Hepatitis and Harm Reduction Program Manager New Mexico

• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division • • 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •

www.nmhivguide.org

Dominick V. Zurlo, Ph.D. Educational Psychology Hepatitis and Harm Reduction Program Manager New Mexico Department of Health Public Health Division Infectious Disease Bureau [email protected]


Understanding the Need !  1994-97 - Sero-prevalence study

(Doherty, 2001)* !  1003 Individuals Injecting Substances

participated: !  0.5% HIV positive !  61% hepatitis B positive !  82% hepatitis C positive

!  Fastest increase in HCV - individuals injecting who are under 30 (NMDOH 2016)

*Samuel, M.C., Doherty, P.M., et. al, 2001. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA. Epidemiological Infections, 127, 475-484.


Understanding the Need !  Overdose:

!  2001-2011: highest rate of unintentional overdose deaths in the US (CDC, 2012)

!  2016: NM ranked 13th in the US (CDC, 2018)

!  Overdose mortality rate among Native Americans in New Mexico

!  14.1 per 100,000 !  117 people between 2010-2014

(NMDOH Epidemiological Profile, 2016 https://nmhealth.org/data/view/substance/1862/)


~50,000InteractionsinFY2017

50%↑EnrollmentsSince2012

~8MillionSyringesExchangedinFY2017

As of 11/2017

• Hepatitis and Harm Reduction Program • Infectious Disease Bureau • Public Health Division 1190 S. St. Francis Drive, Suite S1300, Santa Fe, NM 87505 • nmhealth.org • nmhivguide.org •

Enrollment " Over 12,000 unique codes recorded in FY18

" Exchanged ~ 8 million syringes in FY17

" 50,000 exchanges in FY17

"  Syringes are collected both during syringe

service sessions and through public syringe drop-

boxes.


Harm Reduction Act: Syringe Service Program

"  Enacted in 1997

"  Implemented on February 2, 1998 (NMSA 1978 24.2C)

"  On this day: "  6 programs

"  24 people

"  Collected 19 syringes

"  Distributed 260 syringes


Enrollment " 9,600 individuals enrolled in 2016

" Exchanged ~ 8 million syringes in FY17

" 50,000 exchanges in FY17

"  Collection rate 94%-96% of syringes distributed

"  This does not include syringe drop-boxes, which collect

an additional 300,000 to 500,000 syringes (NMDOH –

2013-16)


Capacity Building: How Did We Get Here?

"  Harm Reduction Specialist Certification Training "  Started in 2008 - standardized 8-hour curriculum

"  6.5 CME/CEUs are offered (through the New Mexico AIDS Education and Training Center)

"  Pre-requisites of HIPAA and bloodborne pathogen courses are required prior to the training

"  Renewal every two years

"  Has a focus on Stigma and Substance Use "  There are 426 current Certified Specialists (9/13/18)

"  In total, since 2008, over 1240 individuals have been trained (9/13/18)


Capacity Building: Training of the Trainer

• 2009 – 3-day training: Requirement - be interested

• 2011 Requirements: • 2 years Harm Reduction experience • Pre-requisites: HIV, HCV, STD, HIPAA, & Bloodborne Pathogen • Complete an observed training • Commit to providing three trainings each year

• Currently 28 Active Certified Instructors • 9 trained the first year • Total of 92 trained, including from other states


Additional Integration •  2012 - Incorporated Adult Viral Hepatitis Program with

Harm Reduction Program to ensure: •  HCV prevention messages are incorporated into Harm Reduction

Specialist Certification

•  HCV counseling, testing, and referral information is incorporated into the 3-day HIV Counseling, Testing, and Referral Service (CTRS) Training

•  Cross training with both Harm Reduction Specialist Certification and HIV/HCV Counseling, Testing, and Referral Services (CTRS)

•  Offer CEUs and CMEs with trainings (6.5 hours for one day and 19.5 for three days)


Comprehensive Statewide Services • Over 50 locations

• Most are operated by Public Health Offices (PHO) •  21 Contract providers:

•  15 - syringe services, overdose prevention, and hepatitis •  3 - dedicated hepatitis surveillance and support •  1 - focusing on acu-detox •  1 - focusing on Law Enforcement and other training •  1 – focused on telehealth (Project ECHO with the University of New Mexico)

• Services vary across the state, and are integrated as much as possible based upon resources in the area.

