Viral Hepatitis National Strategic Plan For The United .
VIRALHEPATITISNational Strategic PlanA Roadmap to Eliminationfor the United States 2021–2025
VISIONThe United States will be a place where new viral hepatitis infections areprevented, every person knows their status, and every person with viralhepatitis has high-quality health care and treatment and lives free fromstigma and discrimination.This vision includes all people, regardless of age, sex, gender identity,sexual orientation, race, ethnicity, religion, disability, geographic location,or socioeconomic circumstance.Viral Hepatitis National Strategic Plan: 2021–2025i
Acknowledgments: The Viral Hepatitis National Strategic Plan for the United States: A Roadmap toElimination (2021–2025) (Hepatitis Plan) was developed through a robust process that included gatheringfeedback from stakeholders across health care and related fields. Partners throughout the federal government,as well as input from hundreds of nonfederal stakeholders including state, tribal, territorial, and localgovernments, researchers, health plans and providers, community groups, and national and local organizationsthat work in viral hepatitis and related fields, have helped shape the goals, objectives, and strategies in thisPlan. The Office of the Assistant Secretary for Health (OASH) and its Office of Infectious Disease and HIV/AIDS Policy (OIDP) of the U.S. Department of Health and Human Services (HHS) sincerely thank all those whocontributed to making this Hepatitis Plan a reality.Language used in the Hepatitis Plan: The Hepatitis Plan values the lived experiences and choices of allpeople, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographiclocation, or socioeconomic circumstance. To reflect this vision, a concerted effort was made to use inclusiveand person-first language throughout the Hepatitis Plan. Evidence-based, contemporary terminology is alsoused to convey respect and empowerment and to reduce stigma faced by communities and populationsdisproportionately impacted by these infections. Despite these efforts, specific terminology or language maybe unintentionally offensive or stigmatizing to some individuals or populations. Further, language is subjective,and the meaning and use of language changes over time. This approach is intended to help the HepatitisPlan’s users identify these societal shifts in preferred terminology and communicate in a manner that reflectsits vision for a collective, inclusive, and respectful national response.Electronic version of document: Additional information regarding the Hepatitis Plan and associated activitiesmay be accessed at www.hhs.gov/hepatitis.Suggested citation: U.S. Department of Health and Human Services. 2020. Viral Hepatitis National StrategicPlan for the United States: A Roadmap to Elimination (2021–2025). Washington, DC.Viral Hepatitis National Strategic Plan: 2021–2025ii
TABLE OF CONTENTSExecutive Summary.1I. Introduction.4A. The Need for This Viral Hepatitis National Strategic Plan.4B. Challenges and Opportunities.5C. Scope, Approach, and Development of the Hepatitis Plan. 10II. Viral Hepatitis Snapshot. 12A. Hepatitis A. 13B. Hepatitis B. 14C. Hepatitis C. 15III. Viral Hepatitis National Strategic Plan. 17A. Vision. 17B. Goals. 17C. Objectives and Strategies. 18D. Priority Populations. 31E. Indicators. 37IV. Implementation and Accountability. 44A. Federal Partners. 44B. Nonfederal Partners. 44Appendix A: Process/Methodology for Developing and Adopting the Hepatitis Plan. 45Appendix B: Indicators and Targets. 51Appendix C: Federal Steering Committee, Subcommittees, and Staff. 54Appendix D: Acronyms. 59Appendix E: References. 61Viral Hepatitis National Strategic Plan: 2021–2025iii
Tables, Figures, and BoxesTablesTable 1.Progress on National Viral Hepatitis Action Plan 2017–2020 Indicators, 2017. 5Table 2.Definitions Included in the Hepatitis Plan.18Table 3.Priority Populations by Hepatitis Type and Measure.32Table 4.Priority Populations and Summary National-Level Data, Calendar Year 2018.32Table 5.Hepatitis Plan Core Indicators.38Table 6.Hepatitis Plan Disparities Indicators.42Table A.1. Composition of Hepatitis Plan/HIV Plan Joint Federal Steering Committee.46Table A.2. Dominant Themes from Public Comments.48Table B.1. Hepatitis Plan Core Indicators.51Table B.2. Hepatitis Plan Disparities Indicators.52FiguresFigure 1.Estimated proportion of adults aged 19 years who received hepatitis A and hepatitis B . . .vaccination—National Health Interview Survey, United States, 2010–2017. 