Form 0920-22AV Att 3b_Component 2_11-5-2021

Annual Performance Report—Component 2

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Component 2: Core Viral Hepatitis Prevention Activities

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)

2.1—Support viral hepatitis elimination planning and surveillance,

and maximize access to testing, treatment, and prevention

Measures 2.1.1.a – 2.1.1.b

• Establishment and maintenance of a viral hepatitis elimination technical advisory committee (or coalition) with membership to support jurisdictional viral hepatitis elimination planning

• Conduct at least two meetings per year of the viral hepatitis elimination technical advisory committee (or coalition)

Have you established a viral hepatitis elimination technical advisory committee (or coalition) to support viral hepatitis elimination planning?	Select one □ Completed □ In progress		□ Not started
Identify the stakeholder groups that are (or will be) represented on this committee (or coalition). (select all that apply)	□ Public health □ Corrections □ Criminal justice, law enforcement □ Medicaid □ Injury prevention services □ Substance use and mental health services □ Healthcare providers □ HIV care providers □ Hospitals		□ Laboratories □ Community-based organizations □ Local harm reduction coalition members □ Non-profit/advocacy groups □ People with viral hepatitis lived experience □ Other, specify: >> □ N/A (committee not established)
During this reporting period, when did the committee (or coalition) meet? (MM/DD/YYYY)	> >		> >
	□ No meetings held during reporting period □ N/A (committee not established)
If the committee (or coalition) met during this reporting period, please submit a copy of meeting agenda(s) with the APR.		Select one □ Submitted □ Not submitted □ N/A (committee not established)

Measure 2.1.1.c

• Development and maintenance of a viral hepatitis elimination plan with support from the technical advisory committee (or coalition)

Have you developed a viral hepatitis elimination plan?	Select one □ Completed □ In progress	□ Not started
Does it contain plans for elimination of hepatitis C and/or hepatitis B? (select all that apply)	□ Hepatitis C □ Hepatitis B	□ N/A (plan not started)
If the viral hepatitis elimination plan is completed, please submit a copy with the APR.	Select one □ Submitted □ Not submitted □ N/A (plan not started)

Measures 2.1.2.c, 2.1.4.a

• The jurisdictional viral hepatitis elimination plan addresses recommendations for increasing HCV RNA reflex testing

• The jurisdictional viral hepatitis elimination plan addresses provider training in prescribing hepatitis C and hepatitis B treatment

Does your viral hepatitis elimination plan address recommendations for increasing HCV RNA reflex testing?	Select one □ Yes □ No	□ N/A (plan not started)
Does your viral hepatitis elimination plan address provider training in prescribing hepatitis C treatment?	Select one □ Yes □ No	□ N/A (plan not started)
Does your viral hepatitis elimination plan address provider training in prescribing hepatitis B treatment?	Select one □ Yes □ No	□ N/A (plan not started)

Measures 2.1.2.a – 2.1.2.b

• CLIA-certified laboratories that conduct testing for at least 80% of all anti-HCV results identified in the jurisdiction

• The proportion conducting HCV RNA reflex testing was assessed; feedback with recommendations conducted

Have you worked with your surveillance and/or epidemiology teams to identify the total number of CLIA-certified laboratories in your jurisdiction that report hepatitis C antibody testing results?	Select one □ Yes □ No □ In progress
Of the CLIA-certified laboratories you have identified that report hepatitis C antibody testing results, have you selected the subset that reports at least 80% of the hepatitis C antibody testing results in your jurisdiction?	Select one □ Yes □ No	□ In progress □ N/A (labs not identified)
Of this subset, have you performed a needs assessment to identify key barriers and challenges to increasing HCV RNA reflex testing?	Select one □ Yes □ No	□ In progress □ N/A (labs not identified)
What proportion of the subset is conducting HCV RNA reflex testing?	Select one %:	□ In progress □ N/A (labs not identified)
Have you provided recommendations to increase HCV RNA reflex testing?	Select one □ Yes □ No	□ In progress □ N/A (labs not assessed)

Measures 2.1.3.a – 2.1.3.b

• The top 5 highest volume health systems in the jurisdiction identified

• The proportion of health systems promoting routine HCV and HBV testing assessed; feedback with recommendations was conducted

What are the top 5 highest volume health systems in your jurisdiction?	1. 2. 3. 4. 5. □ In progress □ Not started
Have you assessed how many of these health systems are promoting routine HCV testing?		Select one □ Completed □ In progress	□ Not started □ N/A (health systems not assessed)
If so, what percent of health systems are promoting routine HCV testing?		%:	□ In progress □ N/A (health systems not assessed)
Have you assessed how many of these health systems are promoting routine HBV testing?		Select one □ Completed □ In progress	□ Not started □ N/A (health systems not assessed)
If so, what percent of health systems are promoting routine HBV testing?		%:	□ In progress □ N/A (health systems not assessed)
Have you provided feedback to the top 5 highest volume health systems with recommendations on promoting routine HCV and/ or HBV testing?		Select one □ Yes, to all 5 □ No, have not provided feedback to any of them	□ Yes, to some but not all □ N/A (health systems not assessed)

Please use this space to provide information about challenges and successes experienced when implementing Strategy 2.1 activities. Include additional contextual information that would help us interpret your annual performance data.

