Hepatitis B Among Immigrants: Three Community Programs Linked 78% to Care

Of the 850,000 to 2.2 million people in the United States with chronic hepatitis B, about 70 percent were born abroad. Nearly two-thirds do not know they are infected, and fewer than 30 percent are linked to care. Three community programs funded by CDC from October 2014 to September 2017 set out to change that — and got 78 percent of the people they found into care.

Why it matters

Everyone with chronic hepatitis B virus (HBV) infection needs medical care, and about 20–40 percent need antiviral treatment. Without treatment, one in four people with chronic HBV will die prematurely of liver failure, cirrhosis or liver cancer (hepatocellular carcinoma).

Three programs, one method

Each program tested for the hepatitis B surface antigen (HBsAg), confirmed chronic infection with a second test six months later, and worked through community organizations, health centers and health departments. All three held community screening events, used patient navigators, and built prompts into electronic medical records (EMRs).

Patient navigators were trained in HBV, cultural competency, checking insurance, marketplace insurance applications, bilingual education materials, making appointments and guiding patients through the health system.

The results

Of 10,152 people tested, 757 (7.5 percent) had chronic HBV infection. Their median age was 40; 45 percent were female, 80 percent Asian and 16 percent black.

The care continuum across the three programs. Credit: CDC.

• Insurance mattered. 56 percent of uninsured patients received HBV-directed care, against 83 percent with private and 87 percent with public insurance.
• Treatment was more likely for men, people over 50, those with cirrhosis or liver cancer, and those with a family history of HBV or liver cancer. The 18 percent treated is below the 20–40 percent usually expected to need it; the report suggests cost, access to care, patient preferences or differing clinical guidelines as possible reasons, though it did not assess who met treatment criteria.

The households

The Chicago and Livingston/New York City programs also tested household contacts of infected people:

Fourteen percent infected, against 0.3 percent in the general population, is why household and sexual contacts of infected people should be tested and linked to care. Of the 50 susceptible contacts, 74 percent received at least one dose of vaccine, 64 percent two and 50 percent all three by the end of the project.

Limits

Each program tailored its services to its own community, which limits how far the results generalize. Linkage may be undercounted, because some appointments were still pending when the project ended, and missing data limit what can be said about who progressed through care.

Sources

Based on "Community-Based Services to Improve Testing and Linkage to Care Among Non–U.S.-Born Persons with Chronic Hepatitis B Virus Infection — Three U.S. Programs, October 2014–September 2017," by Aaron M. Harris and colleagues (CDC; Asian Health Coalition, Chicago; Saint Barnabas Medical Center, Livingston; Charles B. Wang Community Health Center, New York; University of California, Davis), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.