When Health Department Data Don’t Cut it: Strategies to Track an Epidemic

Author: Shelley Facente Rachel Grinstein Meghan Morris Katie Burk

Theme: Epidemiology & Public Health Research Year: 2022

In the United States there is no nationalized data system that allows for easy tracking of the hepatitis C
virus (HCV). In San Francisco, the health department viral hepatitis surveillance program currently only
reports descriptive statistics regarding positive HCV results. Therefore, the city’s HCV elimination
initiative, End Hep C SF, needed to find creative ways to measure elimination progress.
With the guidance of epidemiologists and other researchers in the Community Research and Data
Stewardship workgroup of End Hep C SF, we have employed numerous strategies to triangulate existing
data to better understand our progress toward HCV elimination. Drawing on existing datasets from local
studies and community-based programs supplements surveillance data.
We have estimated prevalence of HCV antibodies and active HCV infection among people who inject
drugs and the city overall (an estimated 1,000 fewer people with chronic infection in 2019 than 2015);
an HIV and HCV surveillance registry match to identify people co-infected with HIV and HCV, as a part of
our co-infection microelimination effort (approximately 600 co-infected people left to treat); an analysis
of quarterly community-based testing and treatment rates for 2019 and 2020 to assess the impact of
COVID-19; hiring consultants to complete data analyses to assess perinatal HCV and jail-related HCV
testing and treatment needs; and a Results-Based Accountability evaluation system with an associated
data dashboard of HCV-related indicators and performance measures (Figure 1).

Like the patchwork strategy required to obtain healthcare in the absence of a national
health system, for US cities to track progress toward HCV elimination we must similarly devise a
patchwork of available data. This presentation will provide details on the strategies used by End Hep C
SF, along with lessons learned for replication of these methods in other jurisdictions where systematic
citywide data are not available.
Disclosure of Interest Statement:
Dr Facente has received consulting fees from Gilead Sciences and Dr Morris has received grant funding
from Gilead Sciences, both for unrelated work. No pharmaceutical grants were received in the
development of this work, though Gilead Foundation and AbbVie Foundation have provided grant support
to End Hep C SF for other efforts.

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