Long term outcome of a community-based hepatitis B awareness campaign: eight-year follow-up on linkage to care (LTC) in HBV infected individuals

Abstract

Background Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality. High HBV prevalence in immigrants and ethnic minorities and numerous barriers to healthcare access are associated with serious health disparities in the United States. Reportedly, self-awareness of HBV infection is low, suggesting a greater need for effective screening and education. Further, low levels of linkage to care (LTC) (completion of a first doctor’s visit after the diagnosis of chronic HBV infection) may be responsible for the lack of engagement over the continuum of care and for needed services. Methods Demographics and survey data were obtained from 97 Korean American adults chronically infected with HBV, initially identified through a series of community screening events in northern New Jersey between Dec. 2009 and June 2015. Eight year follow-up on these HBV-infected individuals was obtained to determine their access to care, and thus the efficacy of a campaign to improve LTC. The participants’ self-awareness of HBV infection and other factors for LTC were also evaluated. Results Of a total of 97 HBV-infected participants (age range 30 to 79), 74 were aware of their infections at screening. The remaining 23 had been unaware of their infections until screening. Eight years after the campaign, some 66 of these 97 individuals accessed care (LTC rate 68%). Health insurance status, presence or absence of symptoms and level of knowledge of CHB were among the most significant factors in LTC. Conclusion A community-based hepatitis B screening and education campaign can be instrumental in prompting HBV infected individuals to access care, as demonstrated in the cumulative increase in LTC in our cohort. Despite many years of awareness of HBV infection, many are not accessing care owing to a lack of health insurance, suggesting a pressing need for advocacy and health education to improve access to affordable coverage in the Asian American population. Community efforts and strategies similar to the ones employed in the current study may serve as a model to improve the engagement of HBV-infected individuals in high risk immigrant populations.

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

“…The researchers concluded that despite having HBV guidelines for diagnosing and treating HBV in Europe, policies for diagnostics and treatment varied significantly across Europe. Similar findings were found in the US when comparing those on government‐sponsored insurance (Medicaid) vs those who received their healthcare through the private market 82 …”

Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems

“…28,32 Given that the majority burden of CHB in the United States is seen among Asian and African immigrants, the higher rates of treatment in these groups may be a result of greater awareness of the disease burden among these populations, which are enriched in non-speaking immigrants and indigent care populations. 33,34 The observations of alarmingly low rates of CHB treatment among safety-net populations needs to prompt greater focus on interventions to improve these disparities. While drivers of these disparities are multifactorial, recent studies have demonstrated the importance of provider and patient knowledge in improving HBV monitoring and outcomes.…”

Improving Care for Patients with Chronic Hepatitis B via Establishment of a Disease Registry

“…TABLE 4 Odds of maintaining UTD* status for patients with chronic HBV infection at 6 months for those who were UTD at baseline and odds of achieving UTD status at 6 months for those who were not UTD at baseline for three groups, 1) CIH pilot, 2) Gastroenterology, and 3) HP PC; N 5 4,872 Although we are unaware of other EHR-integrated CHB registries in the United States focused on improving long-term management of CHB infected patients, community-based hepatitis B education campaigns have shown the importance of long-term linkage to care. 22 Standardized education was not a specific intervention in our study; however, patients' HBV infection was discussed during outreach efforts and clinic visits. These discussions likely provided patient education about both hepatitis B in general and the need for routine monitoring.…”

“…Although we are unaware of other EHR-integrated CHB registries in the United States focused on improving long-term management of CHB infected patients, community-based hepatitis B education campaigns have shown the importance of long-term linkage to care. 22 Standardized education was not a specific intervention in our study; however, patients’ HBV infection was discussed during outreach efforts and clinic visits. These discussions likely provided patient education about both hepatitis B in general and the need for routine monitoring.…”