Was Section 2.2 funded?

Select one

□ No NOTE: Stop here if not funded

□ Yes

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2.2—Increase access to hepatitis C and/or hepatitis B testing and referral to care

in high-impact settings

Measures 2.2.2.a – 2.2.2.b

• Jurisdiction established relationship 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 (syringe services programs, substance use disorder treatment programs, correctional facilities, emergency departments, hospital-based programs, sexually transmitted disease clinics, homeless services, health centers, other)

• Number of clients seen, by setting

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

Setting type	Was relationship established to expand HCV testing?	Was relationship established to expand HBV testing?	Number of 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	> □ 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	> □ 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	> □ 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	> □ 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	> □ Unknown
STI clinics questions will be skipped if not applicable	Select one □ Yes □ No □ In progress	Select one □ Yes □ No □ In progress	> □ Unknown
Mobile clinics questions will be skipped if not applicable	Select one □ Yes □ No □ In progress	Select one □ Yes □ No □ In progress	> □ Unknown
Emergency departments questions will be skipped if not applicable	Select one □ Yes □ No □ In progress	Select one □ Yes □ No □ In progress	> □ Unknown
Correctional facilities questions will be skipped if not applicable	Select one □ Yes □ No □ In progress	Select one □ Yes □ No □ In progress	> □ Unknown
Homeless services questions will be skipped if not applicable	Select one □ Yes □ No □ In progress	Select one □ Yes □ No □ 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	> □ 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	> □ 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	> □ Unknown

Measures 2.2.2.c – 2.2.2.f, 2.2.3.a

• Number of clients screened for hepatitis C (anti-HCV), by setting

• Number of clients positive for anti-HCV, by setting

• Number of clients tested for HCV RNA, by setting

• Number of clients positive for HCV RNA, by setting

• Number of clients positive for HCV RNA linked to treatment, by setting

	During this reporting period, number of:
Setting type	Clients screened for hepatitis C (anti-HCV)	Clients positive for anti-HCV	Clients tested for HCV RNA	Clients positive for HCV RNA	Clients positive for HCV RNA 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	> □ Unknown	> □ Unknown	> □ Unknown	> □ Unknown	> □ Unknown

Measures 2.2.2.g – 2.2.2.h, 2.2.3.b

• Number of clients screened for hepatitis B, by setting

• Number of clients positive for HBsAg, by setting

• Number of clients positive for HBsAg linked to care, by setting

	During this reporting period, number of:
Setting type	Clients screened for hepatitis B	Clients positive for HBsAg	Clients positive for HBsAg 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	> □ Unknown	> □ Unknown	> □ Unknown

Please use this space to provide information about challenges and successes experienced when implementing Strategy 2.2 activities. Include additional contextual information that would help us interpret your annual performance data.

Was Section 2.3 funded?

Select one

□ No NOTE: Stop here if not funded

□ Yes

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2.3—Improve access to services preventing viral hepatitis

and other bloodborne infections among people who inject drugs (PWID)

Measures 2.3.3.a – 2.3.3.d

• Number of hepatitis A vaccination doses administered to clients in the high-impact settings, by setting

• Number of clients in the high-impact settings who completed hepatitis A vaccination series, by setting

• Number of hepatitis B vaccination doses administered to clients in the high-impact settings, by setting

• Number of clients in the high-impact settings who completed hepatitis B vaccination series, by setting

	During this reporting period, number of:
Setting type	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	> □ Unknown	> □ Unknown	> □ Unknown	> □ Unknown

Measures 2.3.1.a – 2.3.1.d, 2.3.2.a

• Number of syringe services programs (SSPs) in the jurisdiction

• Number of visits in the jurisdiction, by SSP

• Number of unduplicated SSP clients in the jurisdiction, by SSP

• Mean (median) syringe coverage rates, by SSP

• Number of clients linked to substance use disorder treatment by SSPs in the jurisdiction, by SSP

	During this reporting period, number of:
Syringe services programs (SSPs) in jurisdiction	Total client visits	Unduplicated SSP clients	Clients linked to substance use disorder treatment	Mean syringe coverage rates during this reporting period
SSP 1 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 2 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 3 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 4 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 5 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 6 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 7 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 8 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 9 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 10 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 11 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 12 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 13 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 14 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 15 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 16 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 17 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 18 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 19 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 20 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 21 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 22 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 23 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 24 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 25 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 26 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 27 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 28 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 29 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 30 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 31 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 32 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 33 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 34 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 35 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 36 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 37 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 38 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 39 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 40 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 41 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 42 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 43 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 44 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 45 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 46 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 47 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 48 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 49 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=
SSP 50 Name: >	> □ Unknown	> □ Unknown	> □ Unknown	Mean=

Please use this space to provide information about challenges and successes experienced when implementing Strategy 2.3 activities. Include additional contextual information that would help us interpret your annual performance data.

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