Community-Based Services to Improve Hepatitis B Testing and Linkage to Care Among Hard-to-Reach Populations
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1 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division name here Community-Based Services to Improve Hepatitis B Testing and Linkage to Care Among Hard-to-Reach Populations Aaron M. Harris, MD, MPH, FACP Clinical Prevention Services Team Leader (Acting) Hep B United Webinar October 30, 2018
2 Global Hepatitis B Virus Surface Antigen Prevalence in Adults, Source: Schweitzer A et al.lancet.2015
3 Burden of Chronic Hepatitis B Infection, United States Prevalence: About 1 million chronic infections 65% unaware of infection status 70% are non-u.s.-born 1 million immigrants enter the US annually >60% from intermediate-high HBV endemic countries Top 5: China, Philippines, Vietnam, Korea, India Imported U.S. - Acquired Cases / year 54,000 3,800 Mortality 24% 15% Deaths / year 13, Based on NHANES, Mitchell et al. PLoS One 2011;6(12):e27717
4 Chronic Hepatitis B Care Continuum, USA, 2011 Adapted from: Cohen et al J Viral Hepat 2011
5 Purpose of Hepatitis B Testing and Care Program To improve the capacity of healthcare providers and other stakeholders to serve populations of persons born in countries with intermediate-high HBV prevalence Goals: Increase testing of non-us-born persons for hepatitis B Increase vaccination of susceptible persons Increase linkage to ongoing, high quality HBV-directed care for persons identified with chronic hepatitis B
6 Community-based Hepatitis B Programs Test and Link to Care Interventions through Partnerships Implement 1. Recruitment: Foreign-born persons 2. Screening: HBsAg and HBcAb/HBsAb Increase community and health professional hepatitis B awareness Partnerships Interventi ons 1. State and Local health departments 2. Community-based organizations 3. Medical care clinics 4. Specialty practices Coordinate 1. Community-outreach 2. Patient navigation 3. Other services Train of staff 1. Screening 2. Monitoring 3. Management 4. Referral practices
7 Hepatitis B Linkage to Care Continuum, Three U.S. sites, October 2014 September (100%) 643 (85%) HBsAg-positive Linked to care* 587 (78%) Engaged in care 430 (57%) Retained in care Abbreviation: HBsAg = hepatitis B surface antigen. *Attended >1 medical visit; Received hepatitis B e antigen, HBV DNA, and ALT testing; Attended >2 medical visits; Antiviral treatment given Harris et al. MMWR.2018 Number of HbsAgpositive persons 137 (18%) Prescribed antiviral
8 Unadjusted Odds Ratios for Selected Characteristics among Persons Participating in Three US Programs Factor HBsAg-Positive Linkage to Care Antiviral Rx Male 413 (55) N.S. 1.6 ( ) >50 years old 239 (32) 0.5 ( ) 2.0 ( ) Race, Asian 602 (80%) N.S. N.S. No Health Insurance 121 (16) 0.3 ( ) N.S. Liver cirrhosis 18 (2%) N.S ( ) HCC* 9 (1) N.S (3 202) N.S.: Not statistically significant *HCC: Hepatocellular Carcinoma
9 Hepatitis B Testing and Vaccination of 273 Household or Sexual Contacts of HBsAg+ Persons Household or sexual contacts n (%) Testing Results 273 (100) HBsAg+ 39 (14) Anti-HBc+/anti-HBs+ 71 (26) Anti-HBs+/antiHBc- 101 (37) Anti-HBc+ only 12 (4) Susceptible (negative to 3 HBV markers) 50 (18) Hepatitis B Vaccination Results 50 (100) HepB dose 1 37 (74) HepB dose 2 32 (64) HepB dose 3 25 (50)
10 Best Practice Implementation Strategies Educational curricula Training protocols Patient navigation services Community outreach Screening events HBV testing voucher coupons Clinical decision support tools in EMR
11 Conclusion Hepatitis B testing and linkage to care can be achieved among hard-to-reach populations through partnerships: Community organizations Health centers Public Health Departments Household and sexual contacts of HBsAg+ persons should be tested and linked to care or vaccinated Patient navigators were critical for sustained linkage to care
12 Dr. Paul Weidle, Division Director (Acting) Dr. Noele Nelson, Branch Chief (Acting) Acknowledgements New Jersey/New York (Building Bridges): Dr. Su Wang, Dr. Amy Tang, Janice Lyu, Jill Keating, Judy Yuen, Niki Bannister, Dr. Perry Pong, Ruth Brogden, Wen-chi Chen Sacramento, CA (Scratch-B, UC Davis Health Center): Dr. Christopher Bowlus, Dr. Moon Chen, Dr. Eric Chak, Ann Sanchez, Duke Letran, Julie Ha Thi Dang Chicago (Asian Health Coalition): Dr. Karen Kim, Fornessa Randal, Alia Ryan, Matt Johnson For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC