Sofosbuvir in HCV- HIV Coinfection & HCV GT 1,2,3 PHOTON-1 Trial
HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016)...
Transcript of HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016)...
![Page 1: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/1.jpg)
HIV&HCVinTN:StateoftheState
VanderbiltCCCHIVSymposiumNashville,TN/November3,2017
CarolynWester,MD,MPH|TDHHIV/STD/VHProgram
![Page 2: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/2.jpg)
Outline
• HIVEpidemiology
• “Neutralizing”theHIVCoC
• HCVEpidemiology
• HIVVulnerability
• OutbreakDetection&Response
• HIV&HCVMolecularSurveillance
![Page 3: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/3.jpg)
HIV&AIDSinTN(1982-2015)
![Page 4: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/4.jpg)
HIVdiseasebystatusandyearofdiagnosis(TN,2005-2015)
954 939972
996
712753
923
784
865861 852
![Page 5: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/5.jpg)
Male-to-malesexualcontact
Heterosexualcontact
Injectiondruguse
NewlyDiagnosedHIVintheU.S.byTransmissionCategory(U.S.,2005– 2014)
Diagno
ses,n
YearCDCNationalHIVSurveillanceSystemdata
![Page 6: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/6.jpg)
2020HIVContinuumofCareGoals:NHAS,90-90-90,&Tennessee
• NHAS– Reduce new infections by 25%– 85% linkage < 1 month of diagnosis
• 90-90-90• 90% diagnosed
• 90% on treatment– 90% virally suppressed
• TN Goals*• 85% newly diagnosed “linked” to care < 1 month diagnosis• 90% prevalent diagnosed engaged in care
• 90% engaged virally suppressed
![Page 7: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/7.jpg)
TennesseeHIVContinuumofCare:2010,2015,2020Goals)
*2020linkagegoalrelatestolinkagewithin1monthofdiagnosis;whereasfor2010&2015,linkageiswithin3monthsofdiagnosis.
64%
29% 35%
71%
53% 52%
*85% 90%
81%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Linked Engaged VirallySuppressed
2010
2015
2020
![Page 8: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/8.jpg)
TennesseeHIVContinuumofCare:LinkagetoCare< 3MonthsofDiagnosis(2012– 2015)
72% 80% 76%
71%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
2012 2013 2014 2015
%new
lydiagnosed
linkedto
care
Linkagetocare:individualsnewlydiagnosedwithHIVin2015andhaving≥1CD4orVLresultreported<3monthsofdiagnosis.Datasource:TennesseeeHARS,accessedJune30,2017.Provisionaldata,donotdistribute.
![Page 9: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/9.jpg)
TennesseeHIVContinuumofCare:LinkagetoCarebyTimefromDiagnosis(2015)
47%
71% 79%
86%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
1Month 3Months 6Months 1Year
![Page 10: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/10.jpg)
0
20
40
60
80
100
120
%personsate
pide
miologicrisk
TheHIVNeutral HIVContinuumofCare
Undiagnosed
Diagnosed
HIVCAREANDPREVENTIONARETHESAME=GETTINGTOHIVNEUTRAL
SlidecourtesyofDr.DemetreDaskalakis(NYCDOH)
![Page 11: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/11.jpg)
![Page 12: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/12.jpg)
WorkingtheNeutralCoC:WhatWeHave
• Testing– HDs– CBOs
• Prevention• Treatment• PrEP• SSP• MAT
• Treatment• Linkage(delinquent)• Re-engagementutilizingD2C
![Page 13: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/13.jpg)
WorkingtheNeutralCoC:WhatWeNeed
• RapidAccesstoTreatment– “Rapid-Rapid”testingalgorithms– “Test&Treat”initiatives
• AugmentedPrevention• PrEP• nPEP• SSP
• ExpandedRe-EngagementActivities• D2C(Re-engagement)
![Page 14: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/14.jpg)
WhatThisMightLookLike:Test&Treat,PrEP,nPEP
• Who(identify)• HIVtesting(rapid– rapid)andSTDscreening
• High-risknegatives(historysyphilis,rectalGC/Chl)• Positives(newlydiagnosed,priorsOOC)
• Services– Treatment:MCM,labs,treatment(newdx,priorsARTnaïve)– Prevention:PrEP,nPEP(?)
• Where– CloseproximitytoHDactivities
• How• Costumerfocused:Hoursofoperation,limitedwait,stigma-freeenvt• On-sitestaff:MCM,nurse,APN/PA/physician• On-siteservices:Labs,casemanagement,start-upmeds• Referraltolocalprovidersforon-goingcare
![Page 15: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/15.jpg)
WhatThisMightLookLike:Test&Treat,PrEP,nPEP
• Funding• StateHIVfunding??