6Figure 2.Reported and estimated number of hepatitis A cases—United States, 2010–2018.13Figure 3.Reported and estimated number of acute hepatitis B cases—United States, 2010–2018.15Figure 4.Reported and estimated number of acute hepatitis C cases—United States, 2010–2018.16Figure 5.Rates of reported acute hepatitis B, by age group—United States, 2003–2018.34Figure 6.Rate of deaths with hepatitis B listed as a cause of death among U.S. residents, by race/. .ethnicity—United States, National Vital Statistics System, 2014–2018.34Figure 7.Rates of reported acute hepatitis C, by age group—United States, 2003–2018.35Figure 8.Rates of reported acute hepatitis C, by race/ethnicity—United States, 2003–2018.35Figure 9.Age-adjusted rate of death with hepatitis C listed as a cause by race/ethnicity among U.S. .residents, National Vital Statistics System, 2014–2018.35Figure A.1. Respondent type for all viral hepatitis public comments with available affiliation.47BoxesBox 1.Viral Hepatitis Surveillance and Fact Sheets.12Box 2.Hepatitis A.13Box 3.Hepatitis B.14Box 4.Hepatitis C.15Viral Hepatitis National Strategic Plan: 2021–2025iv
EXECUTIVE SUMMARYViral hepatitis is a serious, preventable public health threat that puts people who are infected at increasedrisk for liver disease, cancer, and death. The Viral Hepatitis National Strategic Plan for the United States: ARoadmap to Elimination (2021–2025) (Hepatitis Plan or Plan) provides a framework to eliminate viral hepatitisas a public health threat in the United States. Elimination is defined by the World Health Organization (WHO)as a 90% reduction in new chronic infections and a 65% reduction in mortality, compared to a 2015 baseline.The Hepatitis Plan focuses on hepatitis A, hepatitis B, and hepatitis C—the three most common hepatitisviruses and that have the most impact on the health of the nation. The Hepatitis Plan, which builds on threeprevious plans, is necessary as the nation faces unprecedented hepatitis A outbreaks, progress on preventinghepatitis B has stalled, and hepatitis C rates nearly tripled from 2011 to 2018. In 2016, it was estimated that3.3 million Americans were living with chronic viral hepatitis: 862,000 with hepatitis B and 2.4 million withhepatitis C. Yet hepatitis A and hepatitis B are preventable by vaccines, and hepatitis C is curable in one shortcourse of treatment. Reversing the rates of viral hepatitis, preventing new infections, and improving care andtreatment require a strategic and coordinated approach by federal partners in collaboration with state and localhealth departments, tribal communities, community-based organizations, and other nonfederal partners andstakeholders.The Hepatitis Plan provides goal-oriented objectives and strategies that can be implemented by a broad mixof stakeholders at all levels and across many sectors, both public and private. It serves as a mechanism toidentify and leverage areas of synergy and resources and to avoid duplication of efforts across agencies. TheHepatitis Plan was developed under the direction of the Office of Infectious Disease and HIV/AIDS Policy(OIDP) in the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and HumanServices (HHS), in collaboration with subject matter experts from across the federal government and with inputfrom a wide range of stakeholders including the public.The Plan establishes the following vision for the nation:VISIONThe United States will be a place where new viral hepatitis infections areprevented, every person knows their status, and every person with viralhepatitis has high-quality health care and treatment and lives free fromstigma and discrimination.This vision includes all people, regardless of age, sex, gender identity,sexual orientation, race, ethnicity, religion, disability, geographic location,or socioeconomic circumstance.Viral Hepatitis National Strategic Plan: 2021–2025Executive Summary 1
