Hepatitis C 2010

Strategies for the New Decade

Session Descriptions and Objectives

Viral Hepatitis Prevention and Control -- Institute of Medicine (IOM) Report

The Institute of Medicine (IOM) is a nonprofit organization that provides science-based advice on matters of biomedical science, medicine, and health. In 2008, the IOM formed a committee of experts in the fields of viral hepatitis and public health to identifying ways to reduce new hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and the morbidity and mortality related to chronic viral hepatitis. This session will describe the process for developing the report and provide an overview of the committee's findings, recommendations and priorities for research, policy, and action.

By the end of this session, participants will be able to:

  1. Summarize the IOM recommendations to reduce new hepatitis B and hepatitis C infections and the morbidity and mortality related to chronic viral hepatitis.

2010 New York State Department of Health Viral Hepatitis Strategic Plan

In 2004, the New York State Department of Health (NYSDOH) published a five-year Viral Hepatitis Strategic Plan. This detailed action plan has served as a valuable guide. During 2004-2009 much was accomplished in the areas of prevention, education, surveillance and research and medical case management. Even so, challenges remain and there is more that can be done. In November 2009, the New York State Department of Health released its updated Plan. The 2010 Viral Hepatitis Strategic Plan provides a roadmap to maximize the effectiveness of the work of a diverse array of individuals, agencies and organizations engaged in fighting viral hepatitis in NYS. This plenary session will describe the process used for updating the Plan. The session will also highlight the goals and strategies within the newly developed hepatitis A, B and C frameworks and discuss strategies for implementation of the plan in various public health settings.

By the end of this session, participants will be able to:

  1. State the Mission and Vision of the NYSDOH Viral Hepatitis Strategic Plan.
  2. List three strategies for implementing the strategic plan in public health programs.

Persistent HCV after SVR -- What does is mean?

Hepatitis C patients who maintain undetectable plasma HCV RNA level 6 months after completion of interferon-based therapy are generally considered "cured." But recent studies indicate that HCV may persist at low levels in the body, and successfully treated patients remain infectious and at risk for liver disease progression. This session will describe

By the end of this session, participants will be able to:

  1. Describe the impact of persistent hepatitis C virus after successful treatment on HCV transmission and the risk for liver disease progression.

Synopsis of HCV Treatment Studies

Keeping current with the medical/research literature is important for the clinician, researcher, patient, and advocate alike. With the volume of clinical data and reports, achieving this goal can be a harder task to accomplish. This session will present a synopsis of the larger and/or more significant HCV trials, such as the PROVE, SLAM-C, IDEAL, and HALT-C trials.

By the end of this session, participants will be able to:

  1. Summarize the outcomes of current hepatitis C treatment studies.

Hepatitis C Treatment Adherence: Building on the HIV Model

As HCV treatment becomes more complex with new classes of agents, adherence will be increasingly important to treatment success as resistance to treatment agents may develop as a result of suboptimal dosing during therapy. Findings from HIV adherence research can be applied to HCV treatment to establish accurate methods to assess adherence, investigate determinants of non-adherence and develop strategies to optimize adherence. This session will review the techniques used for HIV treatment adherence and their utility in maximizing treatment adherence in patients on HCV treatment.

By the end of this session, participants will be able to:

  1. Describe the varying meanings of adherence as it relates to HIV vs. HCV treatment.
  2. Identify the specific challenges patients face in adhering to HCV treatment.
  3. State how the various methods of assessing HIV treatment adherence can be applied to patients on HCV treatment with similar success.

Assessment of non-invasive methods of fibrosis analysis in chronic hepatitis C

Accurate measurement of liver fibrosis is essential for planning treatment and predicting its success in patients with chronic HCV, and the gold standard has been liver biopsy. However, great strides are being made in the development of accurate non-invasive methods for determination of fibrosis. Although no single non-invasive test or model developed to date can match that obtained from actual histology (i.e. inflammation, fibrosis, steatosis). This talk will discuss how combinations of two modalities of non-invasive methods can reliably differentiate between minimal and significant fibrosis, and thereby avoid liver biopsy in a significant percentage of patients.

By the end of this session, participants will be able to:

  1. Identify the existing non-invasive methods of assessing liver fibrosis.
  2. Describe the benefits of existing non-invasive methods over standard liver biopsy, as well as their disadvantages.
  3. List the non-invasive liver fibrosis assessment modalities used in combination that can be recommended over liver biopsy.

STRIVE - Study to Reduce Intravenous Exposures

Limiting the spread of new HCV infections is a critical public health and clinical intervention. This session will describe the STRIVE study, a randomized behavioral intervention trial that sought to understand better the factors that could lead to the reduction of unsafe injection practices. The session will discuss the ramifications of the study's results, and how the lessons learned might be applied on a broader realm in the hopes on preventing the proliferation of new hepatitis C infections.

By the end of this session, participants will be able to:

  1. Describe the behavioral intervention used in The Study to Reduce Intravenous Exposures (STRIVE) aimed at reducing HCV risk behaviors among injection drug users.

Prevention and Management of Resistance in the Chronic HBV Patient

As many as 2 million individuals in the United States are chronically infected with the hepatitis B virus (HBV). Although, antiviral therapy against HBV is recommended in patients to prevent progression of liver disease, the management of persons diagnosed with HBV infection may be complicated by the emergence of anti-HBV drug resistance. This session will report the most recent data on the development of drug-resistant HBV infection and on methods for monitoring viral load and detecting resistance. It will also report on FDA-approved treatments for chronic hepatitis B and their known resistance rates. Finally, it will present currently recommended treatment strategies for the prevention of HBV drug resistance and the management of patients with drug-resistant HBV disease

By the end of this session, participants will be able to:

  1. Describe the mechanisms for development of resistance during HBV treatment
  2. Discuss methods for monitoring and detecting development of resistance.

Hepatitis B - Management in the HIV -infected patient

Nearly 10% of the estimated 36 million people having HIV worldwide suffer from chronic hepatitis B virus (HBV) infection. The advent of new antiviral agents against HBV and the recent availability of improved molecular diagnostic tools have revolutionized the management of HIV/HBV coinfected patients. The session will provide an update of the current knowledge about HBV/HIV coinfection and provide practical advice about how to give the best care to HIV-infected persons with chronic hepatitis B.

By the end of this session, participants will be able to:

  1. Discuss the treatment options for HBV in HIV-infected individuals.

Strategic Planning for Your Program

Hepatitis C-related programs continue to face a multitude of challenges with limited available resources. Programs that engage in strategic planning build a strong foundation for continued growth. This session will provide information to participants on how to develop a strategic plan for their agency, including how programs can explore their current mission and vision, identify collective goals and strategies, and develop action plans and timelines to fulfill their objectives. The session will also help agencies identify activities to implement the NYSDOH Viral Hepatitis Strategic Plan.

By the end of this session, participants will be able to:

  1. Describe three key steps in the process of developing a strategic plan.

Accessing Hepatitis C Clinical Trials

There are many clinical trials available that evaluate medical drugs and vaccines for persons living with chronic hepatitis C. This session will include descriptions of how patients are recruited for clinical trials, how the trials are approved and monitored, things that patients should consider before enrolling in a trial, how to obtain support and potential risks and benefits of participation.

By the end of this session, participants will be able to:

  1. List three questions that should be asked before enrolling in a hepatitis C clinical trial.
  2. Describe the process involved with accessing hepatitis C clinical trials.