• Staff• Pre-RyanWhiteregistration
– Casemanagement– Laboratorytesting– Medications
» 2weeksofARVs» 1monthofPrEP» 1monthnPEP
• Operationalizing• ProviderswithHIVexpertise• HDco-location• Accesstomedicationsat340bprices(STDFormulary?)• Test&Treat:NOTappropriatefortreatmentexperiencedclients• nPEP:GatewaytoPrEP,butdemandmayoverwhelmotheractivities
![Page 16: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/16.jpg)
NextSteps
v SecureFunding
v PilotTest&Treat,PrEP,nPEP
v Establishandscale-upSSPs
v Outbreakpreparednessandresponse
![Page 17: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/17.jpg)
IntersectionofEpidemics
OpioidAbuse
HepatitisC HIV
![Page 18: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/18.jpg)
DistributionofAcuteHCV&NewHIVCaseRatesinTN(2016)
TennesseeNBS,accessedFebruary10,2017TennesseeeHARS,accessedJune30,2017
PopulationSource,AmericanCommunitySurvey2011-2015CountyAverages
AcuteHCVCases
NewlyDiagnosedHIVCases
![Page 19: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/19.jpg)
ReportedCasesofAcute HCVinTN
2011 2012 2013 2014 2015
US caserate 0.4 0.6 0.7 0.7 0.8
cases 1,229 1,778 2,138 2,194 2,436
TN caserate 1.3 2.0 1.5 1.9 2.6
cases 83 129 98 123 173
rank 4th 4th 6th 5th 4th
http://www.cdc.gov/hepatitis/statistics/2015surveillance/pdfs/2015hepsurveillancerpt.pdf*per100,000population
![Page 20: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/20.jpg)
NewlyReportedCasesofChronic HCVinTN
*CentralofficechronicHCVsurveillanceeffortsaugmentedbeginning7/1/15
CaseClassification
2013 2014 2015* 2016
Confirmed 1,782(44%)
3,385(50%)
7,394(59%)
10,442(50%)
Probable 2,234 3,421 5,244 10,496
Total(C+P) 4,016 6,806 12,628 20,938
![Page 21: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/21.jpg)
Confirmed&ProbableCasesofChronicHCVinTN(2016)(n=20,938)
![Page 22: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/22.jpg)
HCVPrevalenceAmongWomenwithLiveBirths(TN&U.S.,2009– 2014)
3.84.7
5.4
7.07.8
10.0
1.8 2.0 2.22.6
3.03.4
0
2
4
6
8
10
12
2009 2010 2011 2012 2013 2014
Per 1
,000
Liv
e Bi
rths
Year
Tennessee US
PatrickSetal,MMWR2017
![Page 23: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/23.jpg)
EstimatingtheTotalBurdenofHCVinTN
v StatelevelHCVPrevalenceEstimatesUsingNHANESDatao TNpopulation=6,651,194o EstimatedrateHCV(+)inU.S.=1.3%
o EstimatedcasesHCVAb(+)inTN=86,466o Past5yrs,acuteHCVrateTN2.1– 3.3xhigherthanU.S.
o Initialweighted estimatedcasesHCVAb(+)inTN=233,456
v Accountfor#HCV Ab(+)casesinTN’snon-civilianpopulationo ~23%HCVAb(+)individualsintheU.S.arenotaccountedforinNHANES*
o Incarcerated,homeless,hospitalized,nursinghomes,military,reservationso Adjustingforestimatesamongnon-civilianpopulation…
FinalestimateHCVAb(+)casesinTN=303,189
*EdlinBR,etal.TowardamoreaccurateestimateoftheprevalenceofhepatitisCintheUnitedStates.Hepatology2015;62:1353–1363.
![Page 24: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/24.jpg)
ContextforOutbreak Planning
![Page 25: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/25.jpg)
TNCountiesHighlyVulnerabletoHIV/HCVOutbreakAmongPWID
VanHandelMMetal,JAIDS,2016
![Page 26: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/26.jpg)
HCVTesting&GHOSTPilotinTN
• June1– October31,2016
4,753ptstestedforHCV• 8.4%Ab(+)
• 73.2%RNA(+)
![Page 27: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/27.jpg)
HCVTesting:HDPilotResults(cont’d)
RiskFactor Totaln(%)
N=4753
HCVAb(+)n(%)N=397
HCVAb(-)n(%)
N=4356
PValue
Injectiondruguse 425(8.9) 276(64.9) 149 (35.1) <0.0001
Intranasaldruguse 967(20.3) 295(30.5) 672(69.5) <0.0001
Tattoo/piercing 1092(23.0) 188(17.2) 904(82.8) <0.0001
Incarceration 1309(27.5) 303(23.1) 1006(76.9) <0.0001
Transfusion 62(1.3) 13(21.0) 49(79.0) 0.0003
Noriskfactors 2598(54.7) 39(1.5) 2559(98.5) <0.0001
v 4,753personstestedo 8.4%Abpositive
§ 74.1%RNApositive
![Page 28: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/28.jpg)
OutbreakResponseWorkgroup
![Page 29: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/29.jpg)
DevelopedTools
Outbreak Response Plan
Outbreak Response Form
REDCap Database
SNA R Code
Specimen Collection and Transport
![Page 30: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/30.jpg)
RegionalClusterInvestigation(Apr2017)
OnApril21,2017• NotifiedofuptickinnewHIVdiagnosesin2PHRs
