Karen E. Kim, MD Professor of Medicine Dean for Faculty Affairs Director, Center for Asian Health Equity University of Chicago
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1 Karen E. Kim, MD Professor of Medicine Dean for Faculty Affairs Director, Center for Asian Health Equity University of Chicago 1
2 2 billion people have been exposed to HBV million people chronically infected Over two thirds are from China Cirrhosis, liver failure, HCC develop in 15-25% of chronic HBV patients WHO. Hepatitis B. Fact Sheet Lavanchy D. J Viral Hepat. 2004;11: Lok AS. N Engl J Med. 2002;346:
3 It is estimated that up to 2.2 million persons in the United States are chronically infected with HBV. Foreign-born Asian and African individuals in the U.S. are disproportionately affected by chronic HBV Foreign-born Asian individuals make-up nearly 60% Foreign-born African individuals account for nearly 12% 1. CDC. MMWR 2008;57(No. RR-08) 2. Knowdley. Hepatology 2012;56(2)422
4 The prevalence of chronic HBV infection in API Americans is as high as 15% in some studies. Almost two-thirds of chronically infected API Americans are unaware of their infection status because they have not been tested for HBV Less than 5% are in treatment IOM. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C.
5 HBV is responsible for 75-80% of virus-associated HCC (compared to 10-20% for HCV) 2 HBV carries a lifetime risk HCC of 10-25% 3 Worldwide, Asian have the highest rates of liver cancer 1. CDC McMahon. Hepatol 2009;49(Suppl 5):S45 index.htm. 5. Beasley. Hepatology. 1982;2(5): Perz. J Hepatol 2006;45(4): Qian. Cancer Epidemiol Biomarkers Prev 1994;3(1):3
6 1. CDC. Surveillance for Viral Hepatitis United States, HBV-RELATED DEATHS BY RACE/ETHNICITY Race/Ethnicity 2010 Rate 2011 Rate 2012 Rate 2013 Rate White, non-hispanic Black, non-hispanic Hispanic Asian/Pacific Islander American Indian/Alaskan Native Overall
7
8 Hepatitis B Incidence Among Persons 19 Yrs By Race/Ethnicity, Black Cases/100, Asian/Pacific Islander AI/AN Hispanic White Overall decline ~ 75% Decline among API ~ 85% CDC, Year
9 Rationale for Hepatitis B Screening Early Rx and risk based treatment likely to reduce chronic complications from HBV RCT shows that CHB treatment leads to lower HCC Cost effective to treat Greater than 65% of those with CHB don t know it!
10 Policy: FUNDING VIRUS Prevalence (millions) % unaware Deaths 2006 Vaccine HBV % 3,000 YES HCV % 12,000 NO CDC budget 2010 $ per pt HBV/ HCV , Million HIV % 14,016 NO 1.2 Billion $4/pt $1000/ pt
11 Disproportionate disease burden Lack of data Lack of awareness Lack of Resources 11
12 12
13 Build the infrastructure and capacity of pan-asian communities for hepatitis education and prevention. Provide targeted outreach and health education through community health workers (CHWs). Increase hepatitis screening rates for at-risk Asian populations. Provide appropriate linkage to care for Asians for either the hepatitis vaccine or medical follow-up for chronic infections. 13
14 Multisector Partnership Local government Providers Community based organizations Academic centers Ethnic media Evidence based interventions and strategies 14
15 Collaborations with local, city and state government agencies Provided funding for communitybased hepatitis education and outreach Provided local-level hepatitis surveillance data for community mapping Invited local officials to speak at hepatitis advocacy events Advocate for a new line item for at risk AAPI and African immigrants for HBV-$500,000K RFA 15
16 CDC (funded since 2008) Beijing center grant CDC Conference Grant AHRQ R24-Partnership for Healthier Asians NCI P20 16
17 ACTIVITY * Total People Educated 3,495 4,787 7,800 6,029 8,031 2,743 32,885 Number of Group Educations Number of Health Fair Events Number Referred for Screening/ Immunization ,432 3,770 3,318 5,672 3, ,494 Adults Screened ,139 17
18 18
19
20 Project Phoenix In 2012, AHC awarded CDC Cooperative Grant to conduct HBV surveillance and screening in Chicago Metropolitan area. Screenings performed Screenings available for analysis (98.6%) HBsAg + 69 (6%) Anti-HBc (18%) Country of Origin # Screened # Positive Carrier Rate China % Africa % Laos % Cambodia % Nepal % Tibet % Other % Philippines % Korea % Vietnam % Mongolia % India % Burma % USA % TOTAL %
21 Primary Care Providers (PCPs) HPNs CHWs Communitybased Organizations (CBOs) CHWs and HPNs will have joint: Reciprocal site and facility visits Cultural competency training Translation phone line training HBV education and training Medical Process and Linkage-to-care training
22 Number Percent Notified of Result % Referred for Medical Care % Visit Attended/In Progress % Sought care through PCP % TOTAL IN CARE 65.2%
23 23
24 Opportunity To eliminate a cause of Disparity and Death Evidence based strategies Education Vaccination Screening Treatment
25 DIALOGUE FOR ACTION 25
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