, and treatment programs, much of this work has been 

conducted independently, sometimes in isolation from other related efforts. Following the 

Institute of Medicine’s (IOM) 2010 report, Hepatitis and Liver Cancer, which recommended 

steps to reduce the threats posed by hepatitis B and hepatitis C, Dr. Howard Koh, Assistant 

Secretary for Health, convened an interagency workgroup composed of subject matter experts 

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

strategic viral hepatitis action plan that would:

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

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

are identified and provided care and treatment; and 

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

collaborations with other government agencies and nongovernmental organizations.

Critical input into the Action Plan was also provided by stakeholders from other federal

agencies; professional societies; and state, local, and community partners. The actions 

presented in the Action Plan represent efforts to be undertaken in calendar year 2011, 2012, or 

2013. Some of the actions outlined in the Plan can be accomplished by using existing resources 

through improved coordination and integration, while others are subject to the availability of 

funds.

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

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

convened a Viral Hepatitis Action Plan Implementation Group (VHIG) and charged it with 

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

comprises representatives from across HHS and other federal agencies and is chaired by Dr. 

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

VHIG have met numerous times over the first year of the Action Plan and served as point 

persons within their respective agencies and offices on matters related to the Action Plan. The 

VHIG also established a separate Education Work Group to coordinate focused activities 

related to patient and provider education on 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 II

Interagency Implementation Progress Report - Year 1 

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 

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

Viral Hepatitis Policy Advisor 

Agency for Healthcare Research and 

Quality 

William B. Baine, M.D. 

Senior Medical Advisor 

Center for Outcomes and Evidence 

Centers for Disease Control and Prevention 

John Ward, M.D. 

Director 

Division of Viral Hepatitis, National Center for 

HIV/AIDS, Viral Hepatitis, STD and TB 

Prevention 

Centers for Medicare & Medicaid Services 

Renee Henry, M.S.N., R.N. 

Health Insurance Specialist 

Division of Chronic and Post-Acute Care 

Quality Measurement and Health Assessment 

Group 

Office of Clinical Standards and Quality 

Department of Veterans Affairs 

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

Deputy Chief Consultant 

Clinical Public Health 

Office of Public Health 

Federal Bureau of Prisons 

Jeff Allen, M.D. 

Chief of Health Programs 

Michelle Williams, Pharm.D. 

Lieutenant, U.S. Public Health Service 

HIV/Hep C Program Manager 

Health Services Division 

Food and Drug Administration 

Peter Lurie, M.D., M.P.H. 

Senior Advisor 

Office of Policy, Planning, and Budget 

Health Resources and Services 

Administration 

Sarah Linde-Feucht, M.D. 

Chief Public Health Officer 

Indian Health Service 

Lisa Neel, M.P.H. 

Program Analyst, HIV Program 

National Institutes of Health 

Jay Hoofnagle, M.D. 

Director 

Liver Disease Research Branch, National 

Institute of Diabetes and Digestive and Kidney 

Diseases 

National Vaccine Program Office 

Jennifer Read, M.D., M.S., M.P.H., D.T.M.&H. 

Senior Scientist 

Office of Minority Health 

Sonsiere Cobb-Souza 

Director 

Division of Program Operations 

Office of the Surgeon General 

Kathy Byrd, M.D., M.P.H. 

Medical Epidemiologist 

Office of Women’s Health 

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

Regional Women’s Health Liaison 

Substance Abuse and Mental Health 

Services Administration 

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

Director 

Division of Pharmacologic Therapies 

Center for Substance Abuse Treatment 

White House Initiative on Asian Americans 

and Pacific Islanders 

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

HHS Liaison 

Interagency Implementation Team 
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis III 

Interagency Implementation Progress Report - Year 1 

Introduction 

This report features brief highlights of progress made during the first year of implementing the 

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

Office of HIV/AIDS and Infectious Disease Policy (OHAIDP), the report documents actions, as 

reported by the federal partners engaged in implementing the Action Plan, that were initiated 

and/or completed between May 2011 and April 2012. Note that this includes several agencies 

and offices that were not specifically tasked in the Action Plan but nonetheless are engaged in 

its implementation. This expanded participation enhances the cross-agency efforts to pursue the 

Action Plan’s goals. 

The Action Plan’s six priority areas are the organizing framework for this report. Within each 

priority area, the Action Plan established specific goals that are used to categorize the progress 

highlights reported by the participating agencies and offices. 

A list of acronyms and abbreviations used in this report is found in Appendix A for reference. 

Federal Partners in Implementing the Action Plan for the 

Prevention, Care and Treatment of Viral Hepatitis 

U.S. Department of Health and Human Services

 Agency for Healthcare Research and 

Quality 

 Centers for Disease Control and 

Prevention 

 Centers for Medicare & Medicaid Services 

 Food and Drug Administration 

 Health Resources and Services 

Administration 

 Indian Health Service 

 National Institutes of Health 

 National Vaccine Program Office 

 Office of HIV/AIDS and Infectious Disease 

Policy 

 Office of Minority Health 

 Office of the Assistant Secretary for 

Health 

 Office of the National Coordinator for 

Health Information Technology 

 Office of the Surgeon General 

 Office on Women’s Health 

 Substance Abuse and Mental Health 

Services Administration 

U.S. Department of Justice

 Federal Bureau of Prisons 

U.S. Department of Veterans Affairs

 Office of Public Health 
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 1

Interagency Implementation Progress Report - Year 1

Priority 1 Educating Providers and Communities to 

Reduce Health Disparities

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

diagnose viral hepatitis and provide care and treatment to 

infected persons.

Centers for Disease Control and Prevention (CDC)

2011 Actions

■ Assess medical and health education materials and programs on viral hepatitis and draft 

plans to improve quality and distribution.

Progress: CDC co-chaired the Education Work Group tasked with an OHAIDP initiated 

project to inventory, review, and post online all federally developed public and health care 

provider education materials related to viral hepatitis in collaboration with the VHIG. CDC led

work with the National Prevention Information Network (NPIN) to catalog and post the 

inventory online. A new banner for viral hepatitis was added to the NPIN page, highlighting 

that there are education materials available on the site. This effort was completed in

April 2012.

■ Work with academic institutions and educational organizations to develop and promulgate 

standardized viral hepatitis curricula for students in postgraduate medical, dental, nursing, 

physician’s assistant, alternative medicine, and other allied health schools.

Progress: CDC has funded the University of Alabama at Birmingham School of Public 

Health and Medical School to assess existing curricula in medical schools and will use the 

information to develop standardized content that can be integrated into existing training 

programs. This effort is in progress with an anticipated completion in September 2012. 

2012 Actions

■ Conduct qualitative and quantitative research designed to understand the knowledge, skills, 

abilities, and attitudes of providers with regard to prevention, care, and treatment of viral 

hepatitis.

Progress: CDC conducted a small qualitative research study on primary care providers’

attitudes about testing for viral hepatitis. This effort was completed in May 2011.

■ Work with specialty medical organizations (e.g., the Infectious Diseases Society of America 

(IDSA), the American Association for the Study of Liver Diseases (AASLD)) to develop and 

disseminate guidelines for the evaluation, management, and treatment of viral hepatitis.

Progress: CDC has funded the University of Washington at Seattle to work with 

International Antiviral Society to develop and disseminate Web-based training modules for 

the evaluation, management, and treatment of viral hepatitis. This effort is in progress with 

an anticipated completion in September 2012.
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

Federal Bureau of Prisons (FBOP)

2011 Action

■ Assess medical and health education materials and programs on viral hepatitis and draft 

plans to improve quality and distribution.

Progress: FBOP updated its Clinical Practice Guidelines for Evaluation and Treatment of 

Hepatitis C and Cirrhosis to include the use of hepatitis C virus (HCV) protease inhibitors in 

the treatment of chronic HCV genotype 1 infection and provided it to all FBOP health care 

providers. In addition, the updated guidelines are available to the general public and to 

federal inmates through established procedures. Other documents were updated to

standardize and better facilitate the process for evaluating the appropriateness of hepatitis C 

treatment for the patient and to aid in the review of pertinent material which aims to improve 

patient outcomes. These activities were completed in March 2012.

Health Resources and Services Administration (HRSA)

2011 Actions

■ Assess medical and health education materials and programs on viral hepatitis and draft 

plans to improve quality and distribution.

Progress: HRSA has assessed relevant materials available from the various HRSA bureaus 

and offices, including online and printed resources, and has shared them with NPIN for 

inclusion in the inventory of federal materials on viral hepatitis for patients and providers.

Relevant materials have been shared and are now available via NPIN.

HRSA is working with and supporting CDC in the creation of a viral hepatitis curriculum, 

which, once available, HRSA will disseminate through its grantees, listservs, and networks.

To aid in this effort, within HRSA, the Office of Global Health Affairs (OGHA) will review the 

Action Plan and create a supporting document that highlights the state of viral hepatitis in 

the U.S. Affiliated Pacific Islands (USAPI). An overview of the state of viral hepatitis in the 

USAPI is anticipated to be completed by August 2012. OGHA will develop cultural 

awareness materials to assist with the development of curriculum and training materials for 

providers in the USAPI. OGHA will also create a database containing USAPI viral hepatitis 

resources and HRSA resources to assist in the response to viral hepatitis in the USAPI. To 

help with the overarching development and quality of the educational curriculum and 

materials, OGHA will provide information specifically on the state of viral hepatitis in the 

USAPI. These efforts are in progress with an anticipated completion in April 2013.

■ Train all health care providers in HHS-sponsored clinical programs (e.g., Federally Qualified 

Health Centers and clinics receiving funds associated with the Ryan White Comprehensive 

AIDS Resources Emergency (CARE) Act) to deliver viral hepatitis vaccination, early 

detection, testing, management of alcohol and other cofactors, and treatment.

Progress: In January 2012, HRSA held a national Webinar on viral hepatitis B and C with 

health center grantees, primary care associations, and national organizations. Topics 

covered included viral hepatitis epidemiology, hepatitis treatment guidelines, the Action 
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

Plan, care and treatment of hepatitis B for Asian and Pacific Islander populations, hepatitis 

C care and treatment for homeless individuals, and the Project Extension for Community 

Healthcare Outcomes (ECHO) telehealth models of expanding capacity to deliver hepatitis 

care. In addition, between July 1, 2010, and June 30, 2011, the Ryan White AIDS Education 

and Training Centers (AETC) provided 3,572 trainings across the Nation focusing on 

hepatitis, with 34,396 health care providers trained. Thirty-five percent of those trainees 

(more than 7,000 providers) were nurses or advanced practice nurses, and 16 percent 

(more than 3,000 providers) were physicians. Forty-one percent of all providers trained on 

hepatitis topics were minorities, including Blacks, Asians, and Hispanics.

■ Work with academic institutions and educational organizations to develop and promulgate 

standardized viral hepatitis curricula for students in postgraduate medical, dental, nursing, 

physician’s assistant, alternative medicine, and other allied health schools.

Progress: HRSA, primarily through the Bureau of Primary Health Care (BPHC) and the 

HIV/AIDS Bureau (HAB), is working with and supporting CDC and others in the creation of a 

viral hepatitis curriculum, which, once available, HRSA will disseminate through its grantees, 

listservs, and networks.

2012 Actions

■ Conduct qualitative and quantitative research designed to understand the knowledge, skills, 

abilities, and attitudes of providers with regard to prevention, care, and treatment of viral 

hepatitis.

Progress: HRSA lacks the resources to conduct such research. HRSA is willing to partner 

with stakeholder groups who may be able to conduct such research.

■ Develop clinical decision aids as a component of electronic medical records (EMR) to 

support appropriate prevention, care, and treatment related to viral hepatitis.

Progress: HRSA is implementing EMRs and meaningful use in stages across all Federally 

Qualified Health Centers and Ryan White Part C Grantees. When clinical decision aids are 

available, HRSA will support their use in the EMRs. This effort is currently in progress with 

an anticipated completion in December 2013.

■ Work with specialty medical organizations (e.g., IDSA, AASLD) to develop and disseminate 

guidelines for the evaluation, management, and treatment of viral hepatitis.

Progress: HRSA worked closely with the National Institutes of Health to ensure that the 

HHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and 

Adolescents were updated to include drug-drug interactions between directly acting agents 

for HCV treatment and antiretrovirals. The updated guidelines are posted on AIDSinfo 

(www.aidsinfo.nih.gov) and were disseminated via the HAB biweekly e-mail to grantees, the 

HAB weekly update to project officers, and the AETCs to Ryan White providers. HRSA 

remains involved in the review and updating of the guidelines, including the section on 

HIV/HCV co-infection.
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

HRSA has disseminated AASLD guidelines to health center project officers. The AASLD 

guidelines were also shared with grantees during the national Webinar on viral hepatitis, 

referenced previously. When further guidelines, programs, educational materials, and tools 

are available, HRSA will disseminate through its networks. This effort is ongoing.

Indian Health Service (IHS)

2011 Action

■ Train all health care providers in HHS-sponsored clinical programs (e.g., Federally Qualified 

Health Centers and clinics receiving funds associated with the Ryan White CARE Act) to 

deliver viral hepatitis vaccination, early detection, testing, management of alcohol and other 

cofactors, and treatment.

