California

Capacity Rubric

Total Grade: 45.5 / 55 points

State Viral Hepatitis Elimination Plan Development

( 4 / 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	3 / 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?	1 / 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:

California has created a viral hepatitis plan, it has been made available to the public, and people with lived/living experience were involved in its development. The state has not committed to publishing progress reports for its plan on an annual basis.

CA's plan addresses the syndemics of HIV, HCV, and STIs. The state's 2016-2020 Hepatitis strategic plan provided more detailed outlines for strategies and benchmark goals for hepatitis elimination that does this current plan. It is unclear whether the state still plans to meet the goals set in the 2016 plan, but we recommend that more clearly defined benchmark goals to assess progress related to HCV be included as part of the state's current HCV strategic plan.

Harm Reduction Laws

( 7 / 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)	1 / 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:

SSPs are legal in California, and there is an exemption on the possession of syringes by SSP participants. This aids the state’s outreach to key risk populations and to expand harm reduction efforts.

Budget Allocation

( 2.5 / 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?	1 / 1 point
If yes, does it specify hepatitis C treatment allocations?	0.5 / 0.5 points

Comments:

While it is noted that prior state budget allocations have specified designated line items for viral hepatitis in the corrections budget, there were no current allocations clearly defined in the most recent state budget.

Improving Viral Hepatitis Prevention, Treatment, and Outcomes

( 27 / 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	1 / 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)	HAV and HBV vaccination information available in 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?	0 / 1 point
If yes, are people with lived/living experience part of this collaboration?	1 / 1 point
Hepatitis C: State of Medicaid Access Grade³	8 / 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:

California Department of Public Health provides a Primary Care Provider toolkit and the University of Washington provider training on its website, among other resources.

It should be noted that a state-drafted guidance for the standard of care for HCV in state corrections exists, and it was not drafted in response to HCV treatment litigation filed against the state. It provides direct-acting antiviral (DAA) treatment for all persons with a confirmed HCV diagnosis held in state corrections in accordance with the AASLD/IDSA treatment guidelines.

While it is unclear whether CalHEP is currently active, hepatitis is included in the End the Epidemics Coalition.

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:

California's Department of Public Health provides regularly updated viral hepatitis epidemiological data and has recently published an epidemiological report for HAV, HBV, and HCV on its website.

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

Arkansas

Colorado