Annual Performance Report—Component 3
Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments
Component 3: Special Projects—Prevention, Diagnosis, and Treatment Related to the Infectious Disease Consequences of Drug Use
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 (5/1/21-9/30/21) □ Year 2 (10/1/21-9/30/22) □ Year 3 (10/1/22-9/30/23) □ Year 4 (10/1/23-9/30/24) □ Year 5 (10/1/24-4/30/26) |
Was Component 3 funded? |
Select one |
□ No NOTE: Stop here if not funded
|
□ Yes |
-----------------------------------------------------------------------------------------------------------------------------------------------------
3.1—Improve access to services for people who inject drugs (PWID)
in settings disproportionately affected by drug use
List all types of settings serving PWID
|
During the reporting period were component 3 activities conducted at one or more syringe services programs (SSPs)? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or substance use disorder (SUD) treatment programs (non-hospital based)? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or hospital-based substance use disorder (SUD) treatment programs? □ Yes □ No |
During the reporting period were component 3 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 3 activities conducted at one or more health centers (non-hospital based)? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or more sexually transmitted infections (STI) clinics? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or more mobile clinics? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or more emergency departments? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or more correctional facilities? □ Yes □ No |
During the reporting period were component 3 activities conducted at one or more homeless services? □ Yes □ No |
During the reporting period were component 3 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 3 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 3 activities conducted at a third other type of setting? □ Yes, specify: __________________ □ No |
Measures 3.1.1.a – 3.1.1.b
Number of PWID served, by setting serving PWID (syringe services programs, substance use disorder treatment programs, correctional facilities, emergency departments, hospital-based programs, sexually transmitted disease clinics, homeless services, health centers, other)
Syringes distributed, by setting serving PWID
|
During this reporting period, number of: |
||||||||||||||
Setting type serving PWID
|
Clients served |
PWID served |
Syringes distributed |
||||||||||||
SSPs questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
SUD treatment programs, non-hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
SUD treatment programs, hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Hospital-based programs (excluding SUD treatment programs which are included separately above) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Health centers (non-hospital based) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
STI clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Mobile clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Emergency departments questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Correctional facilities questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Homeless services questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, first questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, second questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, third questions will be skipped if not applicable |
|
|
|
Measures 3.1.2.a – 3.1.2.d
Number of PWID who are linked to substance use disorder treatment, by setting serving PWID
Number of PWID assessed for opioid use disorder, by setting serving PWID
Number of PWID with opioid use disorder, by setting serving PWID
Number of PWID with opioid use disorder who are linked to medication for opioid use disorder, by setting serving PWID
|
During this reporting period, number of: |
|||||||||||||||||||
Setting serving PWID
|
PWID linked to substance use disorder treatment |
PWID assessed for opioid use disorder |
PWID with opioid use disorder |
PWID with opioid use disorder who were linked to medication for opioid use disorder |
||||||||||||||||
SSPs questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
SUD treatment programs, non-hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
SUD treatment programs, hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Hospital-based programs (excluding SUD treatment programs which are included separately above) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Health centers (non-hospital based) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
STI clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Mobile clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Emergency departments questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Correctional facilities questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Homeless services questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Other type of setting described above, first questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Other type of setting described above, second questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Other type of setting described above, third questions will be skipped if not applicable |
|
|
|
|
Measures 3.1.3.a, 3.1.4.a – 3.1.4.d
Number of clients tested for anti-HCV, by setting serving PWID
Number of clients testing positive for anti-HCV, by setting serving PWID
Number of clients positive for anti-HCV tested for HCV RNA, by setting serving PWID
Number of clients testing positive for HCV RNA, by setting serving PWID
Number of HCV RNA (+) clients linked to hepatitis C treatment, by setting serving PWID
|
During this reporting period, number of: |
||||||||||||||||||||||||
Setting serving PWID
|
Clients tested for anti-HCV |
Clients testing positive for anti-HCV |
Clients positive for anti-HCV tested for HCV RNA |
Clients testing positive for HCV RNA |
HCV RNA (+) clients linked to hepatitis C treatment |
||||||||||||||||||||
SSPs questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
SUD treatment programs, non-hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
SUD treatment programs, hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Hospital-based programs (excluding SUD treatment programs which are included separately above) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Health centers (non-hospital based) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
STI clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Mobile clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Emergency departments questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Correctional facilities questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Homeless services questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Other type of setting described above, first questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Other type of setting described above, second questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||||||
