Hepatitis B virus screening in Asian immigrants: Community‐based campaign to increase screening and linkage to care: A cross‐sectional study

Abstract

Background and Aims: Despite established screening guidelines, many Asian immigrants remain unscreened. Furthermore, those with chronic hepatitis B (CHB) are not linked to care citing multiple barriers. The objective of this study was to determine the role of our community-based hepatitis B virus (HBV) campaign on HBV screening and the success of linkage to care (LTC) efforts.Methods: Asian immigrants from the New Jersey and New York metropolitan areas were screened for HBV from 2009 to 2019. We started to collect LTC data starting in 2015, and those found to be positive were followed up. In 2017, because of low LTC rates, nurse navigators were hired to aid in the LTC process. Those excluded from the LTC process included those who were already linked to care, declined, and/ or had moved or passed away.Results: Total of 13,566 participants were screened from 2009 to 2019, of which, the results for 13,466 were available. Of these, 372 (2.7%) were found to have positive HBV status. Approximately 49.3% were female and 50.1% were male, and the rest were of unknown gender. A total of 1191 (10.0%) participants were found to be HBV negative but required vaccination. When we started to track LTC, we found 195 participants that were eligible for LTC between 2015 and 2017 after the exclusion criteria were applied. It was found that only 33.8% were successfully linked to care in that time period. After hiring nurse navigators, we saw LTC rates increase to 85.7% in 2018 and to 89.7% in 2019. Conclusion:HBV community screening initiatives are imperative to increase screening rates in the Asian immigrant population. We were also able to demonstrate that nurse navigators can successfully help increase LTC rates. Our HBV community screening model can address issues with barriers to care including lack of access in comparable populations.

Existing knowledge, myths, and perceptions about hepatitis B and liver cancer within highly impacted immigrant communities

“… 5 , 6 , 7 The prevalence of CHB among immigrant people living in the U.S. is approximately 3.1 %, with prevalence rates ranging from 4.5 % among people from Oceania, to 5.9 % among people from Asia and 8.6 % among people from Africa. 4 Furthermore, immigrant communities have increased risk of progression to HCC, 8 , 9 , 10 , 11 , 12 and increased rates of premature mortality attributed to CHB-related HCC compared to the non-Hispanic white population in the U.S. 13 , 14 Despite the negative health impacts of CHB and HCC within immigrant groups in the U.S., screening and vaccination rates remain suboptimal, 15 , 16 , 17 , 18 and fewer than 30 % of individuals who are living with CHB are aware of their status. 5 …”

“…Limited knowledge of CHB and the risks it poses, including HCC, is a primary driver of low screening rates within many communities. 18 , 19 , 20 Across communities, increased HBV-related knowledge can reduce associated stigma, 21 , 22 and promote the uptake of protective health behaviors. 23 In the absence of accurate and robust disease-related knowledge, the deeply entrenched HBV-related stigma found in many communities can increase, typically due to the intersection of cultural mores about sexual behavior and perceptions about disease transmission, thus increasing fear of disclosing disease status, 19 , 24 and impeding the practice of protective health behaviors.…”