Progress: IHS has undertaken a number of provider training activities focusing on viral 

hepatitis, including the following: 

□ In December 2010, the IHS National HIV/AIDS Program began a partnership with the 

Office of Minority Health Resource Center and the Seattle Indian Health Board to 

develop a training series integrating HIV and hepatitis services in urban settings to be 

completed in late 2012.

□ Since 1999, the Alaska Native Tribal Health Consortium (ANTHC) Web site has provided 

information for providers on managing hepatitis B and C patients. This includes protocols 

on treating patients with acute and chronically elevated liver function tests. These 

resources are updated quarterly and the next update is planned for completion by June 

2012.

□ IHS is finalizing plans to expand trainings for providers on hepatitis and HIV care 

integration. Beginning in August 2012, IHS will launch an expanded partnership with the 

University of California San Francisco HIV Care Warmline to provide focused technical 

assistance to HIV providers in the IHS system to enhance viral hepatitis integration in 

IHS facilities.

□ Finally, the IHS has a goal to certify all obstetric hospitals as Baby-Friendly by 

December of 2013. The Baby-Friendly® Hospital Initiative (BFHI) is a quality 

improvement effort to increase breastfeeding rates, thereby creating a healthy start on 

life and preventing childhood obesity. The Initiative is a global effort to implement 

practices that protect, promote, and support breastfeeding. The Ten Steps to Successful 

Breastfeeding outline what facilities should do as they seek certification. Included in this 

process is the education of facility employees on appropriate considerations for hepatitis 

A, B, and C in relation to breastfeeding. Online BFHI staff education is available for IHS 

employees to support dissemination of these practices.

All these efforts are ongoing.
Priority 1: Educating Providers and Communities to Reduce Health Disparities

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 5

Interagency Implementation Progress Report - Year 1

National Institutes of Health (NIH)

2011 Action

■ Work with academic institutions and educational organizations to develop and promulgate 

standardized viral hepatitis curricula for students in postgraduate medical, dental, nursing, 

physician’s assistant, alternative medicine, and other allied health schools.

Progress: NIH is providing expert advice; however, this initiative is being led by CDC.

2012 Action

■ Work with specialty medical organizations (e.g., IDSA, AASLD) to develop and disseminate 

guidelines for the evaluation, management, and treatment of viral hepatitis.

Progress: Guidelines for therapy of hepatitis C (genotype 1) were published by AASLD in 

October 2011 (Hepatology, 54(4), 1433–1443). The guidelines were developed with 

significant input from staff of the Intramural Research Program of the National Institute of 

Diabetes and Digestive and Kidney Diseases (NIDDK). These guidelines were widely 

disseminated and are available on the AASLD Web site. Guidelines for hepatitis C care will 

evolve quickly as new agents are approved in the next 1–5 years. Additionally, NIH 

representatives, including ones from the National Institute of Allergy and Infectious Diseases 

(NIAID) and the Eunice Kennedy Shriver National Institute of Child Health and Human 

Development (NICHD), participated in developing updated HHS guidelines for antiretroviral 

use in HIV-infected persons, including hepatitis B virus (HBV)-co-infected individuals. The 

guidelines for adults and adolescents were released in April 2012 

(http://www.aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0/); 

for infants and children, in August 2011 

(http://www.aidsinfo.nih.gov/guidelines/html/2/pediatric-treatment-guidelines/0/); and for 

pregnant women, in September 2011 

(http://www.aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/). NIH representatives, 

including ones from NIAID and NICHD, are also participating in developing updated 

guidelines for prevention and treatment of opportunistic infections such as viral hepatitis in 

HIV-infected adolescents and adults (release expected in October or November 2012) and 

in HIV-infected and -exposed children (release expected in August 2012).

Office of the Assistant Secretary for Health (OASH)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, OASH’s 

OHAIDP undertook several activities in support of it, including the following:

OHAIDP co-chaired the Education Work Group and initiated a project to inventory, review, and 

post online all federally developed public and health care provider education materials related to 

viral hepatitis in collaboration with the VHIG. This effort was completed in April 2012.

OASH presented during a number of national and international conferences to increase 

awareness of the Action Plan; the work of HHS and federal partners to implement the Action 

Plan; and the need to better prepare the health care workforce to prevent, diagnose, and 

provide care and treatment to persons infected with viral hepatitis. These conferences have 
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

included the annual meeting of the American Association for the Study of Liver Disease and the 

International Conference on Viral Hepatitis (International Association of Physicians in AIDS 

Care). These efforts are ongoing.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2011 Action

■ Begin implementation of the viral hepatitis educational curriculum in drug-treatment centers 

(e.g., Addiction Technology Transfer Centers (ATTC)) to educate providers serving priority 

populations.

Progress: SAMHSA’s 14 ATTCs have begun developing and implementing curricula that 

address hepatitis screening and prevention activities. Additionally, SAMHSA’s project to 

Enhance Substance Abuse Treatment Services to Promote Healthy Lifestyles through 

Addressing Hepatitis Infection among Intravenous Drug Users (IDU) has provided hepatitis 

A virus (HAV)/HBV vaccine and HCV test kits to opioid treatment programs (OTP) that treat 

primarily racial- and ethnic-minority populations with HIV or at risk for exposure to hepatitis 

infection. In December 2011, a best-practices Treatment Improvement Protocol (TIP), 

Addressing Viral Hepatitis in People with Substance Use Disorders (SUD), was published 

and publicized through SAMHSA’s March 2012 blog post. All 1,260 SAMHSA-certified OTPs 

were made aware of the TIP. These efforts are ongoing.

2012 Action

■ In collaboration with behavioral, mental health, and social service provider organizations, 

networks, and groups, develop and disseminate training materials and programs on viral 

hepatitis prevention, care, and treatment.

Progress: SAMHSA’s Center for Substance Abuse Treatment (CSAT) participated in 

meetings of the Federal Training Centers Collaborative (FTCC) to increase knowledge of

HIV, hepatitis, and substance abuse. SAMHSA provided information to the FTCC on 

substance abuse and hepatitis. In addition, CSAT provided grants to 17 medical residency 

programs across the country responsible for formulating and disseminating screening, brief 

intervention, and referral to treatment (SBIRT) technology through curriculum development 

and training of local communities in SBIRT implementation. The curricula address the 

intersection between injection drug use and hepatitis. These efforts are ongoing.

Department of Veterans Affairs (VA)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, VA 

undertook several activities in support of it, including the following:

VA conducts a bimonthly Webinar series open to all hepatology and infectious disease clinical 

teams, primary care teams, and mental health and SUD providers from VA medical centers on 

best practices and standards of care in hepatitis care and treatment. This activity started in 2010 

and will be ongoing through fiscal year (FY) 2013.
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

VA conducted a 300-person face-to-face meeting for frontline VA clinicians providing HCV care 

in September 2011 to educate providers on prescribing new triple therapy for HCV and 

managing patients on treatment. Participation at this meeting included representatives from 

CDC and FBOP.

VA is providing specific training for both pharmacists and mental health professionals in 

hepatitis care. Pharmacists are currently being trained at regional “boot camps.” VA has 

provided specialized training for 340 clinical pharmacists in hepatitis C care since May 2011.

The face-to-face meetings will continue into FY 2013. The goal of these activities is to increase 

the number of hepatitis C treaters and to establish well-trained multidisciplinary teams to care 

for Veterans with hepatitis C.

VA is also developing an HIV/HCV Psychology Postdoctoral Fellowship Program, designed to 

train clinical psychologists to manage the unique mental health and substance use 

comorbidities frequently found in patients infected with HIV and/or HCV. VA has hired a director 

of the program and funded four new positions for HIV/HCV Psychology Postdoctoral Fellow for 

FY 2013–2015.

All of these efforts are ongoing.

GOAL 1.2 Decrease health disparities by educating communities about 

the benefits of viral hepatitis prevention, care, and treatment.

Centers for Disease Control and Prevention (CDC)

2011 Actions

■ Conduct formative research with populations at risk for HBV and HCV infection to 

understand knowledge, attitudes, and behaviors related to testing, care, and treatment of 

chronic viral hepatitis.

Progress: CDC has conducted formative research with populations at risk for HCV infection 

with the goal of understanding their knowledge, attitudes, and behaviors related to testing 

for chronic viral hepatitis. This effort was completed in 2011.

■ Develop a national educational campaign and pre-test campaign materials with members of 

the target audience.

Progress: CDC has developed and pre-tested materials for the Know More Hepatitis 

campaign to encourage those at risk for chronic HCV to get tested. Plans have been 

developed to launch the first phase of this campaign in May 2012. CDC is planning on a 

national education campaign targeting Asian Americans and will conduct the associated 

formative research in 2013. These efforts are in progress and will continue through the 

remainder of 2012 and into 2013.
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

2012 Actions

■ Launch a pilot project in several U.S. cities to create and test educational messages, 

materials, and strategies to be used for a national campaign.

■ Partner with regional, state, local, and tribal organizations for the planning and 

implementation of a national education campaign.

■ Award community grants designed to reach specific at-risk populations with culturally 

sensitive and linguistically appropriate evidence-based interventions.

Progress: Limited resources within the CDC have prohibited the launch of a pilot campaign 

as well as the issuing of community grants to educate at risk populations.

■ Collaborate with federal partners, private industry, and the media to designate May 19 as 

Hepatitis Testing Day in the United States.

Progress: A variety of activities have been planned to support May 19 as Hepatitis Testing 

Day. This effort is in progress with an anticipated completion in May 2012.

Indian Health Service (IHS)

2011 Action

■ Develop a national educational campaign and pre-test campaign materials with members of 

the target audience.

Progress: The IHS National HIV/AIDS Program is planning to disseminate appropriate 

Know More Hepatitis materials and messages from the CDC campaign. In addition, IHS is in 

the process of implementing two youth-centered health education programs inclusive of 

hepatitis prevention messages: one in partnership with the Office of Adolescent Health, the 

Office of Minority Health Resource Center, and CDC and another in partnership with Project 

Red Talon and CDC. These efforts are in progress with an anticipated completion in

December 2013. The IHS National HIV/AIDS Program will also develop, in partnership with 

a viral hepatitis treatment team, broad-audience promotional materials to increase coinfection status awareness, knowledge, and care among clinicians as well as expanded 

materials for co-infected patients. All products will be tested during development. This effort 

will be initiated in November 2012.

National Institutes of Health (NIH)

2012 Action

■ Spur development of an annual global forum to promote communication and collaboration 

among diverse stakeholders (e.g., health ministries, nongovernmental organizations, 

academia, and industry).

Progress: NIH (specifically NIDDK and NIAID) held a research workshop on hepatitis E in 

the United States in March 2012 with participants reporting on findings throughout Asia, 

Europe, and the United States, as well as participation from the Food and Drug 

Administration (FDA), CDC, VA, the American Red Cross, and private industry. Several NIH 
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

Institutes and centers are planning national or international workshops on topics related to 

viral hepatitis, such as a meeting on alcohol, viral hepatitis, and pancreatitis to be sponsored 

by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in September 2012 in 

Beijing, China.

NIH, through NIDDK and NIAID, also provides educational materials to promote public 

awareness about viral hepatitis, including awareness in at-risk groups, and highlighted 

related research and educational efforts pertaining to Hepatitis Awareness Month and World 

Hepatitis Day in May 2012, through the Web, social media, and other communication 

outlets. These efforts are ongoing.

NIH does education, outreach, and screening activities. Research on these areas also is 

conducted.

Office of Minority Health (OMH)

2011 Action 

■ Continue to promote May as “Hepatitis Awareness Month” in the United States and work 

with the media to communicate timely viral hepatitis messages.

Progress: As part of the official launch of Hepatitis B United, OMH, along with CDC and 

OHAIDP, presented on a Webinar with hepatitis B leaders and advocates on March 27, 2012,

to promote partnership opportunities for the May 2012 national observance of Hepatitis 

Awareness Month. OMH highlighted the viral hepatitis related dimensions of the HHS Plan for 

Asian-American, Native Hawaiian, and Pacific Islander (AANHPI) Health and the National 

Partnership for Action. OMH has partnered with CDC to promote Hepatitis Awareness Month 

and increase awareness of perinatal transmission of hepatitis B from mother to child. These 

efforts are in progress with an anticipated completion in May 2012.

Office of the Surgeon General (OSG)

2011 Action

■ Continue to promote May as Hepatitis Awareness Month in the United States and work with 

the media to communicate timely viral hepatitis messages.

Progress: OSG published a “Surgeon General’s Perspective” column on Hepatitis Testing 

Day and the importance of testing in the May–June 2012 issue of the journal Public Health 

Reports. This activity was completed in April 2012.
Priority 1: Educating Providers and Communities to Reduce Health Disparities

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

Interagency Implementation Progress Report - Year 1

Office on Women’s Health (OWH)

2012 Action

■ Continue to promote May as “Hepatitis Awareness Month” in the United States and work 

with the media to communicate timely viral hepatitis messages.

Progress: OWH has made plans to integrate hepatitis prevention into National Women’s 

Health Week (May 13–19, 2012) activities, including prominent display on the OWH Web 

page of hepatitis education information and promotion of Hepatitis Testing Day (May 19) as 

well as the forthcoming online viral hepatitis risk assessment tool from CDC. These efforts 

are in progress with an anticipated completion in May 2012.

