Hepatitis Free San Diego Community Health Screenings. Binh N. Tran, PharmD, MS, MBA April 15, 2013

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1 Hepatitis Free San Diego Community Health Screenings Binh N. Tran, PharmD, MS, MBA April 15, 2013

2 Overview Impact of health fairs and outreach events as providers of health services and educational information in the community. Seriousness of Hepatitis B among the Asian groups in San Diego Hepatitis Free San Diego: Breakthrough project on Viral Hepatitis B screening and Care in San Diego County

3 Asian Pacific Health Foundation in Kearny Mesa, San Diego

4 Hepatitis B 2 Billion ever infected 400 Million infected now worldwide 1 Million die each year of liver cancer or cirrhosis (scarring of the liver) 25% life time risk for each HBsAg(+) patient to develop liver cancer or cirrhosis Second most common cause for liver cancer after cigarettes

5 Global Distribution of Hepatitis B (2008) n 1 in every 12 Asian Americans are living with chronic HBV FIGURE 1. Global distribution of Hepatitis B virus infection (2008). About 1 in every 12 Asian Americans are living with HBV chronically. Adapted from US Department of Health and Human Services, CDC;

6 Hepatitis B Prevention Project In San Diego by the Asian Pacific Health Center and Community Health Group from 2003 to 2005 Funded by The California Endowment Collaboration with Jade Ribbon Campaign gave a total of 1657 persons screened. HBsAg (+) persons: 116 (7.0%) 6

7 Tests for HBV From venipuncture blood drawings, tests for: 1. Hepatitis B surface antigen for infection 2. Antibody to B surface antigen for immunity 3. Antibody to B core for exposure

8 Table 1: Prevalence of Hep B in 2 Asian groups Date, Group April 1, 2007, APAMSA Quantum Senior Center April 13, 2008, APAMSA Hanbit Church Sept Dec 2008 San Diego Herald Center 9 sites Number screened Number of positives 8 (14.8%) 0 (0%) 11 (5%)

9 Hepatitis Free San Diego Project Hepatitis B Screening for all Asian and Pacific Islander groups in San Diego County Focused HBV screening program at UCSD for at risk populations Project activities by Robert Gish, MD, Director of the Center for Hepatobiliary Disease and Abdominal Transplantation at UCSD in collaboration with Binh Tran, PharmD Previous screening experiences: 8,000 persons in Northern California, 2,900 persons in San Diego County. Point of care innovative approaches

10 Viral Hepatitis and Care Project in San Diego County

11 Hep B Screening and Metabolic syndrome assessment at UCSD Organized by the Student Health Services and Team HBV at UCSD on May 6, More than 90 students were screened.

12 Survey on Barriers to Hep B & C screenings Extensive survey utilized at outreaches in the community. Questionnaire on preferred method of screening (traditional blood drawing, finger stick test, or saliva test). Data collected and analyzed with regard to age, gender, ethnicity and socioeconomic factors.

13 Pilot runs at Wesley Church 21 patients on Aug 27, 2012 One Hep B positive (4.8%) confirmed by Point of care POC and Standard of care SOC testings. No Hep C positives. 19 patients on Aug 29, 2012 No positives on Hep B or Hep C.

14 Health Fair at Holy Spirit Church October 14, 2012 Collaboration with SSPPS APhA SC students for Hypertension, Diabetes, Cholesterol screening, Heartburn Awareness, Immunization education. Cervical Cancer Awareness in Vietnamese Women Glaucoma screening Hepatitis B screening (51 persons, 2 positive results: 3.9%)

15 Table 2: Five profiles for Hepatitis B patients ( ) Profile 1 Profile 2 Profile 3 Profile 4 Profile 5 1.HBsAg negative negative Positive negative Negative 2.Anti HBcore negative negative Positive Positive Positive 3.Anti HBs negative Positive negative Positive Negative Significance 1.No chronic infection; not a hepatitis B carrier. 1.No Chronic Infection; not a hepatitis B carrier. 1.Has acute or chronic hepatitis B infection 1.No Hep B infection in the blood 1.No infection at the moment 2.Never been infected with Hep B virus. 2.Not infected with Hep B virus 2. Have been infected with Hep B virus 2.Has been exposed to Hep B 2. Has been exposed to Hep B 3.No immunity (no protection) against Hep B. 3. Has immunity due to vaccination 3. No immunity or protection against Hep B 3.Has cleared the blood of HBV infection (when combined with negative HBsAg) 3. No clinical meaning at this time. Action Get vaccinated No vaccination See Primary Watch for Watch for risks of

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17 Outreach at Phat Da Temple Oct 28, patients 2 positive results (12.5%) Next Sunday Nov 18, 2012: Outreach at Sovannkiry Cambodian Temple nd Street, San Diego, CA Am to 1 PM

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19 POC tests at Phat Da Temple

20 Outreach in Escondido Family Health Day Indoor health services

21 Hep B Free San Diego Regional efforts to prevent and control Hepatitis B in San Diego County Introduced at the Asian Cultural Festival in Point Loma on May 1 st 2011 Hepatitis Month Students from UC Riverside drove down, recruited by John Swing and his father.

22 2013 New Year at Mira Mesa Park

23 Working with UCSD Skaggs School of Pharmacy Since 2011, on Barriers to Hepatitis B Screening and Knowledge among Asian populations in San Diego County with: Sandy Chong Cindy Nguyen Poster presented on campus Spring 2013: three students work on Cost efficiency analysis of Point of care tests versus Standard of care tests for Hepatitis B and C. Christina Nguyen Lillian Nguyen Xuan Phan

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28 Conclusions Collaborative works between Asian Pacific Health Foundation and UCSD, Tzu Chi Foundation, San Diego Herald Center are building up resources to help control Hepatitis B in San Diego County. Medical and pharmacy students put their training in action, benefiting largely the community. Get Tested for Hepatitis B and C!

29 Our Next event:

30 Contact Information For screening: Binh Tran, PharmD, Asian Pacific Health Foundation For linkage to care: Robert Gish, MD, UC San Diego Health System Liver Center,

31 Thank you Binh N. Tran, PharmD Executive Director Asian Pacific Health Foundation 4844 University Ave, Ste C San Diego, CA Ph: Fax: Mobile: btran.aphc@sbcglobal.net