Eradication of Hepatitis B: A Nationwide Community Coalition Approach to Improving Vaccination, Screening, and Linkage to Care

Cohen, Chari; Caballero, Jeffrey; Martin, Melinda; Weerasinghe, Isha; Ninde, Michelle; Block, Joan M.

doi:10.1007/s10900-013-9699-4

Cited by 31 publications

(16 citation statements)

References 14 publications

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“…Unlike CHeCS, the current study cohort is primarily Asian American, and one quarter of patients’ primary language was not English. Our findings from a Northern California population contribute to existing cohort data by reflecting practice patterns among foreign-born patients and their families, and may be helpful in addressing health care disparities, as foreign-born individuals remain at disproportionately high risk for complications related to CHB [5, 6, 29–31]. Additionally, our findings provide prevalence estimates for comorbid conditions that may influence liver disease progression such as obesity and diabetes in this primarily Asian study population.…”

Section: Discussionmentioning

confidence: 72%

Characteristics and Management of Patients with Chronic Hepatitis B in an Integrated Care Setting

et al. 2014

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Background Few population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA. Methods We retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a “recent” 18-month study window (July 2009–December 2010), or as “ever” based on records dating to 1995. Results The mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values <0.001). During the study period, 1,649 (14 %) received HBV treatment, while 5 % of untreated patients had evidence of treatment eligibility. Among 599 patients newly initiated on HBV therapy, 76 % had guideline-based indications for treatment. Conclusions Most patients initiated on HBV treatment met eligibility, and very few patients with evidence of needing treatment were left untreated. However, monitoring of ALT and HBV DNA levels, as well as HCC surveillance, were not frequent, underestimating the proportion of patients that warranted HBV therapy. Viral monitoring and cancer surveillance are therefore important targets for improving the scope of CHB care in the community setting.

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Section: Discussionmentioning

confidence: 72%

Characteristics and Management of Patients with Chronic Hepatitis B in an Integrated Care Setting

et al. 2014

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“…These individuals chronically infected with HBV are not engaged in any care, reflecting a poor hepatitis B LTC in Korean American community. Other investigators have also reported that only a minority of HBV infected people can access care [ 9 - 11 ]. In fact, it was estimated that only 40 % of the HBV infected subjects screened in community setting were successfully linked to care [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, providers and healthcare system currently available in the US lack the understanding of the significance of CHB. To be specific, there is a lack of public health systems to meet the needs of multicultural populations [ 9 , 13 ]. There is also a poor communication between providers and patients of different racial, ethnic, or cultural backgrounds.…”

Section: Introductionmentioning

confidence: 99%

Chronic hepatitis B in Korean Americans: decreased prevalence and poor linkage to care

et al. 2016

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BackgroundChronic hepatitis B virus(HBV) infection is a major cause of liver related morbidity and mortality. HBV infection remains largely underdiagnosed in Asian American population, and it is also poorly linked to clinical care. We, therefore, assessed the HBV prevalence and evaluated linkage to care among Korean Americans in order to develop strategic plans to reduce the impact of HBV in a high risk community.MethodsSerologic screening and survey were provided to 7157 Korean American adults (age 21–100) in New Jersey between December 2009 and June 2015. All participants were tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core IgG antibody (anti-HBc). Additional survey was conducted on the subjects chronically infected with HBV on their history of infection. Self-administered questionnaires were employed to evaluate demographic and epidemiologic characteristics.ResultsOf those 7157screened, 171 (2.4 %) were HBV infected, 2736(38.2 %) were susceptible to HBV, and 4250(59.4 %) were immune. The prevalence of chronic HBV varied between the age groups: 1.18 % (age21-30); 2.53 % (age 31–40); 2.76 % (age 41–50); 2.90 % (age 51–60); 2.06 % (age 61–70); and 1.37 % (age 71–100). The rate of HBsAg was significantly higher in males (3.04 %) as compared to females (1.93 %). At least 75 % of these HBV infected subjects had been previously diagnosed, but were not engaged in care.ConclusionThis screening study suggests that the HBV prevalence in Korean Americans is significantly lower than currently understood. On the other hand, many of the individuals chronically infected with HBV cannot access care, suggesting a poor linkage-to-care (LTC). Further, a large percentage of the population is still susceptible to HBV. Study findings will be used to develop strategies to tailor community-based HBV screenings and LTC to the high risk populations.

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“…Campaigns in San Francisco, New York and Philadelphia have been able to demonstrate the success of providing outreach programs with low-cost or free HBV testing and vaccination 9, 10, 15 . We were able to provide free vaccination series to 100% of HBV naïve patients, and we successfully connected over 75% of HBsAg positive persons to medical care.…”

Section: Discussionmentioning

confidence: 99%

HBV Outreach Programs Significantly Increase Knowledge and Vaccination Rates Among Asian Pacific Islanders

et al. 2014

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Introduction Hepatitis B virus (HBV) testing and vaccination rates remain low among Asian-American/Pacific Islanders (APIs) despite high rates of HBV infection. The aim of our study was to assess the effectiveness of an outreach campaign to increase HBV knowledge, testing, and vaccination among a cohort of APIs. Methods Vietnamese Americans were invited to participate in a free HBV screening and vaccination outreach program though pubic service announcements. Attendees completed a survey to assess barriers to vaccination and HBV-related knowledge before and after a 30-minute education session by a bilingual board-certified gastroenterologist. Results Among 98 participants, 100% (22/22) of HBV naïve patients were provided a HBV vaccination series at no cost and over 75% (14/18) of HBV-infected patients were connected to further medical care. Notable reported barriers to prior testing and/or vaccination were cost of the vaccine, concern about missing work for evaluation, and lack of provider recommendation. Knowledge levels about HBV risk factors, potential consequences, and treatment options were poor at baseline but significantly increased after the education session (49% vs. 64%, p<0.001). Conclusion Outreach campaigns linked with education can successfully address several barriers to HBV testing and offer an approach to improve HBV awareness and prevention among difficult-to-reach populations.

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Eradication of Hepatitis B: A Nationwide Community Coalition Approach to Improving Vaccination, Screening, and Linkage to Care

Cited by 31 publications

References 14 publications

Characteristics and Management of Patients with Chronic Hepatitis B in an Integrated Care Setting

Characteristics and Management of Patients with Chronic Hepatitis B in an Integrated Care Setting

Chronic hepatitis B in Korean Americans: decreased prevalence and poor linkage to care

HBV Outreach Programs Significantly Increase Knowledge and Vaccination Rates Among Asian Pacific Islanders

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