• HIV, HCV and other STD counseling and testing • Adult Viral Hepatitis vaccination and testing • Adult Viral Hepatitis surveillance • Wound and abscess care

• Other health care • Food bags • Fresh/bottled water • Acu-Detox treatment • Suboxone treatment • Referrals to other substance use services


Hepatitis C Surveillance !  U-30 HCV Surveillance for HCV

! Contact individuals with positive lab results ! Act as a referral and educational source ! Ensure people have the necessary information for their next steps

Source: Dr. Kimberly Page, UNM: Hepatitis C Virus (HCV) in New Mexico: Statewide Comprehensive Plan and Profile of the Epidemic 2016, New Mexico Hepatitis C Coalition, 2016, p. 8


Elimination of Hepatitis C

Source: Dr. Kimberly Page, UNM Hepatitis C Virus (HCV) In New Mexico: Statewide Comprehensive Plan and Profile of the Epidemic https://nmhealth.org/about/phd/idb/hip/

“…we estimate that use of the syringe exchange would have led to a 61% reduction in hepatitis B and a 65% reduction in hepatitis C among local injection drug users.”

Hagen, H., Des Jarlais, D.C, et al. Reduced Risk of Hepatitis B and Hepatitis C among Injection Drug Users in the Tacoma Syringe Exchange Program American Journal of Public Health, November 1995, vol 85, No 11. p. 1536


Naloxone and Overdose Prevention •  Program started in 2001 •  Originally a 3-hour training – Some problems:

•  Participants falling asleep •  Participants needing to use •  Too much information – cognitive overload!

•  In 2005-2006 the program started implementing a short 15-20 minute on the street curriculum – to meet people where they are

•  Basic information •  It is not overwhelming •  Handouts re-designed

More easily integrated into outreaches and clinics


Hepatitis and Harm Reduction Program Naloxone Distribution Overview 2012-2016

168.5%increaseinsuccessfulopioidoverdosereversalsreportedfrom2012to2016.



Reducing Barriers: Legislation

!  Mirror-bills !  HB 277 sponsor - Representative Terry H. McMillan,

M.D. !  SB 262 sponsor - Senator Richard C. Martinez !  Included an emergency clause to take effect

immediately

!  Unanimous - all committees and both chambers

!  Signed on March 4th, 2016 by Governor Suzanna Martinez


•  Meet people where they are

•  Treat people as people

•  Ask people what they need

•  Use affirming language

•  Mistakes happen – learn and move forward

•  Active navigation/Linkage-to-Services

Reducing Barriers: Stigma and Awareness


20 Years – Then and Now

February2 1998 2018Programs/Offices 6 18PeopleServed 24 206SyringesCollected 19 7,319SyringesDistributed 260 9,230


DominickV.Zurlo,Ph.D.EducationalPsychologyHepatitisandHarmReductionProgramManagerNewMexicoDepartmentofHealthPublicHealthDivisionInfectiousDiseaseBureau505-827-2507Dominick.Zurlo@state.nm.us

Thank you & Contact Information

www.nmhivguide.org

Special thank you to NMDOH Staff for their help and support: Chandelle Chavez – Overdose Prevention Coordinator Andrew Gans, M.A. – HIV, STD and Hepatitis Section Manager John Murphy – HIV Training Coordinator Richard Sober – Syringe Service Coordinator Josh Swatek, B.A.- Adult Viral Hepatitis Coordinator And thanks to community partners throughout the years including: Phil Fiuty, Bernie Lieving, Dr. Bruce Trigg, Dr. Mary Murphy, Dr. Laura Tomedi, Diana McCague, and all others who have worked in Harm Reduction or helped in New Mexico.


References

ThankyoutoNMDOHandCommunityContributorsLaineM.Snow,M.S.W–formerAdultViralHepatitisCoordinatorKimberlyPage,Ph.D.M.P.H,M.S.–ProfessorandChief,Epidemiology,Biostatistics&PreventiveMedicine,UNMHSC

CDCMorbidityandMortalityWeeklyReports2002-2018https://www.cdc.gov/mmwr/mmwr_wk.htmlHagen,H.,DesJarlais,D.C,etal.ReducedRiskofHepatitisBandHepatitisCamongInjectionDrugUsersintheTacomaSyringeExchangeProgramAmericanJournalofPublicHealth,November1995,vol85,No11.p.1536

NewMexicoDepartmentofHealth:PublicHealthDivisionandEpidemiologyandResponseDivisionhttps://nmhealth.org/about/erd/andhttp://nmhealth.org/about/phd/idb/hrp/andhttps://nmhealth.org/data/view/substance/1862/)Page,Kimberly,(2016)HepatitisCVirus(HCV)InNewMexico:StatewideComprehensivePlanandProfileoftheEpidemichttps://nmhealth.org/about/phd/idb/hip/

Samuel,M.C.,Doherty,P.M.,et.al,2001.Associationbetweenheroinuse,needlesharingandtattoosreceivedinprisonwithhepatitisBandCpositivityamongstreet-recruitedinjectingdrugusersinNewMexico,USA.EpidemiologicalInfections,127,475-484.Ward,JohnM.D.(2015)DirectoroftheCDCViralHepatitisPreventionProgramasquotedin:USAToday,May8,2015.HepatitisCinfectionssoaring,fueledbyprescriptionpainkillerabuse.

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Hepatitis and Harm Reduction Program Manager New Mexico