Arizona

Capacity Rubric

Total Grade: 30 / 55 points

State Viral Hepatitis Elimination Plan Development

( 0 / 5 points )

In this section we assess whether a jurisdiction has drafted a publicly available viral hepatitis plan that is current and reflects the priorities outlined in the HHS Viral Hepatitis National Strategic Plan and the World Health Organization’s goals to eliminate hepatitis by 2030.

Does the state have a viral hepatitis elimination plan?¹	0 / 3 points
If yes, is there a commitment to publish progress reports on at least an annual basis?	0 / 1 point
If yes, are people with lived/living experience included in the development process?	0 / 1 point

¹ A ‘plan’ is defined herein as one that: (a) has goals aligned with the HHS Viral Hepatitis National Strategic Plan and the World Health Organization’s goals to eliminate hepatitis by 2030; (b) includes specific actions, activities, and commitments to achieve goals; (c) is an active plan covering the current year; and (d) is available to the public.

Comments:

Arizona does not currently have a viral hepatitis plan, but a plan is in development. The state has enacted policies and practices that support ongoing elimination efforts.

Harm Reduction Laws

( 6 / 8.5 points )

The Harm Reduction Laws section analyzes laws jurisdictions have in place that support the implementation of harm reduction strategies proven to reduce rates of viral hepatitis transmission, such as syringe service programs.

Are syringe service programs (SSPs) legal?	3 / 3 points
Is there a state law expressly authorizing SSPs?	1 / 1 point
If yes, is it a needs-based law, or does it require a 1-for-1 item trade for needles and syringes? (Needs-based= 1 point; 1-for-1 requirement = 0 points)	0 / 1 point
Are there Good Samaritan Laws in place to protect persons who assist others that are experiencing a substance use-related medical emergency?	1 / 1 point
Are there laws in place to protect persons seeking medical assistance for a substance use-related medical emergency that they are experiencing?	0.5 / 0.5 points
Is possessing substance use/injection drug use (IDU) equipment (‘works’) legalized, decriminalized, or illegal? (Legalized = 2 point; decriminalized = 1 point; illegal = 0 points)	0 / 2 points
Where IDU equipment is illegal, is there an exemption for syringes received from an SSP?	0.5 / 0.5 points

Comments:

While SSPs were recently legalized, a drawback to Arizona’s SSP practices is that they can only operate a 1-for-1 exchange. While state law allows a facility to collect as many syringes as it wants, the amount it distributes cannot exceed the number it collects. The state should consider amending 2021 Ariz. Legis. § 36-798.51(C) so that it is no longer a modified 1-for-1 syringe exchange but rather allows for needs-based exchange, especially because the same legislation also has a stated purpose of ensuring that hypodermic syringes and injection supplies are not shared or reused. This purpose implies a desire to function on a needs-based model, but other explicit language of the same statute overshadows the intent. A needs-based SSP policy would broaden the efficacy of these programs to reduce transmission of hepatitis, HIV, and other diseases. Additionally, the possession of substance use/injection drug use equipment is illegal, but there is an exemption on the possession of syringes by SSP participants.

Budget Allocation

( 1 / 5.5 points )

How much and in what manner a jurisdiction allocates fiscal resources for its viral hepatitis elimination strategies is critical to providing the support needed to realize stated elimination goals.

If a viral hepatitis elimination plan has been drafted and been made available to the public, have funds been specifically allocated to implement the plan’s strategies?	0 / 2 points
Do the state budget allocations mention viral hepatitis?	1 / 1 point
Do the state budget allocations mention elimination?	0 / 1 point
Does the state corrections budget mention viral hepatitis?	0 / 1 point
If yes, does it specify hepatitis C treatment allocations?	0 / 0.5 points

Improving Viral Hepatitis Prevention, Treatment, and Outcomes

( 18 / 31 points )

To improve prevention, treatment, and outcomes, jurisdictions must employ innovative and inclusive strategies that reflect best practice approaches and expand access to the health care interventions needed to diagnose and treat viral hepatitis.