This vision is accompanied by five high-level goals, which frame the Plan’s more specific objectives. The orderof goals and objectives does not indicate any prioritization, and many are intertwined. The five goals and theirassociated objectives are as follows:Goal 1: Prevent New Viral Hepatitis Infections1.1Increase awareness of viral hepatitis1.2Increase viral hepatitis vaccination uptake and vaccine development1.3Eliminate perinatal transmission of hepatitis B and hepatitis C1.4Increase viral hepatitis prevention and treatment services for people who use drugs1.5Increase the capacity of public health, health care systems, and the health workforce toprevent and manage viral hepatitisGoal 2: Improve Viral Hepatitis–Related Health Outcomes of People with Viral Hepatitis2.1Increase the proportion of people who are tested and aware of their viral hepatitis status2.2Improve the quality of care and increase the number of people with viral hepatitis whoreceive and continue (hepatitis B) or complete (hepatitis C) treatment, including people whouse drugs and people in correctional settings2.3Increase the capacity of the public health, health care delivery, and health care workforce toeffectively identify, diagnose, and provide holistic care and treatment for people with viralhepatitis2.4Support the development and uptake of new and improved diagnostic technologies,therapeutic agents, and other interventions for the identification and treatment of viralhepatitisGoal 3: Reduce Viral Hepatitis–Related Disparities and Health Inequities3.1Reduce stigma and discrimination faced by people with and at risk for viral hepatitis3.2Reduce disparities in new viral hepatitis infections, knowledge of status, and along thecascade/continuum of care3.3Expand culturally competent and linguistically appropriate viral hepatitis prevention, care,and treatment services3.4Address social determinants of health and co-occurring conditionsGoal 4: Improve Viral Hepatitis Surveillance and Data Usage4.1Improve public health surveillance through data collection, case reporting, and investigationat the national, state, tribal, local, and territorial health department levels4.2Improve reporting, sharing, and use of clinical viral hepatitis data4.3Conduct routine analysis of viral hepatitis data and disseminate findings to inform publichealth action and the publicViral Hepatitis National Strategic Plan: 2021–2025Executive Summary 2
Goal 5: Achieve Integrated, Coordinated Efforts That Address the Viral Hepatitis Epidemicsamong All Partners and Stakeholders5.1Integrate programs to address the syndemic of viral hepatitis, HIV, STIs, and substance usedisorders5.2Establish and increase collaboration and coordination of viral hepatitis programs andactivities across public and private stakeholders5.3Identify, evaluate, and scale up best practices through implementation and communicationscience research5.4Improve mechanisms to measure, monitor, evaluate, report, and disseminate progresstoward achieving organizational, local, and national goalsThe vision, goals, objectives, and other components of the Hepatitis Plan were developed and approved by adedicated Steering Committee, composed of subject matter experts from across the federal government, withpublic comment from numerous and varied stakeholders. The Plan is designed to be accessible to a broadaudience, including people working in public health, health care, government, community-based organizations,research, and academia. It serves as a roadmap for all stakeholders at all levels to guide development ofpolicies, initiatives, and actions for viral hepatitis prevention, screening, and treatment. The Hepatitis Planidentifies disproportionately impacted populations with higher rates of hepatitis incidence, prevalence,and mortality (i.e., priority populations) so that federal agencies and other stakeholders can focus theirresources to realize the greatest impact. The priority populations were identified based on national-level data.Stakeholders are encouraged to review the data for the populations they serve to help focus their efforts.Interwoven throughout the Plan and highlighted in Goal 5 is the critical need to integrate viral hepatitisprevention, screening, diagnosis, and treatment, including breaking down operational and funding silosamong HIV, sexually transmitted infections (STIs), substance use disorders, and other public health efforts.Substance use includes the use of illicit drugs and the misuse of legal substances such as alcohol andprescription drugs. This integrated approach is even more critical in light of the COVID-19 pandemic, whichhighlights the health inequities faced by populations disproportionately impacted by viral hepatitis andCOVID-19. Approaches that address individual-, community-, and structural-level factors and inequities thatcontribute to these epidemics, such as stigma, social determinants of health, and health disparities, are alsointerwoven throughout the HIV National Strategic Plan and the STI National Strategic Plan (both of which areplanned for release in fiscal year [FY] 2021). The Hepatitis Plan is designed to facilitate a whole-person healthperspective and whole-of-nation