Department of Veterans Affairs (VA)

2011 Actions

■ Develop a national educational campaign and pre-test campaign materials with members of 

the target audience.

■ Continue to promote May as Hepatitis Awareness Month in the United States and work with 

the media to communicate timely viral hepatitis messages.

Progress: VA is developing public health messaging to increase awareness of viral 

hepatitis among Veterans and VA staff across the system. VA is partnering with the CDC, in 

particular their Know More Hepatitis campaign, which will be adopted for VA dissemination.

This effort is in progress with an anticipated completion in May 2012.
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 11

Interagency Implementation Progress Report - Year 1

Priority 2 Improving Testing, Care, and Treatment to 

Prevent Liver Disease and Cancer

GOAL 2.1 Identify persons infected with viral hepatitis early in the 

course of their disease.

Agency for Healthcare Research and Quality (AHRQ)

2011 Action

■ Support U.S. Preventive Services Task Force (USPSTF) efforts to update guidelines for 

hepatitis C testing and treatment.

Progress: AHRQ is directed by statute to convene the USPSTF and to provide ongoing 

scientific, technical, and administrative support. In compliance with this requirement, AHRQ 

commissioned two Evidence-Based Practice Center (EPC) systematic evidence reports on 

HCV screening and treatment. AHRQ provided these reports to the USPSTF to assist the

members in updating their recommendation on screening for hepatitis C infection. The

USPSTF is expected to publish a draft recommendation statement on screening for hepatitis 

C in adults for public comment in the autumn of 2012. AHRQ has also ensured that experts 

from across HHS have been kept abreast of the progress of the USPSTF. AHRQ has posted

draft EPC evidence reports on Screening for Hepatitis C Virus Infection in Adults and

Treatment for Hepatitis C Virus Infection in Adults: A Comparative Effectiveness Review on 

its Internet site (http://www.uspreventiveservicestaskforce.org/uspstf/uspshepc.htm). The 

final recommendation statement is expected to be posted in June 2013.

2012 Action

■ Develop and implement performance measures for hepatitis testing in HHS-sponsored 

health programs (e.g., community health centers, IHS clinics, HIV test sites).

Progress: AHRQ helped support a serial cross-sectional evaluation of the Hepatitis C 

Assessment and Testing Project (HepCAT). The HepCAT consists of two community-based 

interventions designed to increase HCV testing in urban primary care clinics in comparison 

with a baseline period. The first intervention (risk-based screener) prompted physicians to 

order HCV tests based on the presence of HCV-related risks. The second intervention (birth 

cohort) prompted physicians to order HCV tests on all patients born within a high-prevalence 

birth cohort (1945–1964).
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

Centers for Disease Control and Prevention (CDC)

2011 Action

■ Revise CDC guidelines for hepatitis C testing and linkage to care and treatment.

Progress: CDC drafted and cleared recommendations for one-time HCV testing of persons 

born between 1945 and 1965. As of April 2012, the document is going through HHS review 

and clearance. CDC will issue a request for public comment in the Federal Register, on the 

revised recommendations, likely in May 2012. This activity is in progress with an anticipated 

completion in July 2012 and publication of the revised guidelines in the Morbidity and 

Mortality Weekly Report.

2012 Action

■ Strengthen community-based programs providing testing and linkages to care, particularly 

those serving foreign-born populations.

Progress: CDC has begun a demonstration project aimed at identifying and targeting 

foreign-born populations from hepatitis B endemic countries who reside in the United States 

for screening, vaccination, and referral for care. Project sites in Philadelphia, PA, and 

Seattle, WA, have been identified, with three community-based organizations (CBO) 

participating in the demonstration project (the Hepatitis B Foundation in Philadelphia and the 

Hepatitis B Coalition and the Hepatitis Education Project in Seattle). Screening will begin in 

summer 2012 with an anticipated completion in August 2013.

Health Resources and Services Administration (HRSA)

2012 Action

■ Promote HHS-recommended viral hepatitis testing as a standard of care in all federally 

sponsored primary care programs (e.g., community health centers, IHS clinics).

Progress: HRSA has presented on the cross-agency Action Plan in national meetings for 

health centers and Primary Care Associations. Additionally, the AASLD Practice Guidelines 

have been disseminated to all Health Center Program project officers

Office of Minority Health (OMH)

2012 Action

■ Strengthen community-based programs providing testing and linkages to care, particularly 

those serving foreign-born populations.

Progress: OMH, in collaboration with the Association of Asian Pacific Community Health 

Organizations, conducted monthly calls with 20 organizations representing 10 cities with the 

highest concentration of AANHPI populations to work on hepatitis B activities. OMH 

developed a process to award 8–10 mini-grants to CBOs in cities with high concentrations of 

AANHPIs to replicate a city- and countywide model similar to San Francisco Hepatitis B 

Free in August 2012. The Hepatitis B United coalition, which includes HHS federal partners 
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 13

Interagency Implementation Progress Report - Year 1

such as OHAIDP, CDC, and OMH, will provide support and technical assistance to the

funded CBOs. These efforts are ongoing and will continue through 2012.

Office of the Assistant Secretary for Health (OASH)

2011 Action 

■ To the extent possible, coordinate across agencies to ensure that guidelines for hepatitis B 

and hepatitis C testing, care, and treatment are aligned.

Progress: OHAIDP is working with the CDC Division of Viral Hepatitis (DVH) regarding the 

anticipated update to the CDC hepatitis C screening guidelines and with staff from AHRQ 

who work with the USPSTF regarding the current review of the USPSTF hepatitis C 

screening recommendations. OHAIDP is coordinating efforts to assess and coordinate 

materials and guidelines for viral hepatitis through VHIG, the federal cross-agency 

workgroup coordinating collaborative activities to implement and monitor the Action Plan.

The CDC HCV screening guidelines are expected to be final in summer 2012 and the 

USPSTF HCV screening recommendations are expected to be final in 2013.

2012 Action

■ Develop a cross-agency process for identifying and eliminating barriers to the 

implementation of viral hepatitis testing and linkage of infected patients to care and 

treatment.

Progress: OHAIPD conducted a 1-day technical consultation with a group of approximately 

45 experts and stakeholders on February 23, 2012, to examine approaches for implementing 

routine hepatitis B and C testing in health departments, jails and prisons, community health 

centers, and other primary care settings and CBOs. The consultation highlighted barriers, 

strategies, best practices, and models regarding implementation of routine testing for viral 

hepatitis. A final report from the consultation will be released in May 2012.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2012 Action

■ Implement HHS-recommended viral hepatitis testing as a standard of care in drug

treatment programs.

Progress: SAMHSA’s TIP, Addressing Viral Hepatitis in People with Substance Use 

Disorders, was finalized and released in February 2012. The CSAT discretionary HIV 

grantees, SAMHSA-certified OTPs, and State Substance Abuse Authorities were notified 

and made aware of recommendations pertaining to drug treatment. Plans are currently 

underway to implement recommendations outlined in the TIP.

The CSAT-funded ATTC for HIV, Hepatitis, and Substance Abuse conducted a conference 

on street-level intervention strategies for addiction, HIV/AIDS, and hepatitis on October 17–

19, 2011, in Silver Spring, MD. The conference featured information on hepatitis testing in 
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

substance abuse programs such as SAMHSA-certified OTPs (more than 1,250) that treat 

many individuals who are injecting or have injected drugs in the past.

An OTP medical education training course curriculum was reviewed by CSAT and will be 

revised to include additional information on HCV screening and testing and preventive 

services. An effort was initiated to revise OTP accreditation guidelines including sections on 

hepatitis prevention and referral services. All OTPs must be accredited and these guidelines 

help shape OTP infectious disease practices.

Department of Veterans Affairs (VA)

2012 Action

■ Implement data elements (e.g., those concerning disease staging, hepatocellular carcinoma 

monitoring, comorbidity management) in EMRs to monitor hepatitis testing, care, and 

treatment in health care settings.

Progress: VA has clinical reminders available (a prompt in the EMR) to remind primary care 

teams to offer HCV screening and testing as indicated. These reminders have been in use 

for many years. In 2012, VA revisited the clinical reminder and has encouraged VA medical 

centers to increase use of the HCV clinical reminder.

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

treatment.

Centers for Disease Control and Prevention (CDC)

2012 Action

■ Identify and disseminate best practices for the prompt linkage of persons testing positive for 

viral hepatitis to needed care and treatment.

Progress: CDC began development of linkage to care interventions and will be formatively 

and rigorously evaluated over the next 2 years and completed by 2013.

Centers for Medicare & Medicaid Services (CMS)

2012 Actions

■ Identify opportunities (e.g., those afforded by the Affordable Care Act) to improve the 

provision and coordination of comprehensive viral hepatitis services in public and private 

health plans.

Progress: CMS Medicare currently covers hepatitis B vaccines and their administration for 

certain beneficiaries at intermediate or high risk of contracting hepatitis B under Medicare 

Part B. Medicare also provides drug and vaccine coverage under Parts C and D. Part D 

drug coverage has become more affordable with coverage in the gap as provided by the 

Affordable Care Act. This effort is ongoing.
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 15

Interagency Implementation Progress Report - Year 1

■ Identify Medicaid options (e.g., Section 1115 waivers, health homes) to improve outreach 

and care coordination for HBV-infected women and their household contacts.

Progress: CMS’s Centers for Medicaid and Children’s Health Insurance Program Services 

and CDC have met to discuss this and determine how to leverage our authorities to 

effectively carry out this action. This activity is ongoing.

Federal Bureau of Prisons (FBOP)

2012 Action

■ Develop and implement effective medical management models for use in priority 

populations.

Progress: In March 2012, FBOP published updated Clinical Practice Guidelines for 

Evaluation and Treatment of Hepatitis C and Cirrhosis to include the use of HCV protease 

inhibitors in treatment of chronic HCV genotype 1 infection. Other documents were updated 

to standardize and better facilitate the process for evaluating the appropriateness of 

hepatitis C treatment for the patient and to aid in the review of pertinent material that aims to 

improve patient outcomes. These action items are supplementary to the already established 

protocols of identifying inmates with hepatitis, upon intake, to be placed in chronic care 

clinics where they are routinely evaluated and managed as indicated. In addition, at intake 

and at other periods while incarcerated, risk factors for hepatitis are assessed, and 

appropriate hepatitis screening is conducted, as indicated in the FBOP Preventive Health 

Care Guidelines.

Health Resources and Services Administration (HRSA)

2012 Actions

■ Create databases of testing and care referral services available in local areas.

Progress: HRSA was not able to initiate this action due to lack of resources.

■ Develop and implement effective medical management models for use in priority populations.

Progress: In FY 2011, HAB, through the Special Projects of National Significance program, 

awarded grants to 29 organizations across two separate cohorts (14 continuation and 15 

new awards) to implement focused model interventions designed to increase access to and 

completion of HCV treatment for HIV-positive patients in Ryan White HIV/AIDS program 

funded clinical settings.

HRSA also funded an Evaluation and Technical Assistance Center (ETAC) to provide 

clinical training and technical assistance on the implementation of HCV treatment models for 

patients within Ryan White-funded HIV primary care programs, conduct a rigorous 

evaluation of the demonstration models, and disseminate findings and lessons learned from 

implemented demonstration models. The ETAC will continue to provide clinical consultation 

through monthly multisite webinars. In addition, the ETAC will continue to assess the 

effectiveness, feasibility, and costs of the service delivery model for which each 

demonstration site is funded. From these assessments, the ETAC will identify which 
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

model(s) of patient care best served HIV/HCV co-infected patients within a diverse set of 

communities and publish the findings with the goal of creating a replicable and sustainable 

model for integrating HCV treatment into Ryan White programs.

HAB was awarded the HHS Secretary’s Minority AIDS Initiative funds in 2012 to expand the 

number of Telehealth Training Centers from three to nine starting in summer 2012. These 

multiyear projects target low volume providers to build capacity to identify and treat HIV with 

expansion focusing on hepatitis to be implemented throughout all AETC Telehealth Training 

Centers.

These efforts are in progress and ongoing.

Indian Health Service (IHS)

2012 Actions

■ Identify and disseminate best practices for the prompt linkage of persons testing positive for 

viral hepatitis to needed care and treatment.

Progress: IHS facilities utilized telemedicine networks managed by the University of New 

Mexico (ECHO) and ANTHC (LiverConnect) to improve the care and treatment of persons 

living with hepatitis. The network of telemedicine doctors, nurses, and pharmacists has built

a strong foundation for care and treatment in IHS sites. The results of a consensus 

conference in 2012 included a panel of experts representing OB/GYNs and other primary 

care providers and included the development of a simple algorithm for providers who care 

for pregnant women to provide prenatal screening and identify pregnant women who are

hepatitis B surface antigen positive (HBsAg+). This protocol will be published in an OB/GYN 

journal in the spring of 2012.

GOAL 2.3 Improve access to and quality of care and treatment for 

persons infected with viral hepatitis.

Centers for Medicare & Medicaid Services (CMS)

2012 Action

■ Establish clinical quality measures to monitor performance.