Does the jurisdiction provide/distribute viral hepatitis educational information and materials geared towards the public?²	1 / 1 point
If yes, do they provide perinatal information/education for: HBV	1 / 1 point
HCV	0 / 1 point
Did the jurisdiction expand Medicaid?	3 / 3 points
Does the jurisdiction offer or recommend provider training to increase workforce capacity to treat more people with viral hepatitis?	3 / 3 points
If a plan has been drafted and made available to the public, does it include strategies to offer DAA treatment for HCV to all persons with a confirmed HCV diagnosis held in state corrections in accordance with the AASLD/IDSA treatment guidelines?	0 / 3 points
If no plan exists or state corrections are not mentioned in the state’s viral hepatitis plan, does a separate state-drafted guidance for the standard of care for HCV in state corrections exist – that was NOT drafted subsequent to viral hepatitis treatment access litigation brought against the jurisdiction – that provides DAA treatment for all persons with a confirmed HCV diagnosis held in state corrections in accordance with the AASLD/IDSA treatment guidelines?	2 / 2 points
If a separate standard also does not exist, has there been litigation within the jurisdiction or a region of the jurisdiction (e.g., city or county) that has prompted changes to be made regarding hepatitis screening and treatment within corrections facilities? (NOTE: not scored)	N/A
Does the jurisdiction utilize or provide support for (financial and/or in-kind) targeted interventions to expand access to viral hepatitis prevention, testing, and treatment services to key populations (e.g., BIPOC communities, people experiencing homelessness, people who use drugs) disproportionately affected by viral hepatitis? (Such interventions include but are not limited to mobile outreach units, non-traditionally located/on-location services, and programs targeting specific racial or cultural communities)	3 / 3 points
If no, are there non-governmental programs/community organizations located within the jurisdiction that are providing the aforementioned interventions to the key outreach populations listed above (as well as others) that are receiving funding from the federal government (HRSA, SAMHSA or another agency), or some other source?	0 / 1 point
Does the jurisdiction provide linguistically diverse informational materials on viral hepatitis prevention, screening, and treatment?	2 / 2 points
If yes, list languages available (NOTE: not scored)	Spanish
Is there an enduring collaborative network (i.e., task force, steering committee, etc.) within the state that is cross-cutting amongst state agencies, community organizations, advocacy groups, and healthcare providers to plan and coordinate activities and leverage resources?	2 / 2 points
If yes, does the jurisdiction lead this collaboration?	1 / 1 point
If yes, are people with lived/living experience part of this collaboration?	0 / 1 point
Hepatitis C: State of Medicaid Access Grade³	0 / 10 points

² Jurisdictions can receive credit for this question for educational materials created by the state as well as for utilizing/distributing information such as the CDC’s “Know More Hepatitis” campaign.

³ To date, there is no grading system that assesses hepatitis B treatment access. The Hepatitis B Foundation published an analysis of health insurance plans in 14 states that show evidence of one or more discriminatory practices in accessing hepatitis B treatment. Additional research is needed to assess state barriers to hepatitis B treatment.

Complete list of state grades available at the State of Hep C website.

Comments:

Arizona has implemented diagnostic HCV testing at intake in state corrections for persons in certain risk groups, and those who self-identify as requesting a test due to increased risk. The state also makes HCV treatment available to all incarcerated persons with a confirmed diagnosis, but utilizes a prioritization scale for initiating treatment. The state should expand to universal, opt-out diagnostic testing at intake, and remove prioritization criteria to provide treatment to all diagnosed persons, unless clinically contraindicated.

The state provides HCV provider training through Project ECHO and has recently reduced barriers to treatment access for Medicaid beneficiaries by removing its sobriety requirement. The state could further increase access by removing the prescriber requirement and ensuring parity across Fee-for-Service and managed care organizations.

Hep Free AZ is an active, state-led collaborative network that is cross-cutting amongst state agencies, community organizations, advocacy groups, and healthcare providers to plan and coordinate activities and leverage hepatitis elimination resources, and people with lived/living experience that are part of this collaboration. The coalition is currently developing an elimination plan.

Improving Viral Hepatitis Surveillance and Data Usage

( 5 / 5 points )

Publishing epidemiological data at consistent intervals allows researchers, medical practitioners, and individuals to evaluate current diagnosis rates, demographic information, and other statistics to assess progress towards elimination. In this section of the rubric, we measure jurisdictions’ data sharing transparency.

Has the state recently published a comprehensive viral hepatitis epidemiological report/profile (within the last two (2) years) that includes data on: HAV (1 point)	1 / 1 point
HBV (1 point)	1 / 1 point
HCV (1 point)	1 / 1 point
Does a jurisdiction have a public-facing website with regularly updated (within the last two (2) years) viral hepatitis epidemiological data included on it?	2 / 2 points

Comments:

While the state maintains an easily navigable data dashboard site for many infectious diseases, transparency for viral hepatitis data is inconsistent. There is only a comprehensive, updated epidemiological report available for HAV. HCV data has not been updated on the state site since 2017 counts.

Updated July 12, 2022

Key Terms

AASLD:	American Association for the Study of Liver Diseases
DAA:	Direct-Acting Antiviral Medications
IDSA:	Infectious Diseases Society of America
IDU:	Injection Drug Use
PWID:	People Who Inject Drugs
PWUD:	People Who Use Drugs
“Works”:	Drug use equipment, including, but not limited to, syringes, pipes, bongs, and roach clips

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