Other type of setting described above, third questions will be skipped if not applicable |
|
|
|
|
|
Measures 3.1.3.b, 3.1.4.e – 3.1.4.f
Number of clients screened (anti-HBc, HBsAg, anti-HBs) for HBV, by setting serving PWID
Number of clients testing positive for HBsAg, by setting serving PWID
Number of HBV (+) clients linked to hepatitis B care, by setting serving PWID
|
During this reporting period, number of: |
||||||||||||||
Setting serving PWID
|
Clients screened for HBV (anti-HBc, HBsAg, anti-HBs) |
Clients testing positive for HBsAg |
HBV (+) clients linked to hepatitis B care |
||||||||||||
SSPs questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
SUD treatment programs, non-hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
SUD treatment programs, hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Hospital-based programs (excluding SUD treatment programs which are included separately above) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Health centers (non-hospital based) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
STI clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Mobile clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Emergency departments questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Correctional facilities questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Homeless services questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, first questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, second questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, third questions will be skipped if not applicable |
|
|
|
Measures 3.1.3.c, 3.1.4.g – 3.1.4.h
Number of clients screened for HIV, by setting serving PWID
Number of clients testing positive for HIV, by setting serving PWID
Number of HIV (+) clients linked to HIV treatment, by setting serving PWID
|
During this reporting period, number of: |
||||||||||||||
Setting serving PWID
|
Clients screened for HIV
|
Clients testing positive for HIV |
HIV (+) clients linked to HIV treatment |
||||||||||||
SSPs questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
SUD treatment programs, non-hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
SUD treatment programs, hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Hospital-based programs (excluding SUD treatment programs which are included separately above) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Health centers (non-hospital based) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
STI clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Mobile clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Emergency departments questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Correctional facilities questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Homeless services questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, first questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, second questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||
Other type of setting described above, third questions will be skipped if not applicable |
|
|
|
Measure 3.1.4.i
Number of clients referred for treatment for bacterial or fungal infections, by setting serving PWID
|
During this reporting period, number of: |
Setting serving PWID |
Clients treated or referred for treatment of bacterial or fungal infections |
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 3.1.5.a – 3.1.5.d
Number of hepatitis A vaccination doses administered to clients, by setting serving PWID
Number of clients who completed hepatitis A vaccination series, by setting serving PWID
Number of hepatitis B vaccination doses administered to clients, by setting serving PWID
Number of clients who completed hepatitis B vaccination series, by setting serving PWID
|
During this reporting period, number of: |
|||||||||||||||||||
Setting serving PWID
|
Hepatitis A vaccination doses administered |
Clients who completed hepatitis A vaccination series |
Hepatitis B vaccination doses administered |
Clients who completed hepatitis B vaccination series |
||||||||||||||||
SSPs questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
SUD treatment programs, non-hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
SUD treatment programs, hospital-based questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Hospital-based programs (excluding SUD treatment programs which are included separately above) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Health centers (non-hospital based) questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
STI clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Mobile clinics questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Emergency departments questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Correctional facilities questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Homeless services questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Other type of setting described above, first questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Other type of setting described above, second questions will be skipped if not applicable |
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
> □ Unknown
|
||||||||||||||||
Other type of setting described above, third questions will be skipped if not applicable |
|
|
|
|
Measures 3.1.6.a – 3.1.6.c, 3.1.7.a
Number of new confirmed acute hepatitis B cases reported among PWID in the jurisdiction
Number of new confirmed acute hepatitis C cases reported among PWID in the jurisdiction
Number of new confirmed HIV cases reported among PWID in the jurisdiction
Jurisdiction reports data on hepatitis C continuum of care for PWID in the jurisdiction, consistent with CDC guidance
How many new confirmed acute hepatitis B cases were reported among people reporting a history of injection drug use in your jurisdiction during this reporting period? |
> □ Unknown |
How many new confirmed acute hepatitis C cases were reported among people reporting a history of injection drug use in your jurisdiction during this reporting period? |
> □ Unknown |
How many new confirmed HIV cases were reported among people reporting a history of injection drug use in your jurisdiction during this reporting period? |
> □ Unknown |
Do you report hepatitis C viral clearance cascade data for reported cases among people reporting a history of injection drug use in your jurisdiction? |
Select one □ Yes □ No |
Please use this space to provide information about challenges and successes experienced when implementing Strategy 3.1 activities. Include additional contextual information that would help us interpret your annual performance data.
For example, the number of locations associated with each setting type, or other explanatory notation, could be listed here if needed. |
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Cooley, Laura A. (CDC/DDID/NCHHSTP/DVH) |
File Modified | 0000-00-00 |
File Created | 2022-08-11 |