Progress: CMS’s Physician Quality Reporting System (PQRS) currently has nine measures 

related to hepatitis C that physicians and other eligible professionals can report in the PQRS 

Incentive Program. The measures include the following: (1) Testing for Chronic Hepatitis C:

Confirmation of Hepatitis C Viremia, (2) Hepatitis C: RNA Testing Before Initiating 

Treatment, (3) Hepatitis C: HCV Genotype Testing Prior to Treatment, (4) Hepatitis C: 

Antiviral Treatment Prescribed, (5) Hepatitis C: HCV RNA Testing at Week 12 of Treatment,

(6) Hepatitis C: Counseling Regarding Risk of Alcohol Consumption, (7) Hepatitis C: 

Counseling Regarding Use of Contraception Prior to Antiviral Therapy, (8) Hepatitis C: 

Hepatitis A Vaccination in Patients with HCV, and (9) Hepatitis C: Hepatitis B Vaccination in 

Patients with HCV.
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 17

Interagency Implementation Progress Report - Year 1

Health Resources and Services Administration (HRSA)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, HRSA 

undertook several activities in support of it, including the following: 

HRSA, along with SAMHSA, cosponsors the Center for Integrated Health Solutions (CIHS) to 

integrate behavioral health and primary care. In 2012, CIHS will develop resources for the 

prevention of hepatitis C. BPHC has ongoing discussions with homeless grantees and the 

National Health Care for the Homeless Council (a BPHC national cooperative agreement) on 

hepatitis prevention.

Hepatitis C and homelessness were highlighted in a Webinar in January 2012 to a national 

audience of health center grantees, primary care associations, national cooperative 

agreements, and BPHC staff. BPHC has been in discussion with Project ECHO on integrating 

behavioral health providers in the treatment team for hepatitis C. Project ECHO was highlighted 

in the national Webinar on viral hepatitis.

Indian Health Service (IHS)

2012 Action

■ In accordance with clinical quality measures, develop clinical decision schema and other 

tools to ensure quality care for patients living with viral hepatitis.

Progress: In February 2011, LiverConnect was launched. It is updated bimonthly. This is a 

resource for providers, a forum to present patients, and a venue for the formal continuing 

medical education of providers. In addition, the Liver Disease and Hepatitis Program Patient 

Newsletter provided the latest research, latest treatment options, and information on 

biannual testing drives (liver function tests and viral load) for IHS grantees and clinicians.

This is updated quarterly.

Office of the Assistant Secretary for Health (OASH)

2011 Action 

■ Coordinate the development of recommendations to guide the provision of care and 

treatment to persons living with viral hepatitis.

Progress: OASH will review all existing federally developed patient and provider materials 

relevant to the care and treatment of viral hepatitis to assess completeness and gaps. The 

findings of this assessment will be used to prioritize next steps in the development of 

recommendations to guide the provision of care and treatment to persons living with viral 

hepatitis and is expected to be completed in the summer of 2012.
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

Office of Minority Health (OMH)

2012 Action

■ Improve linkage to care and treatment among persons infected with viral hepatitis.

Progress: All OMH grantees under the HIV/AIDS Health Improvement for Re-entering Exoffenders (HIRE) and Linkage 2 Life (L2L) programs have integrated viral hepatitis 

prevention education and services with their HIV prevention programs. During the first 

quarter of FY 2012, a total of 1,487 individuals received counseling, testing, and referral 

(CTR) services for viral hepatitis and HIV under the HIRE program; 2,492 received CTR 

services for viral hepatitis and HIV under the L2L.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2012 Action

■ Develop “brief interventions for alcohol” training and disseminate via federally funded 

training centers and other partner organizations.

Progress: SAMHSA’s Center for Mental Health Services grant program, Primary and 

Behavioral Health Care Integration (PBHCI), supported grants to improve the physical 

health status of people with serious mental illness by supporting communities to coordinate 

and integrate primary care services into publicly funded community mental health and other 

community-based behavioral health settings. A number of PBHCI grantees reported that 

they conduct hepatitis testing as a routine part of primary care services.

CSAT’s SBIRT State Demonstration Grants offered screening, brief intervention and referral 

to traditional alcohol and other drug specialty treatment services in 12 states. The New York 

grantee has three sites specifically in HIV clinics which also have served hepatitis clients.

Many of the states have offered services in clinics and emergency rooms serving the 

hepatitis population, among many others. CSAT SBIRT community grantees have promoted 

the collaborative connectivity between the primary care area and referral to specialty 

treatment including hepatitis.

CSAP supports extensive programs in alcohol education and training through various 

SAMHSA-funded substance abuse prevention and training programs as well as through the 

Drug Free Communities program, a collaboration funded by the Office of National Drug 

Control Policy and managed by SAMHSA.

Department of Veterans Affairs (VA)

2012 Actions

■ In accordance with clinical quality measures, develop clinical decision schema and other 

tools to ensure quality care for patients living with viral hepatitis.

Progress: VA began to develop a standardized curriculum for the ECHO training model to 

support training and mentorship of providers in rural and underserved areas to promote the high 
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

quality standards of care VA expects for diagnosis, care, and treatment for all Veterans with 

chronic hepatitis. This effort is in progress with anticipated completion in September 2012.

VA continues to collect information on hepatitis C quality measures and health outcomes on 

all Veterans with hepatitis C through VA’s Hepatitis C Clinical Case Registry. These data are

then used to provide feedback to VA medical facilities and VA providers on the quality of 

care that they are providing to Veterans with chronic hepatitis C. Quality improvement 

projects and interventions are then instituted to ensure a high standard of care for all 

Veterans across the United States. The annual reports on performance of HCV quality 

measures and health outcomes are posted on the VA intranet by facility, and a summary 

aggregate report is posted on the Internet for the public to view. This effort is ongoing.

■ Develop “brief interventions for alcohol” training and disseminate via federally funded 

training centers and other partner organizations.

Progress: Since 2006, BAI training has been provided to 395 clinicians who care for 

Veterans with hepatitis C and alcohol abuse or dependence. Since May 2011, 37 clinicians 

have received the training, and another 37 will attend training in May 2012.

GOAL 2.4 Advance research to facilitate viral hepatitis prevention and 

enhance care and treatment for infected persons.

Agency for Healthcare Research and Quality (AHRQ)

2012 Action

■ Evaluate promising models of care to address the unique issues faced by priority 

populations affected by viral hepatitis.

Progress: AHRQ has commissioned an EPC evidence report on Adherence to Hepatitis C 

Treatment Interventions: A Comparative Effectiveness Review. A draft is expected to be 

available late in May 2012; after going through review at AHRQ, it will be posted for public 

comment and peer review by early July 2012.

In June 2011, AHRQ supported the University of New Mexico Health Sciences Center 

evaluation of their ECHO project. Project ECHO was designed to bring effective treatment 

for HCV infection to underserved areas via the transference of state-of-the-art medical 

knowledge to primary care providers and nurses.

Centers for Disease Control and Prevention (CDC)

2012 Action

■ Conduct comparative research on culturally and ethnically sensitive approaches to and 

operations associated with viral hepatitis testing across diverse patient populations.

Progress: CDC began to develop studies designed to evaluate the effectiveness of testing 

and prevention messages for diverse patient populations. These studies will specifically 
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

examine changes in knowledge and behavior after the provision of testing interventions.

CDC’s goal is to develop and disseminate evidence based interventions for hepatitis testing.

This effort is in progress with an anticipated completion in 2013.

Food and Drug Administration (FDA)

2011 Action

■ Support development of point-of-care assays to detect serological evidence of both 

exposure to viral hepatitis and active viral hepatitis infection.

Progress: In February 2011, FDA approved a supplement to the premarket approval 

application for the OraQuick HCV Rapid Antibody Test with an expanded indication for the 

use of fingerstick whole blood in the assay. Additionally, in November 2011, FDA granted a

Clinical Laboratory Improvement Amendments (CLIA) waiver for the OraQuick HCV Rapid 

Antibody Test.

National Institutes of Health (NIH)

2011 Actions

■ Support development of point-of-care assays to detect serologic evidence of both exposure 

to viral hepatitis and active viral hepatitis infection.

Progress: In January 2012, NIH published a program announcement requesting 

applications in the area of rapid screening tests for all forms of viral hepatitis: PA-12-090 

and -091, “New Technologies for Viral Hepatitis SBIR and STTR.” Participating Institutes are 

NIDDK; the National Cancer Institute (NCI); the National Heart, Lung, and Blood Institute 

(NHLBI); NIAAA; NIAID; and NICHD. The NIH Clinical Center’s Department of Transfusion 

Medicine has conducted studies related to serologic detection of viral hepatitis infection, 

including a transmission study in an animal model. This study is completed, and results 

published online in April 2012 (Busch et al., Blood, e-published April 12, 2012). The National 

Institute on Drug Abuse’s (NIDA) Seek, Test, Treat, and Retain research paradigm is 

developing effective strategies to identify hepatitis infections sooner within vulnerable 

populations, including the criminal justice system, within integrated care clinics and drug 

treatment programs both foreign and domestic.

■ Support investments in basic, translational, comparative, and effectiveness research to 

facilitate the discovery and development of effective and well-tolerated treatments for viral 

hepatitis and related disease resulting from chronic viral hepatitis infection (e.g., 

hepatocellular carcinoma).

Progress: Several NIH institutes and centers continue their ongoing support of basic and 

applied research on viral hepatitis, including primary and secondary prevention as well as 

treatment of the infection and its complications, such as hepatocellular carcinoma. The 

annual funding level for viral hepatitis research supported by NIH is approximately $176 

million (source: Research, Condition, and Disease Categorization FY 2011 combined actual 

spending for hepatitis A, B, and C).
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

The Hepatitis B Research Network, sponsored by NIDDK, initiated two prospective clinical 

trials and is about to launch a third such study evaluating the relative efficacy and safety of 

current therapies and their combination. NIDDK’s Adult to Adult Living Donor Liver 

Transplantation (A2ALL) Cohort Study supports the exploration of pre-liver transplant HCV 

treatment strategies to prevent HCV re-infection following liver transplant. Additionally, data 

and samples from clinical research studies related to hepatitis C, such as A2ALL, Hepatitis

C Antiviral Long-Term Treatment Against Cirrhosis, and Pegylated Interferon +/- Ribavirin 

for Children With Hepatitis C, are available for future research through the NIDDK 

repository. The NICHD Maternal Fetal Medicine Network developed a study of hepatitis C in 

pregnant women that is in the final stages of development. A multicenter clinical trial of an 

herbal product, silymarin, for treatment resistant hepatitis C (National Center for 

Complementary and Alternative Medicine, NIDDK) was concluded in 2011, and results will 

be published in the Journal of the American Medical Association. The NIH Intramural 

program includes clinical research protocols on therapy of hepatitis B, C, and D (NIDDK) 

and in patients with HIV-HCV co-infection (NIAID).

In March 2012, NIH hosted a research workshop on hepatitis E in the United States, 

focusing on research opportunities in the diagnosis, prevention, and treatment of hepatitis E 

virus infection, which can cause severe acute as well as chronic hepatitis and cirrhosis.

Research recommendations from the conference will be disseminated, and workgroups on 

specific issues have been formulated. Additional NIH research workshop topics related to 

viral hepatitis are being considered by the Institutes and Centers. Also, the International 

Maternal Pediatric Adolescent AIDS Clinical Trials group, led by NIAID with cofunding by 

NICHD and the National Institute of Mental Health, has established a new Hepatitis 

Scientific Committee charged with promoting viral hepatitis prevention and treatment 

protocols in pregnant women, infants, and children (with or without HIV co-infection) 

domestically and internationally.

NIDA funds several research projects domestically and internationally that focus on effective 

integration of hepatitis testing and care within opioid treatment programs.

2012 Actions

■ In collaboration with industry, spur development of new tests (e.g., tests capable of 

distinguishing between acute and chronic hepatitis C, less costly alternatives to current HCV 

polymerase chain reaction testing).

Progress: NIH published a program announcement requesting applications in the area of 

developing assays that discriminate ongoing and active infection from recovery and 

immunity. PA-12-090 and -091, “New Technologies for Viral Hepatitis SBIR and STTR,” was 

released in January 2012 (http://grants.nih.gov/grants/guide/pa-files/PA-12-090.html and 

http://grants.nih.gov/grants/guide/pa-files/PA-12-091.html). Participating Institutes are 

NIDDK, NCI, NHLBI, NIAAA, NIAID, and NICHD. This effort is slated for completion in 

January 2015.
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

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

Interagency Implementation Progress Report - Year 1

■ Revise eligibility criteria for the AIDS clinical trials network and other HIV-related clinical 

trials to expand studies of viral hepatitis treatment, including direct-acting antiviral therapies 

for patients with hepatitis C and patients co-infected with HIV and HCV.

Progress: NIH’s AIDS Clinical Trials Group protocols are currently designed with flexible 

cutoff levels for liver function tests to avoid unnecessarily excluding those co-infected with 

HBV and HCV. In November 2011, the therapeutic clinical trials networks expanded their 

capacity to enroll persons infected with HCV and those co-infected with HCV and HIV.

■ Conduct studies aimed at determining how genetics influence individual susceptibility to the 

development of chronic liver disease, cirrhosis, and liver cancer. Develop global 

collaborations for the conduct of basic research and clinical trials and for monitoring adverse 

events and antiviral mutations.