– 1pairlinkedPWID (namedascontacts)
• PromptedaninvestigationintoapossibleclusterofHIV/HCV
ActionItems• MobilizedOutbreakResponseFormandREDCapDatabase• DevelopedHIVClusterCaseDefinition• Developed“SituationReport”• EstablishedICSroles®ularcallschedule(CO,PHRs,Lab)• Distributedspecimencollectiontransportguidelines
![Page 31: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/31.jpg)
“SituationReport”Elements• CurrentSituation
– Definitions– #HIVCases/#Contacts
• #InterviewedwithOBRF• #Specimenscollected
• EpiCurve
• LineLists– Cases:HIVDx,RiskFactors,HCVstatus– Contacts:ContactType(P1,P2,P3),HCVstatus
• LaboratoryTestResults– HIV,HCV,HBVtesting
• ActionSteps
![Page 32: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/32.jpg)
“EpiCurve”(HIVClusterInvestigation)
![Page 33: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/33.jpg)
HIV&HCVMolecularTesting• Goal
– Focusoncasesandcontacts• Intervieww/OBRF• Collectspecimens
– HIVtesting(HIVmolecularsurveillance)– HCVtesting(GHOSTtesting)– HBVscreening
• Reality– “Outreach”testingconductedfirstweekendofinvestigation– Manycontactswithlimitedinfoorsimplydidnotwanttobefound– Importanttoembedphlebotomyinoutreach– OftennotenoughspecimenforbothHIVandHCVmoleculartesting
![Page 34: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/34.jpg)
SocialNetworkAnalysis
![Page 35: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/35.jpg)
SocialNetworkAnalysis
![Page 36: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/36.jpg)
HIVMolecularTesting
• ToidentifyexistingHIVtransmissionnetworks
• HIVMolecularTesting– 16casestested
• 9 “recent” and 4 “prevalent” HIV infections (3 unknown)• 3clustersidentified
– 2personcluster(MSM,MSM)– 2personcluster(MSM,NIR)– 4personcluster(MSM/PWIDx3,MSMx1)
![Page 37: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/37.jpg)
IdentifyingLinkages:HIVMolecularTesting
![Page 38: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/38.jpg)
HCVMolecularTesting(GHOST)
• ToidentifyexistingHCVtransmissionnetworksasaharbingerofpotentialHIVtransmissionnetworksamongPWID
• Builtlabcapacityduring2016HCVtestingpilotinEasternTN
![Page 39: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/39.jpg)
HCVTesting&GHOSTPilotinTN
• June1– October31,2016
4,753ptstestedforHCV• 8.4%Ab(+)
• 73.2%RNA(+)(n=291forGHOST)
![Page 40: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/40.jpg)
GHOST-identifiedtransmissionnetworks
TNPilotcases291samples
8transmissionclusters(19cases)
Unrelatedcases
Linkagebytransmission(>96.3%seq.identity)
0.037
![Page 41: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/41.jpg)
GHOST:HIVClusterInvestigation
• 22HCVRNA(+)positivepersonsidentified– 7fromHIVclusterinvestigation– 15from“outreach”testing
• 4linkagesidentified(allfrom“outreach”testing)– 2personcluster…..bothHIV(-)– 1personlinkedto2016pilot– 1personlinkedto2016pilot
# #HCVTested(PWID)
#HCVAb(+)(PWID)
#HCVRNA(+)
HIVCases 33 15(5) 3(3) 1
PriorHIVPositives 12 0 0 0
Contacts 95 10(8) 8 (8) 6
“Outreach” 22 22 15 15
![Page 42: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/42.jpg)
OngoingTNHCVsurveillance
0.037
(291)Pilotcases+
(7)Clustercases+
(15)Outreachcases
3additionalclusters(totalof11)
![Page 43: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/43.jpg)
LessonsLearned/NextSteps
LessonsLearned• Betterintegrationofteams(PHEP/CO/PHRs)• Missedalotoftestingopportunities
– Ensureadequatesamplecollection– DBtocapturemoleculartestingresults
NextSteps• Securesoftwaretoincorporate
moleculartestingintoSNA• SecureEpiforoutbreaksurgecapacity• Intelligentresourceallocation
– GHOST(outbreaksvs.vulnerablecounties)• Develop“One-Stop-Shops”
![Page 44: HIV & HCV in TN: State of the State · Distribution of Acute HCV & New HIV Case Rates in TN (2016) Tennessee NBS, accessed February 10, 2017 Tennessee eHARS, accessed June 30, 2017](https://reader035.fdocuments.us/reader035/viewer/2022070720/5ee08ae9ad6a402d666bb55f/html5/thumbnails/44.jpg)
ThankYou!
TDHHIV/STD/VHShanellMcGoyLindseySizemoreMichaelRicklesJenniferBlackMeredithBrantleySamanthaMathiesonMelissaMorrison
TDHCEDEPMary-MargaretFillRendiMurphreeCorinneDavisJuliaSchaffner
NYCDOHDemetreDaskalakis
CDCYuryKhudyakovSumathiRamachandranPhilPetersBillSwitzer
TDHStateLaboratoryRickSteeceJimGibsonPaulaGibbsLindaThomas