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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C
Surveillance data are often used to determine how to use resources most effectively. For example, estimates of disease burden are commonly used to provide guidance to policy-makers on the level of funding required for disease-related programs. If surveillance data are not available or understate the disease burden, legislators and public-health officials will not allocate sufficient resources to mount an appropriate public-health response.
Information on disease burden is only one factor that guides policy-makers in allocating public-health resources. Priorities in public funding are also driven by public awareness and advocacy. Therefore, it is important to communicate surveillance trends and disease burden clearly to policy-makers and community advocates. For example, estimates of trends indicate that mortality from HCV may soon exceed that from HIV (Deuffic-Burban et al., 2007). However, despite the large number of individuals and communities affected by hepatitis B and hepatitis C, the resources available for addressing viral hepatitis are only a small fraction of those available for addressing HIV. CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention had a budget of almost $1 billion for 2008, and only 2% of it was allocated to hepatitis B and hepatitis C (Ward, 2008). Sixty-nine percent of the budget was allocated for HIV, 15% for sexually transmitted diseases (STDs), and 14% for tuberculosis.
Programmatic Design and Evaluation
Public-health organizations use surveillance data to design programs that target appropriate populations. For example, CDC requires states to set priorities among populations for HIV prevention according to data generated by HIV/AIDS surveillance programs and community-services assessments (CDC, 2003a). Surveillance data can also be used to evaluate systems for delivery of prevention and care service. A key potential role of hepatitis surveillance programs is to evaluate the effect of HBV vaccination programs (Wasley et al., 2007).
Linking Patients to Care
For some diseases, it is desirable to have a surveillance system closely involved in ensuring the linkage of persons who have new diagnoses to health-care services, often called case management (Fleming et al., 2006). For viral-hepatitis surveillance, linking patients who have recent diagnoses to comprehensive viral-hepatitis programs may be indicated to ensure access to appropriate services, including clinical evaluation, regular followup