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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C
INFRASTRUCTURE AND PROCESS-SPECIFICISSUES WITH SURVEILLANCE
Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. As a result, surveillance data do not provide accurate estimates of the current burden of disease, are insufficient for program planning and evaluation, and do not provide the information that would allow policy-makers to allocate sufficient resources to address the problem. The AVHPCs, funded by CDC in state and territorial health departments, are tasked with identifying mechanisms for educating the public, at-risk populations, and medical-service and social-service providers about viral hepatitis; for managing and coordinating viral-hepatitis prevention activities; and for integrating viral-hepatitis screening programs and related services into health-care settings and public-health programs that serve at-risk adults. In most cases, however, CDC funding covers only the AVHPC’s salary. No funding is provided for viral-hepatitis testing, hepatitis B immunizations, or other services. Most important, AVHPCs are not funded to conduct surveillance activities, although many of them provide technical assistance for such programs.
In addition, CDC’s DVH has scant resources for providing funding and guidance to local and state health departments to perform surveillance for viral hepatitis. The resources provided for viral-hepatitis surveillance contrast sharply with the resources that CDC provides for HIV surveillance. For example, CDC has specific cooperative agreements with the states and territories to conduct core HIV/AIDS surveillance activities. The cooperative agreements are accompanied by dedicated funding, specific CDC project officers and epidemiologists, regular technical-assistance meetings and training, and a help desk that has trained staff to answer database-related questions. The guidance for HIV/AIDS surveillance is a three-volume set containing more than 500 pages of detailed instructions, standards, and guidelines. In contrast, CDC’s cooperative agreements with state and territorial health departments for viral hepatitis do not include surveillance activities. In addition, although CDC’s DVH has produced guidelines for viral-hepatitis surveillance for state and territorial health departments, they are presented in fewer than 50 pages (CDC, 2005a). Given that the guidelines cover three distinct and complex diseases (hepatitis A, hepatitis B, and hepatitis C), they lack the detail necessary to create surveillance practices that are consistent among jurisdictions. As a result of the deficiency of resources dedicated to hepatitis surveillance, data are incomplete, variable, and inaccurate. Inconsistency between jurisdictions seriously undermines the validity of the data provided at the state, regional, and national levels.
The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. For example,