Progress: NIAID, NIDDK, and NCI supported several continuing studies on polymorphisms 

in the IL28b gene, which are shown to be associated with spontaneous elimination of HCV.

Additional studies are focused on identifying specific polymorphisms in other genes (e.g., 

those in the interferon pathway) that may influence spontaneous and treatment induced 

HCV clearance. NCI supports and encourages research in hepatocellular carcinoma as a 

result of viral hepatitis infection. NCI recently released an Omnibus R21 Performance and 

Accountability Report (PAR) (PAR-12-145; http://grants.nih.gov/grants/guide/pa-files/PAR12-145.html). This PAR permits exploratory and developmental research grant applications 

and will fill the void left by the recently expired Etiology, Pathogenesis, and Prevention of 

Hepatocellular Carcinoma R21 program announcement.

■ Evaluate promising models of care to address the unique issues faced by priority 

populations affected by viral hepatitis.

Progress: NIH serves in an advisory capacity for this initiative.

Office of the Assistant Secretary for Health (OASH)

2012 Action

■ Coordinate development of a research agenda to better understand and address the 

multiple barriers for patients with co-occurring conditions.

Progress: In December 2010, OASH published a report titled Multiple Chronic Conditions: 

A Strategic Framework. The report contained recommendations for changes to the way our 

health system addresses chronic illnesses in the United States, from a single disease 

approach to a chronic care model emphasizing health care systems improvements, 

community support, self-management support, delivery design, decision support, and 

clinical information. This report will serve as the basis for future discussions about barriers to 

diagnosing and caring for persons with viral hepatitis and co-occurring conditions.
Priority 2: Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 23

Interagency Implementation Progress Report - Year 1

Department of Veterans Affairs (VA)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, VA

undertook several activities in support of it, including the following: 

VA has a long history of research in viral hepatitis with the goals of improving disease 

identification, chronic viral hepatitis management, access and equity. VA Office of Public 

Health collaborates closely with the VA Office of Research and Development’s HIV & 

Hepatitis Quality Enhancement Research Initiative (QUERI) to develop and direct a 

coordinated research agenda including a number of research projects to improve quality of 

HCV care in VA.
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 24

Interagency Implementation Progress Report - Year 1

Priority 3 Strengthening Surveillance to Detect Viral 

Hepatitis Transmission and Disease

GOAL 3.1 Build a network of state and local surveillance systems with 

sufficient capacity to monitor viral hepatitis transmission and 

disease.

Centers for Disease Control and Prevention (CDC)

2011 Actions

■ Monitor the misclassification of viral hepatitis cases as a quality assurance measure.

Progress: CDC examined and updated case definitions throughout the year. Changes to 

case definitions are planned to be released in the summer of 2012.

■ Use aggregated EMRs to monitor performance measures of hepatitis testing, care, and 

treatment and associated health outcomes.

Progress: CDC began conducting several studies to evaluate testing, care, and treatment 

of viral hepatitis. One study is evaluating current testing practices at four primary care sites 

and subsequently testing an intervention designed to increase testing and linkage to care.

These studies will inform the development of performance measures. This effort is slated for 

completion in 2013.

2012 Actions

■ Identify current gaps in epidemiologic capacity and identify strategies to address them.

■ Upgrade surveillance information technology to improve exchange of surveillance data 

among reporting sites (e.g., laboratories), state and local health departments, and CDC.

Progress: CDC has been unable to initiate this action due to lack of sufficient funding.

■ Conduct special studies to investigate emerging modes of transmission, identify new or rare 

forms of viral hepatitis, and evaluate access to care for persons living with viral hepatitis.

Progress: CDC has funded activities in several health jurisdictions to examine increased 

incidence of acute HCV in young injection drug users, who typically started drug use with 

prescription oral opioid drugs (e.g., oxycodone). This effort is in progress and will be 

completed in November 2012.

■ Pilot the use of EMRs in collaboration with health care systems to improve surveillance.

■ Automate case detection of viral hepatitis using electronic records (e.g., electronic 

laboratory data and electronic health records from Medicare, Medicaid).

Progress: CDC conducted analysis of national ambulatory care records (the National 

Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey).

This is an ongoing effort.
Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 25

Interagency Implementation Progress Report - Year 1

Health Resources and Services Administration (HRSA)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, HRSA 

undertook activities in support of it.

All health centers under HRSA are now reporting on HCV and HBV testing and diagnoses. Data 

from 2011 will be available in the summer of 2012.

Indian Health Service (IHS)

2012 Action

■ Incorporate viral hepatitis diagnostic codes in federal EMR standards.

■ Pilot the use of EMRs in collaboration with health care systems to improve surveillance.

Progress: IHS completed the initial programming for an automated electronic surveillance 

system that will monitor 10 reportable conditions, including hepatitis C. Next steps are beta 

testing and data validation, which will begin May 2012. Additional hepatitis screening and 

support via the IHS EMR will be developed according to the results of the beta tests.

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

2012 Action

■ Incorporate viral hepatitis diagnostic codes in federal EMR standards.

Progress: Viral hepatitis diagnostic codes (ICD-9 through 2013 and ICD-9, ICD-10, and/or 

Systematized Nomenclature of Medicine—Clinical Terms for 2014 and thereafter) are 

required for EMR certification under regulations 45 CFR 170 and are a proposed regulation 

for 2014 EMR certification. This effort was completed.

GOAL 3.2 Monitor viral-hepatitis-associated health disparities.

Centers for Disease Control and Prevention (CDC)

2012 Actions

■ Revise federal surveys to expand the monitoring of health disparities among target 

populations.

■ Publish periodic reports on viral-hepatitis-associated health disparities.

■ For a component of Viral Hepatitis Centers of Excellence, design and conduct state/local 

surveys of marginalized populations (e.g., foreign-born persons, those who were previously 

incarcerated, IDUs) experiencing health disparities caused by viral hepatitis.

■ Gather data from nontraditional sources (e.g., U.S. Census data, clinical datasets, 

counseling and testing databases, health records from correctional settings).
Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 26

Interagency Implementation Progress Report - Year 1

Progress: CDC has not made additional progress on these actions due to inadequate 

resources and the discontinuation of the Racial and Ethnic Approaches to Community Health 

(REACH) program. The REACH Risk Factor Survey had gathered health-related information

from about 25,000 minority persons annually in 28 communities across the United States. 

The survey contained questions about health, chronic diseases, diet, exercise, preventive 

services, and adult immunizations and was a vital source of data about viral hepatitis in 

minority communities.

GOAL 3.3 Monitor provision and impact of viral hepatitis prevention, 

care, and treatment services.

Agency for Healthcare Research and Quality (AHRQ)

2012 Action

■ Document and monitor the provision and impact of viral hepatitis care and treatment services.

Progress: AHRQ helped support a study that evaluated the relationship between 

adherence to HCV therapy and early and sustained virologic response, assessed changes 

in adherence over time, and examined risk factors for nonadherence. This retrospective 

cohort study was performed using the National Veterans Affairs Hepatitis C Clinical Case 

Registry. Results showed that among patients with HCV genotype 1 or 4, sustained 

response increased with higher adherence to ribavirin therapy over the second, third, and 

fourth 12-week intervals. Similar results were found for adherence to interferon therapy. This 

effort was completed in September 2011.

Centers for Disease Control and Prevention (CDC)

2012 Action

■ Create public-private partnerships to establish observational cohort studies and other 

evaluations of persons in care for viral hepatitis.

Progress: The CDC Foundation currently funds the Chronic Hepatitis Cohort Study. This 

study began in March 2010 and will be continuing for the next 5–10 years. CDC also began 

conducting several other studies evaluating the care that newly identified persons receive in 

specific care settings, the studies will be completed in the summer of 2014.

Federal Bureau of Prisons (FBOP)

Though not designated in the Action Plan as a lead agency for any actions under this goal, FBOP 

undertook activities in support of it. FBOP recently began utilizing FBOP Regional Hepatitis 

Clinical Pharmacist Consultants in a team based medicine approach to disease state 

management. These consultants monitor treatment outcomes and provide recommendations on 

the management of side effects of therapy while maintaining cost effectiveness of hepatitis C 

treatment. Implementation of FBOP Regional Hepatitis Clinical Pharmacist Consultants began 

October 2011.
Priority 3: Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 27

Interagency Implementation Progress Report - Year 1

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2012 Action

■ Gather data from nontraditional sources (e.g., U.S. Census data, clinical datasets, 

counseling and testing databases, health records from correctional settings).

Progress: SAMHSA began developing a methodological report that will compare a variety 

of behavioral health measures and specific health conditions (including hepatitis) across 

various federal data systems. Differences in sampling, data collection, and estimation 

procedures will also be assessed. These data systems include the National Survey on Drug 

Use and Health, National Health Interview Survey, National Health and Nutrition 

Examination Survey, Behavioral Risk Factor Surveillance System, and Medical Expenditure 

Panel Survey. This report is planned for completion and release in September 2012.

Department of Veterans Affairs (VA)

2012 Action

■ Promote the development of systems to monitor where persons are tested for viral hepatitis 

and the quality of prevention and care services that they receive.

Progress: VA maintains a Hepatitis C Clinical Case Registry, which is a database of all 

Veterans in VA care with chronic hepatitis C. This allows VA to evaluate the impact of 

hepatitis care, treatment, and any disparities that may exist. By evaluating this information 

critically, VA is able to direct resources and quality improvement efforts in order to maximize 

quality of care. This is an ongoing activity.

GOAL 3.4 Develop and implement new technologies and laboratory 

procedures to improve viral hepatitis surveillance.

Department of Veterans Affairs (VA)

2012 Action

■ Upgrade NNDSS and other surveillance systems to enable the collection of viral hepatitis 

test results from various sources, including public health and commercial laboratories.

Progress: VA began to engage in surveillance efforts for HBV via population-based 

seroprevalence studies and future access to a new Clinical Data Warehouse in 

development. This effort is slated for completion in 2014. 
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 28

Interagency Implementation Progress Report - Year 1

Priority 4 Eliminating Transmission of 

Vaccine-Preventable Viral Hepatitis

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

Centers for Disease Control and Prevention (CDC)

2012 Actions

■ Expand the capacity of perinatal programs to ensure that all HBV-infected mothers are 

identified and linked to care, their newborns receive postexposure prophylaxis, and their 

household contacts are tested and, as appropriate, vaccinated and referred for care.

■ In collaboration with professional organizations (e.g., APHL, the American Society of Clinical 

Pathologists), promote inclusion of pregnancy status on all electronic and paper reports of 

HBsAg+ test results sent by laboratories to clinicians.

■ Identify and implement effective strategies to ensure that all neonates receive a birth dose of 

vaccine as the standard of care in hospitals and birthing centers.

Progress: CDC funded perinatal hepatitis B prevention programs (PHBPP) in 50 states, six 

cities, five territories, and the Freely Associated States. Program requirements included 

identifying HBsAg+ pregnant women, providing case management to their infants to ensure 

that post-exposure prophylaxis is received. Another program requirement is identifying 

household contacts and referring for vaccination as necessary. PHBPPs are funded through 

the 317 immunization funds. In 2008, 96 percent of identified infants born to HBsAg+ mothers 

received hepatitis B immune globulin and the first dose of hepatitis B vaccine within 1 

calendar day of birth, and programs identified 9,681 household and sexual contacts. CDC and 

CMS are actively discussing how CMS can assist CDC in expanding the capacity of the 

PHBPP to eliminate mother-to-child transmission of hepatitis B.

CDC also established a workgroup to focus to explore development of a specific screening 

test designed for pregnant women. A report of a positive test result would indicate that the 

result is from a pregnant woman. The lab workgroup’s anticipated end date is 2014.

CDC submitted a facility-based hepatitis B birth dose measure to the National Quality Forum 

(NQF) for endorsement. NQF endorsed the facility-based hepatitis B birth dose coverage 

measure (#0475) on April 2, 2012, and no appeal was received. The next steps are to 

initiate activities to monitor and evaluate use of the measure for annual progress reporting 

and to conduct a second feasibility study to maintain the measure for the next 3-year review.

Perinatal hepatitis B prevention programs, supported by 317 immunization funds, conducted 

surveys during this project period (2008–2012) to determine whether birthing facilities in 

their jurisdictions have written policies and standing orders on administering a birth dose of 

hepatitis B vaccine prior to discharge.
Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 29

Interagency Implementation Progress Report - Year 1

Centers for Medicare & Medicaid Services (CMS)

2012 Action

■ Identify all HBV-infected pregnant women by increasing laboratory reporting of pregnancy 

status on reports of HBsAg+ tests.

Progress: CMS’s CLIA staff began discussion of opportunities and ways to increase

laboratory reporting of pregnancy.

National Institutes of Health (NIH)

2012 Action

■ In collaboration with partners, evaluate the efficacy and safety of antiviral prophylaxis in 

pregnant women with high viral loads to reduce the likelihood of disease transmission to 

their infants.

Progress: NICHD, in collaboration with CDC, will fund a grant to evaluate the efficacy of 

tenovir, an anti-hepatitis B antiviral drug, to reduce the risk of mother-to-child hepatitis B 

transmission. 

GOAL 4.2 Achieve universal hepatitis A and B vaccination for 

vulnerable adults.

