0920-1353 Increasing Access to Hepatitis C and/or Hepatitis B Test

[NCCHSTP] Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Att 3d_SUPP_APR_Form

OMB: 0920-1353

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Annual Performance Report—CDC-RFA-PS21-21030301SUPP23

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments Supplement

Form Approved

OMB No. 0920-1353

Expiration Date: 11/30/2024

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1353)

Increasing Access to Hepatitis C and/or Hepatitis B Testing and Linkage to Care in High-Impact Settings

Reporting Agency

Reporting jurisdiction
Contact name (person completing form)
Contact phone number (xxx-xxx-xxxx)
Contact email address
Additional contact name(s) (if applicable)
Additional contact phone number(s) (xxx-xxx-xxxx)
Additional contact email address(es)
Date of report submission (MM/DD/YYYY)
Reporting Period (Complete this form with information from Reporting Period selected)	Select one □ Year 1 (6/1/23-9/30/23) □ Year 2 (10/1/23-9/30/24) □ Year 3 (10/1/24-9/30/25)

2.1—Increase routine HCV and/or HBV testing in high-impact settings

2.2—Provide counseling, linkage to treatment, and referral to prevention services in high-impact settings

Measures 2.1.1.a– 2.1.1.c

Status of jurisdiction-established relationships with partners in high-impact settings to identify high priority facilities for expansion of testing for HCV and/or HBV in high-impact settings, by setting type
Developed and documented plan with partners in high-impact settings to increase HCV and/or HBV testing, by setting type
Number of clients seen (all clients and PWID clients), by setting type

During the reporting period, were component 2 activities conducted at one or more syringe services programs (SSPs)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more substance use disorder (SUD) treatment programs (non-hospital based)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more hospital-based substance use disorder (SUD) treatment programs?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more hospital-based programs (excluding SUD treatment programs which are included separately above)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more health centers (non-hospital based)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more sexually transmitted infections (STI) clinics?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more mobile clinics?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more emergency departments?

□ Yes

□ No

During the reporting period were component 2 activities conducted at one or more correctional facilities?

□ Yes

□ No

During the reporting period were component 2 activities conducted at one or more homeless services?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at another type of setting?

□ Yes, specify: __________________

□ No

Note: If more than one other type of setting, list the first other type here and describe the additional other type(s) individually in the following questions.

During the reporting period, were component 2 activities conducted at a second other type of setting?

□ Yes, specify: __________________

□ No

Note: If more than two other types of settings, list the second other type here and describe the additional other type(s) individually in the following questions.

During the reporting period, were component 2 activities conducted at a third other type of setting?

□ Yes, specify: __________________

□ No

Note: If more than two other types of settings, list the second other type here and describe the additional other type(s) individually in the following questions.

Setting type

Was relationship established to expand HCV testing?

Was relationship established to expand HBV testing?

Status of plan developed to expand HCV testing and linkage services

Status of plan developed to expand HBV testing and linkage services

Number of all clients seen at this setting during reporting period

Number of PWID clients seen at this setting during reporting period

SSPs

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

SUD treatment programs, non-hospital based

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

SUD treatment programs, hospital-based

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Health centers (non-hospital based)

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

STI clinics

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Mobile clinics

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Emergency departments

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Correctional facilities

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Homeless services

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Other type of setting described above, first

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Other type of setting described above, second

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Other type of setting described above, third

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

Select one

□ Completed

□ Not started

□ In progress

Select one

□ Completed

□ Not started

□ In progress

□ Unknown

Measures 2.1.1.d, 2.1.2.a, 2.1.1.e, 2.1.2.b, 2.2.1.a

Number of clients screened for hepatitis C (anti-HCV) (all clients and PWID clients), by setting type
Number of clients positive for anti-HCV (all clients and PWID clients), by setting type
Number of clients positive for anti-HCV who are tested for HCV RNA (all clients and PWID clients), by setting type
Number of clients positive for HCV RNA (all clients and PWID clients), by setting type
Number of clients positive for HCV RNA who are linked to hepatitis C treatment (all clients and PWID clients), by setting type

Setting type

Number of clients:

Clients screened for anti-HCV

Clients positive for anti-HCV

Clients positive for anti-HCV who are tested for HCV RNA

Clients positive for HCV RNA

Clients positive for HCV RNA who are linked to hepatitis C treatment

All clients

PWID clients

All clients

PWID clients

All clients

PWID clients

All clients

PWID clients

All clients

PWID clients

SSPs

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, non-hospital-based

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, hospital-based

questions will be skipped if not applicable

□ Unknown

Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

□ Unknown

Health centers (non-hospital based)

questions will be skipped if not applicable

□ Unknown

STI clinics

questions will be skipped if not applicable

□ Unknown

Mobile clinics

questions will be skipped if not applicable

□ Unknown

Emergency departments

questions will be skipped if not applicable

□ Unknown

Correctional facilities

questions will be skipped if not applicable

□ Unknown

Homeless services

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, first

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, second

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, third

questions will be skipped if not applicable

□ Unknown

Measures 2.1.1.f, 2.1.2.c, 2.2.1.b

Number of clients screened for hepatitis B (HBsAg) (all clients and PWID clients), by setting type
Number of clients positive for HBsAg (all clients and PWID clients), by setting type
Number of clients positive for HBsAg who are linked to hepatitis B care or treatment (all clients and PWID clients), by setting type

