HepVu and NASTAD Release Updated Viral Hepatitis Surveillance Status Report

HepVu and NASTAD, leading viral hepatitis organizations, release second annual assessment of viral surveillance practices across U.S. jurisdictions.  

Only 3% of jurisdictions said they could make progress toward elimination goals at current levels of CDC funding for hepatitis surveillance.

Washington, D.C. – Today, HepVu and NASTAD, leading viral hepatitis organizations, released a new report showing U.S. jurisdictions continue to lack funding and resources needed to effectively implement viral hepatitis surveillance programs. HepVu and NASTAD conducted their second-annual survey of jurisdictions, which found that jurisdictions with viral hepatitis elimination plans increased from 43% in 2021 to 70% in 2022, while 20% of jurisdictions did not have dedicated staffing to conduct routine surveillance activities, and 35% of jurisdictions were not able to produce annual surveillance summaries including basic descriptions of viral hepatitis burden of disease. A robust surveillance system allows the U.S. to monitor disease burden and disparities and mount an effective public health response to eliminate viral hepatitis in the U.S. The report also provides a series of recommendations to improve U.S. viral hepatitis surveillance.

An estimated 2.4 million people in the U.S. are living with hepatitis C infection, and up to 2.2 million people could be living with hepatitis B. in the U.S. Robust viral hepatitis surveillance systems are critical to guide strategies for prevention and treatment of infections and to reduce viral hepatitis-related disparities and health inequities. This year, the Biden Administration’s proposed budget to Congress included a $5 billion plan to end hepatitis C nationwide by 2030. The program remains unfunded despite hepatitis C being a leading cause of infectious disease mortality.

“There is an unprecedented effort from the White House to fund a plan to eliminate hepatitis C across the country—and critical to that plan will be the capacity to have basic measurements of the state and local burden of infections, which are not currently available through routine surveillance,” said Heather Bradley, PhD, Associate Professor of Epidemiology at Emory University’s Rollins School of Public Health, and Project Director for HepVu. “Our data show us that while many jurisdictions are doing commendable work with limited resources and have developed elimination plans, most do not have the capacity to implement their plans. With additional funding, jurisdictions can begin to collect the necessary surveillance data to fully understand the burden of viral hepatitis infections, understand systemic inequities in access to care, and work towards national and local elimination goals.”

In 2021, the Centers for Disease Control and Prevention (CDC) released funding for hepatitis C surveillance across 59 jurisdictions. Prior to 2021, only 14 states received federal funding specifically for viral hepatitis surveillance. HepVu and NASTAD collaborated to create the first-ever Viral Hepatitis Surveillance Status Report in 2022. This year’s assessment builds and expands upon the inaugural report with year-over-year trends, deeper dives into capacity by dedicated staffing and funding, and availability of health equity data, based on responses from 54 jurisdictions. The primary intent of the report is to assess how jurisdictions across the U.S. are measuring the impact of viral hepatitis on their communities and to highlight areas in need of additional resources.

“Our inaugural report last year allowed us to create a baseline of viral hepatitis practices across the country, prior to an increase of funding from CDC. Local leaders and policymakers now have reliable and standardized data to understand public health efforts, resources, and response to viral hepatitis across the country,” said Boatemaa Ntiri-Reid, J.D., M.P.H, Senior Director of Syndemic Approaches at NASTAD. “If you look at the program growth trends from year one to year two, these reports show us that a robust surveillance system is possible if we provide jurisdictions with necessary funding and resources.”

Key Findings from the Surveillance Status Report:

Elimination Plans:

• Seventy percent (70%) of jurisdictions had viral hepatitis elimination plans, up from 43% in 2021.
• Half (54%) of jurisdictions are implementing elimination plans, and only 35% have public elimination plans.
• In 2022, only 30% of jurisdictions had the capacity to make progress toward elimination goals, and 33% had the capacity to measure progress toward those goals.
• Only 3% said they could make progress toward elimination goals at current levels of CDC funding for hepatitis surveillance.

Staffing:

• One-fifth (20%) of jurisdictions did not have a full-time employee (FTE) dedicated to viral hepatitis in 2022.
  • The report shows that jurisdictions with one FTE were more likely to have elimination plans, produce annualized summaries, and have adequate data to assess and address health disparities.
• Jurisdictions reported major challenges with hiring and retaining surveillance staff. Staff turnover was a significant impediment to conducting basic viral hepatitis surveillance activities in 2022.

