District of Columbia
Capacity Rubric
Total Grade: 34 / 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 |
---|---|
0 / 1 point | |
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:
DC does not have a viral hepatitis plan, but has enacted policies and practices that support ongoing elimination efforts. The jurisdiction should convene a group of multidisciplinary stakeholders to develop a comprehensive plan to guide efforts to improve its viral hepatitis strategies and outcomes. This process can help identify capacity needs, build collaborative partnerships to pool limited resources, and create targeted interventions to reduce viral hepatitis incidence.
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 |
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 |
0.5 / 0.5 points |
Comments:
SSPs are legal, and function on a needs-based policy. The District provides financial and logistical support for needle exchange programs operated by collaborative partner organizations throughout the city, including a mobile unit. However, possessing syringes is illegal unless received from an SSP.
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 |
0 / 0.5 points |
Improving Viral Hepatitis Prevention, Treatment, and Outcomes
( 22 / 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: |
1 / 1 point |
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 |
0 / 2 points | |
No | |
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 |
0 / 1 point | |
Does the jurisdiction provide linguistically diverse informational materials on viral hepatitis prevention, screening, and treatment? | 2 / 2 points |
Amharic, Chinese, French, Korean, Spanish, and Vietnamese | |
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? | 0 / 2 points |
0 / 1 point | |
0 / 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:
DC provides educational information and materials geared towards the public as well as perinatal information for HBV and HCV, all of which are linguistically diverse and reflect the varied cultural composition of the population.
The DC Health website includes one training resource for providers, The ABCS of Hepatitis for Health Professionals. The jurisdiction should consider including additional resources to improve awareness and capacity to screen for and treat viral hepatitis such as Hepatitis B Online and Hepatitis C Online, or training programs offered by Maryland and Virginia.
DC has expanded Medicaid, yet there are still sobriety and prescriber restrictions that limit HCV treatment access to some recipients.
Improving Viral Hepatitis Surveillance and Data Usage
( 4 / 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: |
0 / 1 point |
---|---|
1 / 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:
DC’s viral hepatitis epidemiological report did not include data on HAV. DC monitors HAV as a vaccine-preventable disease, but because of its frequent correlation with risk factors that also increase incidence of HCV and HBV, it should be included in overall viral hepatitis surveillance.
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 |