Hepatitis and Harm Reduction Program Manager New Mexico ...
Transcript of Hepatitis and Harm Reduction Program Manager New Mexico ...
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
www.nmhivguide.org
Dominick V. Zurlo, Ph.D. Educational Psychology Hepatitis and Harm Reduction Program Manager New Mexico Department of Health Public Health Division Infectious Disease Bureau [email protected]
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Understanding the Need ! 1994-97 - Sero-prevalence study
(Doherty, 2001)* ! 1003 Individuals Injecting Substances
participated: ! 0.5% HIV positive ! 61% hepatitis B positive ! 82% hepatitis C positive
! Fastest increase in HCV - individuals injecting who are under 30 (NMDOH 2016)
*Samuel, M.C., Doherty, P.M., et. al, 2001. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA. Epidemiological Infections, 127, 475-484.
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Understanding the Need ! Overdose:
! 2001-2011: highest rate of unintentional overdose deaths in the US (CDC, 2012)
! 2016: NM ranked 13th in the US (CDC, 2018)
! Overdose mortality rate among Native Americans in New Mexico
! 14.1 per 100,000 ! 117 people between 2010-2014
(NMDOH Epidemiological Profile, 2016 https://nmhealth.org/data/view/substance/1862/)
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
~50,000InteractionsinFY2017
50%↑EnrollmentsSince2012
~8MillionSyringesExchangedinFY2017
As of 11/2017
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Enrollment " Over 12,000 unique codes recorded in FY18
" Exchanged ~ 8 million syringes in FY17
" 50,000 exchanges in FY17
" Syringes are collected both during syringe
service sessions and through public syringe drop-
boxes.
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Harm Reduction Act: Syringe Service Program
" Enacted in 1997
" Implemented on February 2, 1998 (NMSA 1978 24.2C)
" On this day: " 6 programs
" 24 people
" Collected 19 syringes
" Distributed 260 syringes
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Enrollment " 9,600 individuals enrolled in 2016
" Exchanged ~ 8 million syringes in FY17
" 50,000 exchanges in FY17
" Collection rate 94%-96% of syringes distributed
" This does not include syringe drop-boxes, which collect
an additional 300,000 to 500,000 syringes (NMDOH –
2013-16)
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Capacity Building: How Did We Get Here?
" Harm Reduction Specialist Certification Training " Started in 2008 - standardized 8-hour curriculum
" 6.5 CME/CEUs are offered (through the New Mexico AIDS Education and Training Center)
" Pre-requisites of HIPAA and bloodborne pathogen courses are required prior to the training
" Renewal every two years
" Has a focus on Stigma and Substance Use " There are 426 current Certified Specialists (9/13/18)
" In total, since 2008, over 1240 individuals have been trained (9/13/18)
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Capacity Building: Training of the Trainer
• 2009 – 3-day training: Requirement - be interested
• 2011 Requirements: • 2 years Harm Reduction experience • Pre-requisites: HIV, HCV, STD, HIPAA, & Bloodborne Pathogen • Complete an observed training • Commit to providing three trainings each year
• Currently 28 Active Certified Instructors • 9 trained the first year • Total of 92 trained, including from other states
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Additional Integration • 2012 - Incorporated Adult Viral Hepatitis Program with
Harm Reduction Program to ensure: • HCV prevention messages are incorporated into Harm Reduction
Specialist Certification
• HCV counseling, testing, and referral information is incorporated into the 3-day HIV Counseling, Testing, and Referral Service (CTRS) Training
• Cross training with both Harm Reduction Specialist Certification and HIV/HCV Counseling, Testing, and Referral Services (CTRS)
• Offer CEUs and CMEs with trainings (6.5 hours for one day and 19.5 for three days)
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Comprehensive Statewide Services • Over 50 locations
• Most are operated by Public Health Offices (PHO) • 21 Contract providers:
• 15 - syringe services, overdose prevention, and hepatitis • 3 - dedicated hepatitis surveillance and support • 1 - focusing on acu-detox • 1 - focusing on Law Enforcement and other training • 1 – focused on telehealth (Project ECHO with the University of New Mexico)
• Services vary across the state, and are integrated as much as possible based upon resources in the area.
• HIV, HCV and other STD counseling and testing • Adult Viral Hepatitis vaccination and testing • Adult Viral Hepatitis surveillance • Wound and abscess care
• Other health care • Food bags • Fresh/bottled water • Acu-Detox treatment • Suboxone treatment • Referrals to other substance use services
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Hepatitis C Surveillance ! U-30 HCV Surveillance for HCV
! Contact individuals with positive lab results ! Act as a referral and educational source ! Ensure people have the necessary information for their next steps
Source: Dr. Kimberly Page, UNM: Hepatitis C Virus (HCV) in New Mexico: Statewide Comprehensive Plan and Profile of the Epidemic 2016, New Mexico Hepatitis C Coalition, 2016, p. 8
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Elimination of Hepatitis C
Source: Dr. Kimberly Page, UNM Hepatitis C Virus (HCV) In New Mexico: Statewide Comprehensive Plan and Profile of the Epidemic https://nmhealth.org/about/phd/idb/hip/
“…we estimate that use of the syringe exchange would have led to a 61% reduction in hepatitis B and a 65% reduction in hepatitis C among local injection drug users.”
