HRSA-funded health centers play an important role in Ending the HIV Epidemic by serving as a key point of entry for people undiagnosed with HIV. Many health centers provide HIV care services, including Pre-exposure Prophylaxis (PrEP). Health centers emphasize coordinated and comprehensive care, and have the ability to manage patients with multiple health care needs. Integration of HIV testing, prevention, care, and treatment into primary care settings and providing essential enabling services such as outreach, patient education, case management, and care coordination, can increase access and improve health outcomes for patients living with HIV.
According to CDC estimates, more than 1.1 million people in the United States are living with HIV infection, and almost 1 in 7 (15%) are unaware of their infection. Many are members of vulnerable populations and underserved communities.
There was also a dip in the number of patients who were tested for HIV in 2020. According to UDS data, 2.05 million patients were tested in 2020 compared to 2.23 patients in 2019.
Integrating HIV Services through Partnerships for Care
Integrating HIV services into primary care delivery is critical for success—both for health centers and for patients living with HIV. Partnerships for Care (P4C) was a 3-year demonstration project (2014-2017) in which health centers partnered with the CDC-funded state health departments in Massachusetts, New York, Maryland, and Florida. Project goals were to strengthen the workforce, build infrastructure, and provide HIV services.
The P4C project identified promising practices for the integration of HIV services into primary care and for building strong primary care-public health partnerships to expand the provision of HIV prevention and care services. Participating health centers expanded their services to:
- Provide HIV testing to 168,645 patients—a 48.2% increase from 2015 to 2017. This included routine testing of 121,285 previously untested patients.
- Link 93% of newly HIV-positive patients to HIV care within 90 days of diagnosis.
- Show an improving trend in viral suppression rates for patients living with HIV; 79% of these patients were virally suppressed.
The health centers also worked with state health departments (within and across states) to re-engage 1,225 HIV-positive people in care.
The toolkit below captures the resources, tools, and lessons learned from P4C health centers during the project. As health centers integrate HIV and primary care, they may find this information helpful. This three-module toolkit includes case studies and vignettes from P4C grantees, addressing the five P4C focal areas:
- Workforce development
- Infrastructure development
- Service delivery
- Quality improvement and evaluation
- Sustainable partnerships
Integrating HIV Care, Treatment & Prevention Services into Primary Care – A Toolkit for Health Centers (PDF - 11 MB)
Health centers interested in expanding HIV-related services, or improving integration of those services into primary care, may benefit from resources developed or used by other health.
HIV Related Technical Assistance Resources
HRSA Health Center Program: Provision of HIV Pre-exposure Prophylaxis (PrEP) in Health Centers Technical Assistance Resource (PDF - 194 KB) (2019)
HRSA Health Center Program: Provision of HIV Testing in Health Centers Technical Assistance Resource (PDF - 204 KB) (2019)
In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. According to CDC estimates, 2.4 million people in the United States are living with the hepatitis C virus (HCV) and over 860,000 people are living with the hepatitis B virus (HBV, CDC, 2019). Recent outbreaks of hepatitis A, hepatitis B, and hepatitis C have been linked to the opioid epidemic through both injection and non-injection drug use (CDC, 2018). Although baby boomers (adults born between 1945-1965) have the highest prevalence of chronic hepatitis C infection, the highest incidence of new hepatitis C cases occurs among young adults aged 20-29 years.
Many individuals at risk for or living with viral hepatitis are members of vulnerable populations and underserved communities. These individuals may also be at risk for other illnesses or chronic conditions, including HIV and substance use disorder.
Health centers emphasize coordinated and comprehensive care, and the ability to manage patients with multiple health care needs. Primary care integration of viral hepatitis testing, vaccination, other prevention, care, and treatment can increase access and improve health outcomes for at-risk patients and patients with chronic infection. Health centers report data on hepatitis B and hepatitis C testing and diagnoses as part of the Uniform Data System (UDS).
According to 2020 UDS data there was a significant dip in the number of patients who were tested for hepatitis B and C and provided services when compared to 2019.
- In 2019 .93 million patients were tested for hepatitis B and in 2020, .28 million patients were tested.
- In 2019, health centers tested 1.18 million patients were tested for hepatitis C and in 2020 0.77 million patients were tested.
Action Steps and Guidelines for Health Centers
The National Viral Hepatitis Action Plan 2017-2020 details specific opportunities for health care providers, patients, and community leaders to help address viral hepatitis. Hepatitis A and hepatitis B are vaccine preventable. Viral hepatitis testing and vaccination are covered preventive services (CDC, 2016). Viral hepatitis can be a short-term illness, but hepatitis B and hepatitis C can become a long-term chronic infection.
Health centers working to improve viral hepatitis clinical quality and advance integration of hepatitis-related services into primary care may benefit from the following resources.
Screen and Understand Results
The only way to diagnose chronic viral hepatitis is blood testing. Viral hepatitis screening includes multiple tests and can be complex. These resources may help to identify which tests are most appropriate for your patient.
- The U.S. Preventive Services Task Force (USPSTF) has published recommendations to screen for hepatitis B in pregnant women as well as hepatitis B and hepatitis C in persons at high risk for infection.
- CDC provides these resources on viral hepatitis screening:
Safe and effective vaccines are available for hepatitis A and hepatitis B. These vaccines are routinely provided during the primary infant vaccination series and are recommended for vulnerable adolescents and adults as well as anyone seeking protection. There is no vaccine for hepatitis C.
- Vaccines.gov provides overall guidance on the hepatitis A vaccine and hepatitis B vaccine that includes who needs to get the vaccines and the vaccination schedules.
- CDC provides these resources on hepatitis A and hepatitis B vaccination:
Treat Disease and Manage Patients
Safe and effective treatments for hepatitis B and hepatitis C are available. These treatments have been shown to reduce the likelihood of developing cirrhosis and liver cancer. They consist of oral medications and in the case of hepatitis C, treatment can result in a virologic cure.
There are also many interventions providers can recommend for people with chronic hepatitis B and hepatitis C to stay healthy and decrease the chance of disease progression. These include reducing alcohol intake, maintaining a healthy weight, using care with over-the-counter medications, and receiving regular care including monitoring for liver cancer.
Provider Training and Resources