response to the hepatitis epidemics in the United States and to successfullyeliminate viral hepatitis as a public health threat.The Hepatitis Plan also includes indicators for measuring progress and quantitative targets for each indicator.There are eight core indicators, some of which are then stratified to measure progress in addressing disparitiesin viral hepatitis (disparities indicators). Although focused on the years 2021–2025, the Hepatitis Planincludes annual targets through 2030 because it will take more than 5 years to eliminate viral hepatitis as apublic health threat in this nation. To ensure implementation and accountability, a Federal Implementation Planthat documents the specific actions that federal partners will take to achieve the Hepatitis Plan’s goals andobjectives will be released subsequent to the Hepatitis Plan. Progress toward meeting the Plan’s goals will bemonitored and reported annually.In furtherance of the Hepatitis Plan’s syndemic* and whole-of-nation approach, it was developed concurrentlyand in alignment with the inaugural STI National Strategic Plan and the next iteration of the HIV NationalStrategic Plan (both planned for release in FY2021). The Hepatitis Plan also intersects and aligns with the nextiteration of the National Vaccine Plan (also planned for release in FY2021).A syndemic occurs when health-related problems—such as viral hepatitis, HIV, STIs, substance use disorders, and social determinants of health—cluster by person, place, or time.*Viral Hepatitis National Strategic Plan: 2021–2025Executive Summary 3
I. INTRODUCTIONViral hepatitis is a significant public health threat that puts people who are infected at an increased risk forserious disease and death. This Viral Hepatitis National Strategic Plan for the United States: A Roadmap toElimination (2021–2025) (Hepatitis Plan or Plan) covers the most common types of viral hepatitis: hepatitis A,hepatitis B, and hepatitis C. New hepatitis A and hepatitis C i
The third plan, National Viral Hepatitis Action Plan 2017-2020, 12 was directed to all stakeholders in recognition that a broad range of support and commitment is required to reduce viral hepatitis and its impact. Its focus on four goals and
HAV hepatitis A virus anti-HBc hepatitis B core antibody anti-HBe hepatitis B e-antibody anti-HBs hepatitis B surface antibody HBeAg hepatitis B e-antigen HBIg hepatitis B immune globulin HBV hepatitis B virus HBsAg hepatitis B surface antigen HCC hepatocellular carcinoma HCP healthcare provider HCV hepatiti
Hepatitis C 2 What is hepatitis C? Hepatitis C is a disease caused by a virus that infects the liver. This virus, called the hepatitis C virus or HCV for short, is just one of the hepatitis viruses. The other common hepatitis viruses are A and B, which differ somewhat from hepatitis C in the way they are spread and treated.
Viral Hepatitis C: Introduction “Viral hepatitis," refers to infections that affect the liver and are caused by viruses. It is a major public health issue in the United States and worldwide. Not only does viral hepatitis carry a high morbidity, but it also stresses medical resources and can have severe
Viral Hepatitis B: Introduction “Viral hepatitis," refers to infections that affect the liver and are caused by viruses. It is a major public health issue in the United States and worldwide. Not only does viral hepatitis carry a high morbidity, but it also stresses medical resources and can have severe economic consequences. .File Size: 412KB
Mar 22, 2010 · with hepatitis B and hepatitis C can vary considerably between, and within, countries and therefore, even in areas of low overall prevalence, rates in certain sub-populations can be very high.3 Both hepatitis B and hepatitis C are efficiently transmitted through contact with infected bloo
Jul 27, 2017 · Chronic Viral Hepatitis: HBV & HCV Every third person on the planet shows evidence of infection with viral hepatitis 500 million people are chronically infected with hepatitis B or C 1 million die every year: 1 every 30 seconds Globally 57% of cirrhosis an
and Human Services Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (referred to as the Viral Hepatitis Action Plan), the Working Group convened expert panels from various HHS agencies and offices (Appendix B). Panel members were tasked with developing components of the action plan specific to their area of expertise.
BIOGRAPHIES James Brown b. 3 May 1928, Barnwell, South Carolina, USA. Brown claims he was born in 1933 in Macon, Georgia. "The Hardest Working Man In
