Early Identification and Linkage to Care of Foreign-Born People with Chronic Hepatitis B Virus Infection, Multnomah County, Oregon, 2012–2014

Abstract

Objective. Hepatitis B virus (HBV) infection is a global health concern, with a large proportion of high-risk individuals unaware of their infection status. People born in countries with medium to high endemicity of HBV should be tested and linked to care. We describe a program that improved identification and linkage to care for refugees and immigrants at the Multnomah County Health Department in Oregon.Methods. We instituted outreach clinics and community referrals and expanded refugee screening to identify foreign-born people at risk for HBV. We obtained data from electronic health records and electronic laboratory reporting, including patient demographics, hepatitis B testing variables, vaccination history, and-for positive cases-risk-factor and linkage-to-care data. All results were entered into an Internet-based data collection tool. For this analysis, we only used results for testing performed from October 2012 through June 2014.Results. We screened 2,087 foreign-born people for HBV infection and identified 77 (4%) people with positive results. HBV infection prevalence varied by site, with 7% of HBV-positive people identified through the outreach and voucher program and 3% identified through refugee screening. Of the 77 people testing positive for HBV, 72 (94%) were successfully linked to care, of whom 68 (94%) attended their first follow-up visit.Conclusion. Implementation of a culturally competent screening program among immigrants and refugees in Multnomah County improved case finding and subsequent linkage to care.

Evaluation of a Program to Improve Linkage to and Retention in Care Among Refugees with Hepatitis B Virus Infection — Three U.S. Cities, 2006–2018

“…HBV-infected patients require regular monitoring for both infection and sequelae. Several studies have evaluated initial linkage to HBV care for both refugee and nonrefugee immigrant populations (4)(5)(6)(7)(8)(9), but none contained standardized definitions for either linkage to or long-term retention in care for chronic HBV-infected refugees. To assess chronic HBV care, three urban sites that perform refugee domestic medical examinations and provide primary care collaborated in a quality improvement evaluation.…”

Systematic review of electronic health records to manage chronic conditions among displaced populations

“… 29 Another study conducted in the USA showed that the use of these same principles, specifically in screening for Hepatitis B, led to notable improvements in the proportion of patients linked to care and receiving treatment. 28 …”

“…4 10 17-26 Nineteen studies assessed the impact of EHRs on health outcomes in populations after arriving in an asylum country. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Quality assessment of included studies According to the critical appraisal tools described in the methods section, 20 articles were of medium-high quality, nine were of medium quality and three were low-quality. The qualitative studies demonstrated acceptable methodological quality but did not report on the influence of the researcher.…”

“…Nineteen studies assessed the impact of EHRs on chronic disease health outcomes for asylum seekers. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The uses of EHRs in these studies ranged from screening measures to characterising the chronic diseases in a population to improving guidelines and reducing the health disparities in asylum populations compared with the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Several studies commented on the utility of EHRs as screening tools for asylum populations.…”

Review article: current gaps and opportunities in HBV prevention, testing and linkage to care in the United States—a call for action

“…Immigrants and refugees represent a major component of the HBV‐infected population in the US 4,5 . Various programmes had been launched to screen and connect the infected foreign‐born individuals to care 26,66‐70 . In a recent quality improvement evaluation of programme to provide linkage to care to refugees with CHB, the proportion of linkage to care after first diagnosis in the US ranged from 29% to 53% 71 …”