Setting type

Number of clients:

Clients screened for HBV (HBsAg)

Clients positive for hepatitis B

Clients positive for hepatitis B who are linked to hepatitis B care and treatment

All clients

PWID clients

All clients

PWID clients

All clients

PWID clients

SSPs

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, non-hospital-based

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, hospital-based

questions will be skipped if not applicable

□ Unknown

Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

□ Unknown

Health centers (non-hospital based)

questions will be skipped if not applicable

□ Unknown

STI clinics

questions will be skipped if not applicable

□ Unknown

Mobile clinics

questions will be skipped if not applicable

□ Unknown

Emergency departments

questions will be skipped if not applicable

□ Unknown

Correctional facilities

questions will be skipped if not applicable

□ Unknown

Homeless services

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, first

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, second

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, third

questions will be skipped if not applicable

□ Unknown

Measures 2.2.1.c

Disseminate to setting-specific partners a quarterly report that summarizes testing and linkage to care data (i.e., HCV and HBV client-level cascade data) (all clients and PWID clients) for that setting to highlight accomplishments and identify areas of improvement

Did you disseminate a quarterly report summarizing HCV and HBV testing and linkage to care/treatment data to setting-specific partners during the reporting period?

□ Yes

□ No (describe why not):

Please upload all reports disseminated:

(upload files)

Measures 2.2.1.d

Success stories that describe how specific linkage to treatment models or practices resulted in increased number of clients engaging in HCV treatment (including data sources used to track client-level HCV cascade data), by setting type (minimum two stories per year)

Please upload two success stories:

(upload files)

Measures 2.2.2.a-2.2.2.f

Number of PWID clients who are referred to SUD treatment, by setting type
Number of PWID clients who are referred to other prevention services (other than SUD treatment), by setting type
Number of PWID clients diagnosed with HCV who are referred to SUD treatment, by setting type
Number of PWID clients diagnosed with HCV who are referred to other prevention services (other than SUD treatment), by setting type
Number of PWID clients diagnosed with HBV who are referred to SUD treatment, by setting type
Number of PWID clients diagnosed with HBV who are referred to other prevention services (other than SUD treatment), by setting type

Setting type

Number of PWID clients:

Referred to substance use disorder treatment

Referred to other prevention services

Diagnosed with HCV and referred to substance use disorder treatment

Diagnosed with HCV and referred to other prevention services

Diagnosed with HBV and referred to substance use disorder treatment

Diagnosed with HBV and referred to other prevention services

SSPs

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, non-hospital-based

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, hospital-based

questions will be skipped if not applicable

□ Unknown

Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

□ Unknown

Health centers (non-hospital based)

questions will be skipped if not applicable

□ Unknown

STI clinics

questions will be skipped if not applicable

□ Unknown

Mobile clinics

questions will be skipped if not applicable

□ Unknown

Emergency departments

questions will be skipped if not applicable

□ Unknown

Correctional facilities

questions will be skipped if not applicable

□ Unknown

Homeless services

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, first

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, second

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, third

questions will be skipped if not applicable

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

□ N/A

□ Unknown

2.3—Build public health laboratory capacity for HCV and/or HBV testing

Measures 2.3.1.a-2.3.1.c

Number of anti-HCV tests conducted at state or local public health laboratories (for all clients and for PWID clients)
Number of positive anti-HCV test results that were tested for HCV RNA at state or local public health laboratories (for all clients and for PWID clients)
Number of HBV tests conducted at state or local public health laboratories (for all clients and for PWID clients)

Setting type

Number of tests conducted at state or local public health laboratories:

Anti-HCV tests

HCV RNA tests (among positive anti-HCV test results)

HBV tests

All clients

PWID clients

All clients

PWID clients

All clients

PWID clients

SSPs

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, non-hospital based

questions will be skipped if not applicable

□ Unknown

SUD treatment programs, hospital-based

questions will be skipped if not applicable

□ Unknown

Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

□ Unknown

Health centers (non- hospital based)

questions will be skipped if not applicable

□ Unknown

STI clinics

questions will be skipped if not applicable

□ Unknown

Mobile clinics

questions will be skipped if not applicable

□ Unknown

Emergency departments

questions will be skipped if not applicable

□ Unknown

Correctional facilities

questions will be skipped if not applicable

□ Unknown

Homeless services

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, first

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, second

questions will be skipped if not applicable

□ Unknown

Other type of setting described above, third

questions will be skipped if not applicable

□ Unknown

Measures 2.3.1.d

Success stories that describe how recipients improved public health laboratory capacity to conduct HCV RNA reflex testing, including evidence that improved capacity resulted in increased number of clients linked to treatment: minimum one story per year

Please upload two success stories:

(upload files)

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Cooley, Laura A. (CDC/DDID/NCHHSTP/DVH)
File Modified	0000-00-00
File Created	2024-09-14