Federal Bureau of Prisons (FBOP)

2012 Action

■ Integrate hepatitis A and B vaccination as a standard of care in federal prevention and 

clinical programs that serve priority populations.

Progress: FBOP updated the Clinical Practice Guidelines for Preventive Health Care for 

hepatitis A and B vaccinations in July 2011. Proper medical practice necessitates that all 

cases are evaluated on an individual basis and that treatment decisions are patient specific.

Health Resources and Services Administration (HRSA)

2012 Action

■ Integrate hepatitis A and B vaccination as a standard of care in federal prevention and 

clinical programs that serve priority populations.

Progress: HAB developed and released performance measures on hepatitis B screening 

and vaccination. The hepatitis B screening measure is the percentage of patients, 

regardless of age, for whom hepatitis B screening was performed at least once since the 

diagnosis of HIV/AIDS or for whom there is documented infection or immunity. The hepatitis 

B vaccination measure is the percent of clients with HIV infection who completed the 

vaccination series for hepatitis B. Both measures are included in the recently developed 
Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 30

Interagency Implementation Progress Report - Year 1

HAB HIV Performance Measure Module. This module is a voluntary tool available to Ryan 

White Program grantees to submit aggregate performance measure data on a quarterly 

cycle. All HRSA-supported health centers are expected to practice evidence-based care and 

follow national practice guidelines including vaccinations for hepatitis A and B. The HAB 

performance measures can be found at 

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html.

In January 2012, HRSA conducted a national webinar on viral hepatitis for community health 

center grantees and reviewed the importance of hepatitis A and B vaccinations among 

vulnerable adults such as Asian and Pacific Islanders and persons who experience 

homelessness. Health centers, like any primary care practice, will choose their own 

guidelines; however, BPHC endorses guidelines developed by CDC and NIH.

Indian Health Service (IHS)

2012 Action

■ Identify strategies, including Affordable Care Act requirements, to expand access to and use 

of viral hepatitis vaccine in all primary care settings.

Progress: The IHS electronic health record provides clinical decision support for vaccines, 

including provider reminders for hepatitis A and B vaccination for all children and for adults 

who received a dose prior to 18 years of age. Work is under way to explore the feasibility of 

developing provider reminders for hepatitis A and B vaccination for unvaccinated patients 

diagnosed with hepatitis C infection and chronic liver disease. ANTHC has separate 

registries for patients with chronic hepatitis C and B that are programmed to generate letters 

every 6 months to remind patients that they are due for laboratory monitoring (liver function 

tests, alpha-fetoprotein levels, and HBV DNA where applicable). These letters include 

patient education handouts and are sent to providers in the field. The registry is updated 

quarterly with the next delivery planned for April 1, 2012.

Office of Minority Health (OMH)

2012 Action

■ Integrate hepatitis A and B vaccination as a standard of care in federal prevention and 

clinical programs that serve priority populations.

Progress: OMH is implementing two HIV/AIDS demonstration programs that serve priority 

populations. One demonstration project, the HIRE Initiative serves federal and state

reentrants that are living with or at high risk for HIV/AIDS. Current grantees coordinate HIV 

and viral hepatitis prevention, counseling, testing, and treatment services. Whereas the L2L 

Health and Social Service Resource Network demonstration program serves families living 

with HIV/AIDS that are in transition from incarceration and substance abuse treatment. All 

grantees under the HIRE (eight) and L2L (six) programs provide hepatitis screening as part 

of their outreach and intake efforts. In some cases, hepatitis vaccines were provided by the 

HRSA-funded or other network partner (HIRE and L2L grantees are primarily CBOs). These 

programs will conclude in August 2013.
Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 31

Interagency Implementation Progress Report - Year 1

Department of Veterans Affairs (VA)

2012 Actions

■ Integrate hepatitis A and B vaccination as a standard of care in federal prevention and 

clinical programs that serve priority populations.

Progress: VA’s ongoing “Liver Health Initiative” (LHI) is a focused clinician training program 

aimed at changing clinician behavior in VA SUD clinics. This program was designed to 

educate SUD providers about the risk of viral hepatitis in the population whom they serve 

and to promote liver health and a comprehensive hepatitis prevention program in the 

Veteran SUD population. In addition, SUD programs are encouraged to provide hepatitis A, 

B, and C testing; appropriate vaccination against HAV and HBV; and appropriate linkage to 

medical care for viral hepatitis. VA also recommends hepatitis A and B immunization for 

previously unvaccinated adults who are at increased risk of contracting HAV infection or 

HBV infection and for any other adult who is seeking protection from HAV infection. This 

effort is ongoing and in collaboration with internal VA stakeholders.

GOAL 4.3 Design and test new or improved viral hepatitis vaccines and 

determine the indications for their optimal use.

Food and Drug Administration (FDA)

2011 Action

■ Facilitate development of candidate hepatitis C vaccines designed to induce protective 

immune responses.

■ Collaborate with partners to evaluate hepatitis E vaccination in highly endemic countries.

Progress: FDA conducted research to define the nature of protective immune responses to 

hepatitis C virus and how such immune responses can be induced by vaccines, in order to 

guide vaccine development. This effort is likely to continue until an effective vaccine is 

identified.

National Institutes of Health (NIH)

2011 Actions

■ Facilitate development of candidate hepatitis C vaccines designed to induce protective 

immune responses.

Progress: In 2011, NIAID supported planning efforts for a Phase I and II, double-blinded, 

randomized clinical trial to evaluate a new hepatitis C vaccine candidate. The goals of this 

trial are to evaluate the safety, immune response, and initial efficacy of a vaccine to prevent 

acute and chronic hepatitis C infection in uninfected adults who are at high risk of becoming 

infected with hepatitis C. The study began recruitment in February 2012.
Priority 4: Eliminating Transmission of Vaccine-Preventable Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 32

Interagency Implementation Progress Report - Year 1

■ Estimate the U.S. and global burden of hepatitis E.

Progress: In March 2012, NIDDK and NIAID held a workshop on hepatitis E in the United 

States with partners at CDC, FDA, and others, which included sessions on assessing the 

U.S. and global burden of hepatitis E infection, as well as one on development and testing of 

vaccines, presented by a representative from the National Institute of Diagnostics and 

Vaccine Development in China, a country of high endemicity. Additionally, NIAID supported 

several intramural and extramural research projects on hepatitis E pathogenesis. Efforts 

related to this action are ongoing.

2012 Actions

■ Expand research to develop more effective vaccine strategies against HAV and HBV.

Progress: NIAID is supporting studies focused on the development of an HBV vaccine that 

may be administered orally. This effort is ongoing. NCI SBIR is supporting development of 

another HCV vaccine that is intended to improve the sustained virologic response rate in 

patients being treated with current standard of care therapy for chronic HCV infection.

■ Determine the persistence of the protective immune response to hepatitis B vaccination 

among persons vaccinated as infants, persons in older age groups, and adults with 

comorbidities (e.g., diabetes, liver disease, HIV, and obesity), and assess their need for a 

booster dose.

Progress: NIDDK’s Intramural Research Program is supporting a study of the duration of 

long-term immunity after adult hepatitis B vaccination, which will reveal whether booster 

doses are needed. This study has now been completely enrolled, and results will be 

available within the next year.

National Vaccine Program Office (NVPO)

2011 Action

■ Work with IOM to assess the priority for the development of hepatitis C vaccines.

Progress: In response to a request from NVPO, IOM has begun to develop an evidencebased approach and methodology for identifying and prioritizing the needs for developing 

new vaccines of domestic and global importance. The draft analytical conceptual framework 

and model, along with recommendations on how to use this model for reviewing the catalog 

of preventive vaccines every 2–3 years, will be available for comment in May 2012. An IOM 

stakeholder meeting is planned for autumn 2012 to inform this draft conceptual model.
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 33

Interagency Implementation Progress Report - Year 1

Priority 5 Reducing Viral Hepatitis Caused by 

Drug Use Behaviors

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

hepatitis prevention, care, and treatment services.

Centers for Disease Control and Prevention (CDC)

2012 Action

■ Identify and implement feasible options for integrating viral hepatitis prevention services with 

HIV prevention activities targeting IDUs and other populations at risk for both viral hepatitis 

and HIV.

■ Strengthen technical assistance and training to help prevention programs integrate viral 

hepatitis and HIV prevention strategies.

Progress: CDC has completed the groundwork necessary to begin a demonstration study 

that will assess the use of HCV rapid tests in HIV testing settings. Two sites have been 

selected, and OMB approval has been acquired. Data collection is expected to begin in 

summer 2012 and end in April 2013. CDC expects to learn how the HCV rapid test fits into 

the context of HIV testing and how HCV rapid tests can be best implemented. Lessons 

learned from this demonstration study will inform subsequent studies that will evaluate the 

impact of prevention messages and test results on knowledge and behavior.

Indian Health Service (IHS)

2011 Action 

■ Disseminate evidence-based best practices through a new SAMSHA TIP to guide 

integration of drug treatment and hepatitis prevention, care, and treatment.

Progress: In March 2012, IHS began conducting an assessment of existing resources to 

disseminate evidence-based practices integrating drug treatment and hepatitis prevention, 

care, and treatment.

Office of the Assistant Secretary for Health (OASH)

2011 Action

■ Disseminate evidence-based best practices through a new SAMSHA TIP to guide 

integration of drug treatment and hepatitis prevention, care, and treatment.

Progress: OHAIDP has promoted awareness of SAMHSA’s evidence-based TIP to support 

the integration of drug treatment and hepatitis prevention, care and treatment through a blog 

post about the TIP on AIDS.gov and promoting that post via Twitter and Facebook as well 

as posting a link to it from the Action Plan page on AIDS.gov (www.AIDS.gov/hepatitis). This 

activity is completed.
Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 34

Interagency Implementation Progress Report - Year 1

Office on Women’s Health (OWH)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, OWH 

undertook activities in support of it, including the following:

■ Integrate viral hepatitis prevention and care services as standard components of substance 

abuse and treatment programs.

Progress: OWH integrated new educational materials and information about viral hepatitis 

prevention for the recipients of grants under the OWH program for incarcerated women 

reentering their communities.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2011 Action 

■ Disseminate evidence-based best practices through a new SAMSHA TIP to guide 

integration of drug treatment and hepatitis prevention, care, and treatment.

Progress: SAMHSA completed the peer review and editing process in 2011 and released 

TIP 53: Addressing Viral Hepatitis in People with Substance Use Disorders in February 

2012. The 132-page TIP was written to improve knowledge of HBV and HCV risk, testing, 

care, and treatment among providers of substance abuse treatment. SAMHSA promoted the 

release of this TIP via a blog post on AIDS.gov and the SAMHSA blog as well as in a “Dear 

colleague” letter to all 432 SAMHSA substance abuse treatment grantees. SAMHSA is 

developing dissemination plans with federal colleagues to extend the reach of this resource 

still further. This effort is ongoing.

2012 Actions

■ Identify and implement feasible options for integrating viral hepatitis prevention services with 

HIV prevention activities targeting IDUs and other populations at risk for both viral hepatitis 

and HIV.

Progress: SAMHSA’s Center for Substance Abuse Prevention’s (CSAP) Viral Prevention and 

Care Services has integrated HIV and hepatitis prevention strategies. The CSAT project to 

promote healthy lifestyles through addressing hepatitis infection among racial and ethnic IDUs 

provided 10 trainings to 336 opioid treatment program (OTP) medical and clinical staff on 

hepatitis prevention and integration services between May 2011 and April 2012.

■ Strengthen technical assistance and training to help prevention programs integrate viral 

hepatitis and HIV prevention strategies.

Progress: CSAP’s Viral Prevention and Care Services have integrated HIV and hepatitis 

prevention strategies. The vast majority of CSAP’s viral hepatitis and HIV prevention training 

and technical assistance have been group educational efforts such as trainings or Webinars.

SAMHSA sponsored three workshops related to hepatitis prevention at the 2012 American 

Association for the Treatment of Opioid Dependence National Conference in April 2012. The 

attendees of the workshops learned about the benefits of integrating viral hepatitis 

screening, counseling, treatment, and vaccination in their OTPs.
Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 35

Interagency Implementation Progress Report - Year 1

Department of Veterans Affairs (VA)

2012 Action

■ Strengthen technical assistance to drug treatment providers to facilitate the integration and 

effective delivery of viral hepatitis prevention, care, and treatment services.

Progress: VA is committed to providing high-quality hepatitis care to all Veterans regardless 

of drug or substance use behaviors. VA has incorporated education around models of care 

delivery for Veterans with hepatitis C and ongoing substance use into ongoing training 

programs. This content is incorporated into trainings that VA does on end-stage liver 

disease, treatment of HCV, and the LHI trainings.

GOAL 5.2 Mobilize community resources to prevent viral hepatitis 

caused by injection drug use.

Centers for Disease Control and Prevention (CDC)

2012 Action

■ Increase support for comprehensive and targeted disease prevention partnerships involving 

syringe service programs, state and local health departments, other government agencies 

(e.g., law enforcement), and community representatives.

