HBV Screening Programs

Transcription

1 The Costs and Logistics of Community HBV Screening Programs Chari Cohen, DrPH, MPH Director of Public Health, Hepatitis B Foundation U.S. Institute of Medicine National Strategy on the Elimination of Hepatitis B & C November 30, 2015

2 Low rates of HBV screening in the U.S. 2,000, M Low Estimate High Estimate 1,500,000 1,000, , , , , , , ,000 50,000 0 Number of Chronic HBV Infections Number Aware of their Infection Number Potentially Eligible for Treatment Number Entering into Care Number of Annual HBV Prescriptions Cohen C, Holmberg S, McMahon BJ, Block JM, Brosgart CL, Gish RG, London WT, Block TM. (2011). Is chronic hepatitis B being undertreated in the United States? Journal of Viral Hepatitis, 18,

3 Call to Action: Community Response In 2012, the Hepatitis B Foundation partnered with AAPCHO to establish Hep B United as the first national hepatitis B coalition. Currently, there are local member coalitions in 24 cities and 14 states which collectively reach 3.5 million highrisk APIs. Annual Hep B United National Summit 2014

4 Hep B United Know Hep B Campaign The CDC s national hepatitis B campaign materials, co-branded with Hep B United.

5 Community-Based HBV Screening Programs

6 Community-Based HBV Programming Successes Success in educating and screening large proportions of high-risk, underserved, hard to reach groups Ideal for screening high-risk individuals/communities who do not access care Individual coalitions screen between 200-5,000 individuals each year and educate far more Effective in linking infected individuals with appropriate follow-up medical care Can be as effective as clinic-based screening, with targeted, individualized strategies to enhance patient navigation 1 However, there are many challenges and constraints that community programs face. 1. Chandrasekar E, Kaur R, Song A, Kim KE. (2015). A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings. Journal of Multidisciplinary Healthcare, 8(1 9).

7 Challenges with Community-Based HBV Programming

8 Strategies for Overcoming Challenges Ensure community trust and engagement Promote diversity among coalition partners Train and engage partners Ensure convenience and neutrality of events; cultural and linguistic competency Use theory-driven strategies to affect knowledge, attitudes, beliefs, stigma and lead to behavior change Integrate into existing services and programs Ensure adequate infrastructure and planning Engage community clinics and clinical champions

9 Unaddressed Challenges How can we ensure sustainability of community-based HBV screening and linkage to care? Ongoing Resources Limitations Funding Buy-in Staff Vaccine Referral sites for healthcare Translation

10 Costs of Community-Based HBV Screening Personnel, education, promotion of events, translation, participant recruitment, partnerships, event sites, phlebotomy, materials/equipment, and lab fees (with additional costs for linkage to care and vaccination). Program Outcomes, Costs and Cost-Effectiveness Measures 1 Rein, D. B., Lesesne, S. B., Leese, P. J., & Weinbaum, C. M. (2010). Community-based hepatitis B screening programs in the United States in J Viral Hepat, 17(1),

11 The Role of Community-Based Programming in the Elimination of HBV Infection in the U.S. Community-based HBV programming will play a critical role in eliminating chronic HBV infection in the U.S., including promoting prevention, and reducing morbidity, mortality and health disparities These programs can be highly effective and sustainable, if they are appropriately resourced Implementation of best practices and coordination of efforts can foster efficacy and cost-efficiency Community programs will need continued capacity building/training/technical assistance, and increased funding for program success Community programs cannot be burdened with the entirety of the issue. HBV screening needs to take place within medical homes, clinics, & other primary care settings. Community coalitions also serve as strong advocates for increased prioritization of HBV at the local and national levels.

12 Thank You Hepatitis B Foundation Public Health Research Department Chari Cohen, DrPH, MPH * Kate Moraras, MPH Pavitri Dwivedi, MPH * Gang Chen, MD, PhD Public Health Advisors: Alison Evans, ScD and W. Thomas London, MD Executive Director: Joan Block, RN, BSN For more information, please contact Chari Cohen at or call (215)