The purpose of this survey is to provide an overview of the second goal of Oregon's Viral Hepatitis Elimination Plan, Improve Health Outcomes, and solicit feedback from a wide variety of partners.
 
For the goal of improving health outcomes, we propose three main objectives that represent changes, outcomes and impacts that we want to achieve: 
 
1) Increase screening and diagnosis of hepatitis B (HBV) and C virus (HCV)
2) Increase treatment and monitoring of chronic HCV, and
3) Increase treatment and monitoring of chronic HBV

We want your opinion on the proposed strategies and to hear about what we are missing.  What strategies does your agency or healthcare facility already employ, and are there additional strategies that you could implement? As you go through the document, we have boxes at the end of each set of strategies where we would love your feedback on each aspect.
 

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* 1. Please select the following groups you represent. Please select all that apply.

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* 2. Please add your name or email 

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* 3. 1. Increase screening and diagnosis of HBV and HCV 

A. Implement universal one-time screening for persons > 18 years for HBV and HCV

o   Implement opt out one-time HBV/HCV/HIV screening of adults in healthcare systems

o   Ensure all labs/health systems conduct automatic reflex HCV RNA testing on specimens positive for anti-HCV antibodies

o   Promote clinician training on new recommendation for universal screening for HBV

o   Encourage use of clinical decision support tools and quality improvement initiatives to improve adherence to HBV and HCV screening guidelines

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* 4. 1. Increase screening and diagnosis of HBV and HCV 

B. Increase screening of pregnant women and children exposed to mothers with viral hepatitis during pregnancy

o   Standardize HCV screening as part of prenatal lab panel and as part of admission to labor and delivery if not done during pregnancy

o   Educate pediatric providers about need to screen infants born to mothers who were HCV positive during pregnancy

o   Promote use of clinical decision support tools to track infants born to women found to be positive for HCV during pregnancy to ensure appropriate testing and follow-up by age 18 months

o   Screen infants exposed to HBV 1-2 months following third dose of HBV vaccine

o   Document pregnancy status on labs positive for HBV or HCV

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* 5. 1. Increase screening and diagnosis of HBV and HCV 

C. Increase periodic screening for people with ongoing risk factors

o   Increase screening at community sites, health fairs, and outreach programs serving people who inject drugs (PWID), such as sterile syringe programs (SSPs) and homeless camps and shelters

o   Increase availability of dried blood spot testing to ensure quick access to results and minimize loss of follow-up

o   Develop media campaigns around the importance of screening and availability of treatment for HBV and HCV

o   Promote opt out onsite HBV/HCV screening for those accessing behavioral health or substance use disorder/opioid treatment programs

o   Promote opt out HBV/HCV screening in carceral settings

o  Offer HBV and HCV screening in high-risk settings wherever HIV and STI screening is routinely performed

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* 6. 2. Increase treatment/monitoring of chronic HCV

A. Increase number of patients diagnosed and linked to HCV care

o  Expand use of telemedicine to expand HCV treatment to the entire state, including non-traditional care settings such as SSPs, medications for opioid use disorder (MOUD) and substance use disorder (SUD) treatment centers

o  Promote use of peer recovery specialists or peer navigators in both community and healthcare settings to facilitate linkage to care and improve adherence to medications among high-risk patients

o  Promote cross-systems collaboration to treat HCV among people with all forms of disability, including psychosocial disability

o  Promote use of clinical decision support tools and quality improvement projects in healthcare settings that assure diagnosis and linkage to care

o  Initiate same day treatment for individuals with confirmed HCV

o  Ensure that treatment for HCV continues during periods of incarceration

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* 7. 2. Increase treatment/monitoring of chronic HCV

B. Increase number of providers administering HCV treatment

o   Promote awareness of high effectiveness and ease of treatment with DAAs among all clinicians

o   Provide trainings in collaboration with OHSU’s Extension for Community Healthcare Outcomes (Project ECHO) and the AIDS Education and Training Center (AETC) for PCPs, allopathic and non-allopathic, on HCV treatment

o   Encourage health systems to provide clinician education on HCV treatment as part of mandatory trainings or continuing education

o   Implement clinic champion model by identifying primary care providers trained to treat HCV within all primary care systems

o   Promote use of specialty pharmacy in linking patients to care, providing HCV treatment in collaboration with PCPs, and tracking treatment outcomes

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* 8. 2. Increase treatment/monitoring of chronic HCV

C. Increase patients with chronic HCV who are linked to medical home

o   Assure that patients with HCV receive care management, which includes long term management and surveillance for liver disease

o   Offer care navigation in outreach settings to help people at high risk for HCV to enroll in a health plan

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* 9. 3. Increase treatment/monitoring for chronic HBV

A. Increase number of patients diagnosed and linked to care

o   Promote use of clinical decision support tools and quality improvement projects in healthcare settings that assure diagnosis and linkage to care

o   Reduce stigma around diagnosis of HBV through social marketing and storytelling from people with lived experience

o   Promotes use of peer recovery specialists or peer navigators in both community and healthcare settings to facilitate linkage to care and improve adherence to medications

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* 10. 3. Increase treatment/monitoring for chronic HBV

B. Increase number of primary care providers (PCPs) who can facilitate treatment of HBV and provide long term management

o   Expand telehealth support for PCPs managing patients with HBV

o   Provide trainings in collaboration with OHSU ECHO, Indian Country ECHO, and AETC for primary care providers on HBV screening and co-management of treatment with subspecialists  

o   Encourage health systems to provide clinician education on HBV co-management and long-term surveillance for cirrhosis and liver cancer

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* 11. 3. Increase treatment/monitoring for chronic HBV

C. Increase patients with chronic HBV who are linked to a medical home

o   Increase linkage to PCP or medical home from outreach sites with HBV testing

o   Assure that patients with Hep B receive care management or patient navigation services, which includes long term management and surveillance for liver disease

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