Progress: The Funding Opportunity Announcement (FOA) for 2012 Prevention Public 

Health Fund funding of viral hepatitis testing and linkage to care activities will support 

proposals that emphasize collaboration in addressing prevention needs of persons who 

inject drugs (PWID). The grant announcement for the 2012–2015 Adult Viral Hepatitis 

Prevention Coordinator will also invite partnerships for PWID-focused prevention activities.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2012 Action

■ Increase support for comprehensive and targeted disease-prevention partnerships involving 

syringe service programs, state and local health departments, other government agencies 

(e.g., law enforcement), and community representatives.

Progress: CSAT’s project to enhance OTP treatment services to promote healthy lifestyles 

through addressing hepatitis infection among racial- and ethnic-minority IDUs provided 

training to medical and clinical staff on hepatitis prevention and integration services. CSAT 

began revising OTP accreditation guidelines to support the benefits of integrated hepatitis 

prevention and addiction treatment services. CSAT is supporting several workshops at the 

April 2012 American Association for the Treatment of Opioid Dependence conference that 

focused on integration of hepatitis prevention and addiction treatment services. As part of 

SAMHSA’s Syringe Services Program (SSP) approved by Congress for FY 2011, 10

grantees collaborated directly with needle exchange programs for more than a year. In brief, 

more than 350 clients were enrolled into substance abuse treatment, and more than 85 

percent finished their treatment program. These efforts (outside the SSP) are ongoing.
Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 36

Interagency Implementation Progress Report - Year 1

GOAL 5.3 Provide persons who inject drugs with access to care and 

substance abuse treatment to prevent transmission and 

progression of disease.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2012 Action

■ Pilot different approaches to preventing persons from returning to injection drug use after 

successful clearance of HCV infections following antiviral therapy.

Progress: SAMHSA began exploring the use of the medication Vivitrol as a 

pharmacotherapeutic intervention to prevent relapse and support recovery from opioid use 

disorders among IDUs, including those with HCV and HIV infections. This effort is ongoing.

GOAL 5.4 Expand access to and delivery of hepatitis prevention, care, 

and treatment services in correctional settings.

Centers for Disease Control and Prevention (CDC)

2011 Action

■ Survey correctional facilities to assess current drug treatment and viral hepatitis prevention, 

care, and treatment services.

Progress: CDC surveyed correctional facilities to assess current drug treatment and viral 

hepatitis prevention, care, and treatment services. This effort is ongoing.

Office of Minority Health (OMH)

Though not tasked in the Action Plan as a lead agency for any actions under this goal, OMH 

undertook activities in support of it, including the following: 

■ Promote continuity of viral hepatitis care and drug treatment of inmates who are released 

from incarceration and are reentering the community.

Progress: OMH’s HIRE program sought to improve the health outcomes for individuals 

reentering the mainstream population from federal and state prisons through a systems 

navigation approach. The HIRE Program provides access to HIV and viral hepatitis 

prevention and treatment services to the reentry population through stakeholder 

partnerships that develop and provide community-based HIV/AIDS-related services, 

transitional assistance, and substance abuse and mental health services for the reentry 

population. During the first quarter of FY 2012, a total of 163 HIRE participants were 

referred for drug treatment, and 1,909 were referred for other health care services. This 

effort will be completed in August 2012.
Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 37

Interagency Implementation Progress Report - Year 1

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2012 Action

■ Identify best practices to help correctional facilities improve drug treatment programs 

offering viral hepatitis testing, care, and treatment to incarcerated populations.

Progress: SAMHSA increased coordination with criminal justice activities within CDC by 

initiating plans to work with CDC’s correctional health staff to review existing viral hepatitis 

testing protocols and to provide outreach to constituency groups such as the National 

Correctional Health Services Association and to the Association of State Correctional 

Administrators (ASCA) in conjunction with the National Association of State Alcohol and 

Drug Abuse Directors (NASADAD). CSAT staff met with ASCA and NASADAD on 

substance abuse treatment issues related to offender populations.

GOAL 5.5 Advance research to improve prevention of viral hepatitis 

among persons who use drugs.

Centers for Disease Control and Prevention (CDC)

2011 Action 

■ Examine patterns of HCV transmission of among young IDUs infected with HCV.

■ Expand prevention research to intervene and prevent HCV among young IDUs.

Progress: DVH and CDC recently hired an expert in injection drug use-related issues to 

lead young IDU efforts in the hepatitis program. CDC began examining the injection 

equipment sharing practices of 500 persons who inject drugs in upstate New York. These

data will inform the development of prevention interventions for this population. The IDU 

expert is also working closely with staff in the Epidemiology Team as they collect field data 

on IDU use practices among PWIDs. This effort is slated for completion in spring 2013.

National Institutes of Health (NIH)

2011 Action 

■ Examine patterns of HCV transmission of among young IDUs infected with HCV.

Progress: NIDA has funded a number of research studies on HCV among young injectors.

Many of these studies are in progress. This effort is slated for completion in October 2015.

2012 Actions

■ Expand comparative and effectiveness research to improve viral hepatitis prevention for IDUs.

Progress: NIDA has funded a number of research studies on prevention and treatment of 

HCV, as well as HIV/HCV in drug-abusing populations. NIDA is also in the process of 

issuing FOAs on (1) drug abuse aspects of HIV/AIDS and (2) cohort studies of HIV/AIDS 

and substance abuse, both of which include a focus on HIV/HCV co-infections in IDUs and 

non-IDUs. This effort is expected for completion in the fall of 2016.
Priority 5: Reducing Viral Hepatitis Caused by Drug-Use Behaviors

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 38

Interagency Implementation Progress Report - Year 1

■ Determine the effectiveness of interventions to prevent non-injection drug users from 

initiating injection drug use.

Progress: NIH’s research findings from the studies on HCV prevention and treatment in 

drug-abusing populations will support programs to prevent HCV transmission in these and 

other populations. This effort is slated for completion in October 2016.

■ Develop collaborations with international partners to identify emerging trends in drug use 

and viral hepatitis transmission and to accelerate the development of effective prevention 

strategies.

Progress: NIH released the new US-China Program for Biomedical Collaborative Research 

Request for Application (RFA-AI-12-021; http://grants.nih.gov/grants/guide/rfa-files/RFA-AI-12-

021.html).NCI’s area of interest is for applications focused on the links between infection and 

cancer important in the United States and China. Hepatitis B and C are highlighted as areas of 

particular interest. This effort is slated for completion in October 2016.

NIDA maintains a significant portfolio of international collaborations among U.S. researchers

and colleagues located in India, Iran, Kazakhstan, Georgia, China, and Southeast Asia that 

strive to identify effective testing and prevention strategies among hepatitis mono-infected and 

HIV/HCV dually infected drug users. NIDA also supports research to identify hepatitis 

transmission risks within homeless and other drug abusing youth to identify effective 

behavioral modification strategies to alter risk behavior to prevent viral transmission and 

further abusive drug practices.

■ Expand prevention research to intervene and prevent HCV among young IDUs.

■ Assess the timing of serial HCV antibody testing of IDU cohorts to detect acute (or recent) 

infection.

■ Conduct clinical trials of treatments for acute HCV to assess sustained viral clearance and 

their impact on prevention of secondary transmission among IDUs.

Progress: Related NIDA-funded studies are in progress with preliminary results anticipated 

in 2015. NIAID is currently supporting a Phase I and II, double-blinded, randomized clinical 

trial to evaluate a new hepatitis C vaccine candidate. The goals of this trial are to evaluate 

the safety, immune response, and initial efficacy of a vaccine to prevent acute and chronic 

hepatitis C infection in uninfected adults who are at high risk of becoming infected with 

hepatitis C (IDUs). The study began recruitment in February 2012. This goal is slated for 

completion in October 2015.
Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 39

Interagency Implementation Progress Report - Year 1

Priority 6 Protecting Patients and Workers From

Health Care-Associated Viral Hepatitis

GOAL 6.1 Reduce transmission of viral hepatitis to patients resulting 

from misuse of medical devices and drugs.

Centers for Disease Control and Prevention (CDC)

2011 Actions

■ Enhance provider and purchaser education regarding limiting use of single-dose vials to 

only one patient to encourage increased uptake of prefilled syringes and right-sized 

medication vials.

Progress: CDC promoted education among manufacturers, providers, and purchasers as 

part of the Safer Designs for Safer Injections industry partner meeting and as part of 

ongoing activities relating to the One and Only Campaign. This effort is ongoing.

■ Identify opportunities to improve infection control education, and expand requirements for

continuing education and related competency certifications for health care providers.

Progress: The new CDC and Association of State and Territorial Health Officials Policy 

Toolkit for Healthcare-Associated Infection (HAI) Prevention outlines options relating to 

infection control education and certification. CDC has begun inventorying related state-level 

activities (e.g., a recent Nevada law requiring that health care providers attest to awareness 

of and training in CDC safe injection guidelines). These issues were discussed in December 

2011 at the CDC-hosted Injection Safety: Insurance Stakeholders Meeting.

■ Engage the affected industries to raise awareness of infection control standards, guidelines,

and training needs.

Progress: In 2011, CDC published its Guide to Infection Prevention for Outpatient Settings: 

Minimum Expectations for Safe Care, which specifies infection control standards and 

training needs. CDC, the Safe Injections Practices Coalition, and other partners have 

promoted the guide and accompanying checklist to affected professional groups, health care 

organizations, and governmental partners. Engagement with the insurance industry took 

place at CDC’s December 2011 Injection Safety: Insurance Stakeholders Meeting.

2012 Actions

■ Encourage industry to develop reuse prevention equipment and/or devices that indicate

prior use of injection equipment.

Progress: CDC, FDA, and CMS helped organize and participated in an industry meeting on 

this topic, sponsored by Premier Safety Institute and titled Safer Designs for Safer Injections: 

Innovations in Process, Products, and Practices. CDC’s Division of Healthcare Quality 

Promotion (DHQP) is engaged in ongoing dialogue with industry partners on this topic in the 

context of the CDC-led Safe Injections Practices Coalition. This effort is in progress with an 

anticipated completion in 2013.
Priority 6: Protecting Patients and Workers for Health-Care Associated Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 40

Interagency Implementation Progress Report - Year 1

■ Expand educational campaigns (including injection safety checklists) and infection control

and regulatory guidance, and use campaigns and materials to promote safe use of syringes

and injectable medications.

Progress: The CDC-led Safe Injection Practices Coalition continues to expand 

implementation of the One and Only Campaign. Examples of recent partners that have 

begun promoting safe use messages include the U.S. Air Force, HRSA, the Institute for 

Safe Medication Practices, and the North Carolina Department of Health. In July 2011, the 

Safe Injection Practices Coalition also launched a free continuing education activity on 

Medscape for health care providers titled Unsafe Injection Practices: Outbreaks, Incidents, 

and Root Causes, which has been completed by approximately 20,000 physicians and 

nurses. This effort is slated for completion in 2013.

Centers for Medicare & Medicaid Services (CMS)

2011 Actions

■ Incorporate evidence-based infection control components into applicable health and safety

standards.

Progress: The State Survey Agencies are currently pilot-testing a hospital infection control 

survey tool that includes specific questions dealing with needle sticks, sharps injuries, and 

other employee exposure events; postexposure evaluation and prophylaxis (if exposure 

events exist, the hospital evaluates and develops corrective action plans); and a hepatitis B 

vaccination series to all employees who have occupational exposure and postvaccination 

screening. This effort is in progress.

■ Assist oversight authorities with ensuring the appropriate use of medical devices and the

provision of associated training within health care settings.

Progress: CMS has conducted the Recent Survey and Certification Memos on Glucometers 

(Point of Care Devices) and Insulin Pens and established educational opportunities and 

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

assessment in facilities. This effort is in progress.

The Survey and Certification Group clarified CMS policy on the use of single dose vials and

has provided guidance to State Survey Agencies that the use of medication from single 

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

facility survey, will be cited as an infection control deficiency. Medication from single dose 

vials may be repackaged in accordance with USP 797 standards, either within the facility or 

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

on how the facility ensures that its vendor adheres to USP 797 standards.
Priority 6: Protecting Patients and Workers for Health-Care Associated Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 41

Interagency Implementation Progress Report - Year 1

Food and Drug Administration (FDA)

2011 Actions

■ Issued draft guidance for Industry on the reprocessing of reusable medical devices in health

care settings.

Progress: In May 2011, FDA issued the Draft Guidance for Industry and FDA Staff: 

Processing/Reprocessing Medical Devices in Health Care Settings: Validation Methods and 

Labeling. Additionally, in June 2011, FDA held a public workshop on the reprocessing of 

medical devices; and in October 2011, FDA co-hosted, with the Association for the 

Advancement of Medical Instrumentation (AAMI), the Medical Device Reprocessing Summit.

■ Review and take necessary action on the regulatory status of blood lancets.

Progress: FDA is currently reviewing the regulatory status of blood lancets. This effort is in 

progress.

■ In collaboration with the U.S. Pharmacopeial Convention (USP), revise label content for 

medication vials.

Progress: FDA formed a workgroup of subject matter experts from various offices within the 

agency to discuss best practices and to establish acceptable and consistent labeling 

terminology for medication vials that is clear and understandable to users. This workgroup 

and USP conducted a collaborative, large-scale survey of health care providers in an 

attempt to identify the most effective labeling to discourage unsafe behaviors. FDA, USP,

and CDC are now discussing (1) the harmonization of the definition of “single-dose vial,” (2) 

the circumstances that lead to the use of single-dose vials as multiple-dose vials, and (3) the 

necessary education to enhance the knowledge of health care providers. This effort is slated 

for completion in December 2012.