Health Disparities:

• 61% of jurisdictions have adequate data to assess and address viral hepatitis disparities by risk factor (e.g. people who inject drugs).
• 54% of jurisdictions have adequate data to assess and address viral hepatitis disparities by race/ethnicity.
• 54% of jurisdictions have adequate data to assess and address viral hepatitis disparities by urbanicity.
• 33% of jurisdictions have adequate data to assess and address viral hepatitis disparities by sexual orientation and gender identity.
• 28% of jurisdictions have adequate data to assess and address viral hepatitis disparities by birthplace.

Pregnancy:

• About 40% of infants born to pregnant people living with hepatitis B will develop chronic hepatitis B, yet pregnancy status was considered a reportable condition for hepatitis B for only 71% of jurisdictions.
• As of April 2020, CDC recommends prenatal care providers screen all pregnant persons for hepatitis C. However, pregnancy status was considered a reportable condition for hepatitis C for only 46% of jurisdictions.

Syndemics:

• Only 60% of jurisdictions matched viral hepatitis case reports with HIV surveillance data.
• Only 37% of jurisdictions matched viral hepatitis case reports with STD surveillance data.

Data Dissemination:

• More than 1/3 (35%) of jurisdictions did not have the resources to produce annual surveillance summaries in 2022.
• 69% of jurisdictions produced annual estimates for the number of hepatitis B cases in 2022, but only 15% produced hepatitis B prevalence estimates.
• 83% of jurisdictions produced annual estimates for the number of hepatitis C cases in 2022, but only 20% produced hepatitis C prevalence estimates.

For more information on how those numbers changed from 2021-2022, click here.

Recommendations

Expanded, standardized, and reliable viral hepatitis surveillance is necessary to promote effective public health efforts, identify resource needs, and support response across the U.S. to this epidemic. While public health professionals are doing commendable surveillance work with currently available resources, this report showcases the need for additional funding and resources. Based on the state of viral hepatitis surveillance in the U.S, it is recommended to:

1. Invest in infrastructure needed for viral hepatitis surveillance, including data systems and staff trained in data science.
2. Increase federal and state funding for viral hepatitis surveillance.
3. Target surveillance resources toward monitoring populations with highest viral hepatitis risk, such as people who inject drugs.
4. Prioritize dedicating resources toward health disparities data collection and analysis. Data are not currently adequate to have an equitable viral hepatitis surveillance program despite the Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021-2025 core objective of reducing viral hepatitis-related disparities and health inequities.

About the Survey

HepVu and NASTAD collaborated to create the first-ever viral hepatitis surveillance status report in 2022. This year’s update builds and expands upon the inaugural report with year-over-year trends, deeper dives into capacity by dedicated staffing and funding, availability of health equity data, and more.

HepVu is an interactive online mapping tool that visualizes the impact of the viral hepatitis epidemics on communities across the United States to promote data-driven public health decision-making. NASTAD is a leading non-partisan non-profit association that represents public health officials who administer HIV and viral hepatitis programs in the U.S. to end HIV/AIDS, viral hepatitis, and intersecting epidemics. We worked with a steering committee comprised of state and local health department representatives, national policy/advocacy organizations, and researchers to develop a set of indicators for survey measurement, determine process, develop a survey, and disseminate results.

In March 2023, a survey requesting information on hepatitis B and C surveillance practices in 2022 was sent to 59 state, local, and territorial jurisdictions across the U.S., and 92% of jurisdictions responded. Data were processed by Emory University and compared to additional indicators like prior viral hepatitis funding, dedicated staffing, and other factors. Moving forward, HepVu and NASTAD will continue to collect data from jurisdictions on these indicators each year, analyze the results, and prepare a status report describing findings nationally and by jurisdiction.

For the full report and additional insights, download the report here and share our infographics or read an expert Q&A about viral hepatitis surveillance.

About HepVu

HepVu.org is presented by Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. and the Center for AIDS Research at Emory University (CFAR). HepVu’s mission is to make data widely available, easily accessible, and locally relevant to inform public health decision-making and action. The platform visualizes data, presents insights, and catalyzes research on the viral hepatitis epidemic in the U.S. Each year, HepVu strives to increase the granularity of its publicly available data and continues its commitment to provide public health officials, policymakers, healthcare professionals, researchers, and community leaders with a more comprehensive view of the viral hepatitis epidemic at the local, state, and national levels.