Hagen, H., Des Jarlais, D.C, et al. Reduced Risk of Hepatitis B and Hepatitis C among Injection Drug Users in the Tacoma Syringe Exchange Program American Journal of Public Health, November 1995, vol 85, No 11. p. 1536
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Naloxone and Overdose Prevention • Program started in 2001 • Originally a 3-hour training – Some problems:
• Participants falling asleep • Participants needing to use • Too much information – cognitive overload!
• In 2005-2006 the program started implementing a short 15-20 minute on the street curriculum – to meet people where they are
• Basic information • It is not overwhelming • Handouts re-designed
More easily integrated into outreaches and clinics
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Hepatitis and Harm Reduction Program Naloxone Distribution Overview 2012-2016
168.5%increaseinsuccessfulopioidoverdosereversalsreportedfrom2012to2016.
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
Reducing Barriers: Legislation
! Mirror-bills ! HB 277 sponsor - Representative Terry H. McMillan,
M.D. ! SB 262 sponsor - Senator Richard C. Martinez ! Included an emergency clause to take effect
immediately
! Unanimous - all committees and both chambers
! Signed on March 4th, 2016 by Governor Suzanna Martinez
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
• Meet people where they are
• Treat people as people
• Ask people what they need
• Use affirming language
• Mistakes happen – learn and move forward
• Active navigation/Linkage-to-Services
Reducing Barriers: Stigma and Awareness
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
20 Years – Then and Now
February2 1998 2018Programs/Offices 6 18PeopleServed 24 206SyringesCollected 19 7,319SyringesDistributed 260 9,230
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
DominickV.Zurlo,Ph.D.EducationalPsychologyHepatitisandHarmReductionProgramManagerNewMexicoDepartmentofHealthPublicHealthDivisionInfectiousDiseaseBureau505-827-2507Dominick.Zurlo@state.nm.us
Thank you & Contact Information
www.nmhivguide.org
Special thank you to NMDOH Staff for their help and support: Chandelle Chavez – Overdose Prevention Coordinator Andrew Gans, M.A. – HIV, STD and Hepatitis Section Manager John Murphy – HIV Training Coordinator Richard Sober – Syringe Service Coordinator Josh Swatek, B.A.- Adult Viral Hepatitis Coordinator And thanks to community partners throughout the years including: Phil Fiuty, Bernie Lieving, Dr. Bruce Trigg, Dr. Mary Murphy, Dr. Laura Tomedi, Diana McCague, and all others who have worked in Harm Reduction or helped in New Mexico.
• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •
References
ThankyoutoNMDOHandCommunityContributorsLaineM.Snow,M.S.W–formerAdultViralHepatitisCoordinatorKimberlyPage,Ph.D.M.P.H,M.S.–ProfessorandChief,Epidemiology,Biostatistics&PreventiveMedicine,UNMHSC
CDCMorbidityandMortalityWeeklyReports2002-2018https://www.cdc.gov/mmwr/mmwr_wk.htmlHagen,H.,DesJarlais,D.C,etal.ReducedRiskofHepatitisBandHepatitisCamongInjectionDrugUsersintheTacomaSyringeExchangeProgramAmericanJournalofPublicHealth,November1995,vol85,No11.p.1536
NewMexicoDepartmentofHealth:PublicHealthDivisionandEpidemiologyandResponseDivisionhttps://nmhealth.org/about/erd/andhttp://nmhealth.org/about/phd/idb/hrp/andhttps://nmhealth.org/data/view/substance/1862/)Page,Kimberly,(2016)HepatitisCVirus(HCV)InNewMexico:StatewideComprehensivePlanandProfileoftheEpidemichttps://nmhealth.org/about/phd/idb/hip/
Samuel,M.C.,Doherty,P.M.,et.al,2001.Associationbetweenheroinuse,needlesharingandtattoosreceivedinprisonwithhepatitisBandCpositivityamongstreet-recruitedinjectingdrugusersinNewMexico,USA.EpidemiologicalInfections,127,475-484.Ward,JohnM.D.(2015)DirectoroftheCDCViralHepatitisPreventionProgramasquotedin:USAToday,May8,2015.HepatitisCinfectionssoaring,fueledbyprescriptionpainkillerabuse.