2012 Action

■ Issue a draft guidance for industry addressing the validation of cleaning, disinfection, and 

sterilization of endoscopes.

Progress: FDA has decided not to issue an FDA draft guidance document for industry on 

endoscope reprocessing. Instead, FDA will partner with AAMI to develop a Technical 

Information Report (TIR) on endoscope reprocessing. The Task Force to draft the TIR was 

formed in November 2011 and is already working on the document.
Priority 6: Protecting Patients and Workers for Health-Care Associated Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 42

Interagency Implementation Progress Report - Year 1

GOAL 6.2 Reduce iatrogenic transmission of viral hepatitis associated 

with blood, organs, and tissues.

Centers for Disease Control and Prevention (CDC)

2011 Action

■ Update policies to facilitate implementation of nucleic acid testing (NAT) for HCV among 

organ donors.

Progress: The CDC’s Office of Blood, Organ, and Other Tissue Safety has drafted U.S. 

Public Health Service (PHS) guidelines for reducing transmission of HIV, HBV, and HCV in

solid-organ transplantation. PHS agencies are finalizing the draft guidelines after a CDC-led 

review of public comments of the draft published in the Federal Register in September 2011.

The guidelines will include recommendations for NAT screening for HCV in deceased and 

living donors. This effort is slated for completion in December 2012.

Centers for Medicare & Medicaid Services (CMS)

2011 Action

■ Update policies to facilitate implementation of nucleic acid testing (NAT) for HCV among 

organ donors.

■ Progress: CMS is working to align Organ Procurement Organization (OPO) survey 

guidance with Organ Procurement and Transplantation Network (OPTN) policies on 

hepatitis screening and testing and is in the process of completing the Interpretive Guidance 

for the OPO regulations. These guidelines will include a statement that the OPO must follow 

OPTN rules for the testing of all potential donors for infectious diseases, including HIV and 

hepatitis. The guidelines will also indicate that the OPO makes full disclosure of all test 

results to all transplant surgeons so that they may in turn share these results with the 

intended recipient. CMS also regulated blood transfusions in hospitals and served as a 

member of the committee which drafted the PHS Guideline for Reducing Transmission of 

HIV, HBV, and HCV through Solid Organ Transplantation. These efforts are ongoing.

Food and Drug Administration (FDA)

2011 Actions

■ Engage manufacturers to promote development of rapid, high-sensitivity NAT systems for 

HBV and HCV.

Progress: FDA anticipates completing the action in December 2012.

■ Explore the development of new pathogen reduction technology by examining FDA’s current

regulatory approach.

Progress: Development continues with respect to exploring new pathogen reduction 

technologies. This effort is ongoing.
Priority 6: Protecting Patients and Workers for Health-Care Associated Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 43

Interagency Implementation Progress Report - Year 1

Office of the Assistant Secretary for Health (OASH)

2011 Action

■ Undertake a coordinated cross-agency and public-private collaborative effort to collect,

analyze, and share data on adverse events associated with the donation, processing,

distribution, and transfusion and transplantation process.

Progress: OHAIDP has coordinated the following collaborative efforts:

The National Blood Collection and Utilization Survey, funded by HHS, offers a 

comprehensive analysis of collection and utilization of blood, blood products, and cellular 

therapies in the United States. The results of the survey are used to support important 

blood-related initiatives by the federal government as well as within the transfusion medicine 

community. This survey of hospitals, blood centers, and cord blood banks is conducted 

biennially. It solicits general information about the blood collection facility; transfusion 

service, or cord blood bank; and, depending on the specific activity of the facility, more 

specific data regarding blood collection, transfusion, cellular therapies, and product 

modification, including leukoreduction and irradiation.

The HHS Blood Donor Hemovigilance Analysis and Reporting Tool (DonorHARTTM) was 

developed to collect and analyze adverse events and reactions that occur during the blood 

donation process. The DonorHARTTM system was developed under two OASH Small 

Business Innovative Research contracts with Knowledge Based Systems, Inc. of College 

Station, Texas. This system will provide analysis of factors (e.g., demographic, donation 

process-related, facility-related) correlated with reaction and event rates.

The National Healthcare Safety Network (NHSN) is a secure, Internet-based surveillance 

system that integrates and expands patient and health care personnel safety surveillance 

systems managed by DHQP. NHSN also includes a new component for hospitals to monitor 

adverse reactions and incidents associated with receipt of blood and blood products.

Enrollment is open to all types of health care facilities in the United States, including acute 

care hospitals, long-term acute care hospitals, psychiatric hospitals, rehabilitation hospitals, 

outpatient dialysis centers, ambulatory surgery centers, and long-term care facilities. This 

effort is ongoing.

GOAL 6.3 Reduce occupational transmission of viral hepatitis.

Food and Drug Administration (FDA)

2011 Actions

■ Release a joint safety alert and advisory recommending the use of blunt surgical needles for 

the suturing of fascia.

Progress: An FDA workgroup is in the process of finalizing the document. Release in 

December 2012 is expected.
Priority 6: Protecting Patients and Workers for Health-Care Associated Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 44

Interagency Implementation Progress Report - Year 1

Indian Health Service (IHS)

2011 Action 

■ Identify barriers and develop strategies to address barriers to hepatitis B vaccination among 

health care workers and trainees.

Progress: IHS maintains the Indian Health Manual (http://www.ihs.gov/ihm/index.cfm ) 

which includes guidance for employee hepatitis B immunization, screening, and prophylaxis 

and educational material for employees in Chapter 12.

GOAL 6.4 Enhance understanding of the preventable causes of viral 

hepatitis transmission in health care settings.

Centers for Disease Control and Prevention (CDC)

2011 Actions

■ Link state HAI programs to viral hepatitis surveillance programs.

Progress: DHQP and DVH have had ongoing discussions to identify opportunities and 

strategies for linking these programs. CDC promoted this interaction during the October 

2011 HAI grantee meeting and will do so again at the June 2012 Council of State and 

Territorial Epidemiologists (CSTE) meeting. This effort is slated for completion in 2013.

■ Develop and disseminate best practices for the investigation of potential cases of health 

care-associated viral hepatitis.

Progress: CDC developed, cleared, and posted a best-practices case investigation guide 

that incorporates feedback from selected health department partners. Next steps include 

promoting this investigation guide at the June 2012 CSTE meeting. This effort is slated for 

completion in 2013.

■ Commission a study to evaluate purchasing practices of health care facilities to understand 

the patterns of use that contribute to poor compliance with recommended practices for the 

safe use of medical devices.

■ Conduct site visits and/or focus groups to identify barriers to use of safety devices and 

single-patient medication vials.

Progress: While funding for this specific study has not been identified, CDC has given 

technical input to an FDA-sponsored study of injectable medication vial labeling that is 

being conducted by USP. In addition, focus groups conducted under the auspices of the 

New York State Health Department and DHQP have included a hypothesis-generating 

exploration of purchasing practices among clinicians and clinic managers. Focus-group 

studies funded by DHQP were conducted recently and included a hypothesis-generating 

exploration of barriers to use of safety devices and single-patient medication vials among 

clinicians and clinic managers. A report from the contractor conducting the focus groups is 

currently under review.
Priority 6: Protecting Patients and Workers for Health-Care Associated Viral Hepatitis

Viral Hepatitis Action Plan for the Prevention, Care and Treatment of Viral Hepatitis 45

Interagency Implementation Progress Report - Year 1

■ Engage stakeholders to improve current practices related to narcotics security.

Progress: CDC co-authored a study detailing HCV transmission due to narcotics diversion 

in an April 2012 issue of Annals of Internal Medicine.

National Institutes of Health (NIH)

■ Support clinical trials to explore the safety and efficacy of technologies currently being used 

in other parts of the world.

■ Support grants to promote the development of new processing technologies.

Progress: NHLBI continues its ongoing support of research on reduction or inactivation of 

pathogens, including hepatitis viruses, for blood and blood products such as red blood cells.

For example, a study supported during the period is developing the use of photodynamic 

substances combined with the use of chemiluminescent compounds to generate light in situ 

for pathogen inactivation. This method overcomes the opacity of erythrocytes to UV light.

The NIH Clinical Center’s Department of Transfusion Medicine completed a study, which 

has been submitted for publication, looking at whether peripheral blood mononuclear cells 

serve as a reservoir for HCV replication even in patients who have the serologic and 

molecular pattern of spontaneous or treatment-induced recovery from HCV infection.

Substance Abuse and Mental Health Services Administration (SAMHSA) 

2011 Action 

■ Identify barriers and develop strategies to address barriers to hepatitis B vaccination among 

health care workers and trainees.

Progress: CSAT has begun drafting guidance to encourage grantees to consult with local 

health departments to perform testing and vaccinations of health care staff working in drug 

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

Interagency Implementation Progress Report - Year 1

Appendix List of Abbreviations

AAMI Association for the Advancement of Medical Instrumentation

AANHPI Asian-American, Native Hawaiian, and Pacific Islander

AASLD American Association for the Study of Liver Diseases 

AETC AIDS Education and Training Center

AHRQ Agency for Healthcare Research and Quality (HHS)

ANTHC Alaska Native Tribal Health Consortium

ASCA Association of State Correctional Administrators

ATTC Addiction Technology Transfer Center

A2ALL Adult to Adult Living Donor Liver Transplantation

BFHI Baby-Friendly® Hospital Initiative

BPHC Bureau of Primary Health Care

CARE Comprehensive AIDS Resources Emergency

CBO Community-Based Organization

CDC Centers for Disease Control and Prevention (HHS)

CIHS Center for Integrated Health Solutions

CLIA Clinical Laboratory Improvement Amendments

CMS Centers for Medicare & Medicaid Services (HHS)

CSAP Center for Substance Abuse Prevention (HHS/SAMHSA)

CSAT Center for Substance Abuse Treatment (HHS/SAMHSA)

CSTE Council of State and Territorial Epidemiologists

CTR counseling, testing, and referral

DHQP Division of Healthcare Quality Promotion (HHS/CDC)

DVH Division of Viral Hepatitis (HHS/CDC)

ECHO Extension for Community Healthcare Outcomes

EMR electronic medical record 

EPC Evidence-Based Practice Center

ETAC Evaluation and Technical Assistance Center

FBOP Federal Bureau of Prisons
Appendix A: List of Abbreviations

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

Interagency Implementation Progress Report - Year 1

FDA Food and Drug Administration (HHS)

FOA Funding Opportunity Announcement

FTCC Federal Training Centers Collaborative

FY fiscal year

HAB HIV/AIDS Bureau (HHS/HRSA)

HAV hepatitis A virus 

HBsAg+ hepatitis B surface antigen positive

HBV hepatitis B virus 

HCV hepatitis C virus 

HepCAT Hepatitis C Assessment and Testing Project

HHS U.S. Department of Health and Human Services 

HIRE HIV/AIDS Health Improvement for Re-entering Ex-offenders

HRSA Health Resources and Services Administration (HHS)

IDSA Infectious Diseases Society of America

IDU intravenous drug user 

IHS Indian Health Service (HHS) 

IOM Institute of Medicine

LHI Liver Health Initiative

L2L Linkage 2 Life

NASADAD National Association of State Alcohol and Drug Abuse Directors

NAT nucleic acid testing

NCI National Cancer Institute (HHS/NIH)

NHLBI National Heart, Lung, and Blood Institute (HHS/NIH)

NHSN National Healthcare Safety Network (HHS/CDC)

NIAAA National Institute on Alcohol Abuse and Alcoholism (HHS/NIH)

NIAID National Institute of Allergy and Infectious Diseases (HHS/NIH)

NICHD Eunice Kennedy Shriver National Institute of Child Health and Human 

Development (HHS/NIH)

NIDA National Institute of Drug Abuse (HHS/NIH)

NIDDK National Institute of Diabetes and Digestive and Kidney Disorders (HHS/NIH)
Appendix A: List of Abbreviations

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

Interagency Implementation Progress Report - Year 1

NIH National Institutes of Health (HHS) 

NPIN National Prevention Information Network

NQF National Quality Forum

NVPO National Vaccine Program Office (HHS)

OASH Office of the Assistant Secretary for Health (HHS)

OGHA Office of Global Health (HHS/HRSA)

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

OMH Office of Minority Health (HHS)

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

OSG Office of the Surgeon General (HHS)

OTP Opioid Treatment Program

OWH Office on Women’s Health (HHS)

PBHCI Primary and Behavioral Health Care Integration

PHBPP perinatal hepatitis B prevention program

PHS Public Health Service

PQRS Physician Quality Reporting System (HHS/CMS)

PWID person who injects drugs

QUERI Quality Enhancement Research Initiative 

SAMHSA Substance Abuse and Mental Health Services Administration (HHS)

SBIRT screening, brief intervention, and referral to treatment

SSP Syringe Services Program (HHS/SAMHSA)

SUD substance use disorder

TIP Treatment Improvement Protocol

USAPI U.S. Affiliated Pacific Islands

USP U.S. Pharmacopeial Convention

USPSTF U.S. Preventive Services Task Force

VA U.S. Department of Veterans Affairs

VHIG Viral Hepatitis Action Plan Implementation Group