Sunday, August 18, 2013

Community Screenings Reveal True Prevalence of Hepatitis B Infection

 —Christine. M. Kukka, Project Manager, HBV Advocate

Because it is difficult to screen Asian-Americans for hepatitis Bdue to language barriers, insurance, or cultural barriersthe Asian Pacific Liver Center held 63 free screening across Los Angeles County, home to more than 2 million Asian-Americans.

The screenings, staffed by Korean- and Mandarin-speaking healthcare providers, tested 6,959 adults and found that 387 (5.2%) had chronic hepatitis B. The infection rate was 3.9% among Korean-Americans and 8.6% among Chinese-Americans.
  • About 34% had been infected with HBV and recovered. Of those under age 30, 61% had been immunized.
  • About 27% of those screened required vaccination.
  • Among the 4,909 (66%) participants who claimed they had not been tested for or vaccinated against HBV, the prevalence of chronic infection was 4.1%.
Among 1,630 participants (22%) who reported they were vaccinated:
  • 71% were immune either due to immunization or resolved infection
  • 29% were still susceptible to hepatitis B
  • And 3% had chronic hepatitis B.
Of 555 participants who said they were unsure of their prior HBV testing results, 9% (50) had chronic hepatitis B. Curiously, only 47% of 197 participants who reported having been diagnosed with hepatitis B earlier were positive for infection.

HBV infection was highest among those age 50–59 and lowest among young adults under age 30 and seniors over age 70.

Among those with chronic hepatitis B, the average age was 51, most were male, 99% were foreign-born and 22% did not speak English. About 74% of those infected had no medical insurance.
The healthcare providers sent out test results to all participants and instructed those infected to get medical care. However, only 77% (297) of people with HBV could be reached six months after they were notified of their diagnosis. Among them, 57% reported that they received follow-up medical care.

Among 128 patients (43%) who had not sought follow-up treatment, 81 (63%) cited lack of money and health insurance as the reasons for not seeking care. Even when care and lab tests are heavily subsidized, the costs are still prohibitive, researchers noted.

"In Los Angeles, indigent patients may seek medical care at one of the government (Los Angeles County) clinics, but with only 27% individuals with chronic hepatitis B being able to read English, most ... are unable to navigate through this medical system," they wrote. Even when care is sough, wait times can reach four months, they added.

"To maximize the benefit of limited funding and link the greatest number of individuals with chronic hepatitis B to medical care, priority for allocation of resources should be directed towards screening of patients within primary care physician and gastroenterology practices," they concluded.


Abstract: Demographic and serological characteristics of Asian Americans with hepatitis B infection diagnosed at community screenings.

Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.

There is limited information regarding follow-up and hepatitis B serological status of Asian Americans diagnosed with chronic hepatitis B (CHB) through community screening. 

AIMS:
The aims of this study were to evaluate the prevalence and characterize CHB among Asians living in Los Angeles, assess follow-up of individuals with CHB diagnosed at screening and compare with patients with CHB followed by community gastroenterologists. 

METHODS:
Between October 2007 and May 2010, 7387 Asians were tested for HBV. HBsAg positive individuals (CHB) underwent additional testing for ALT, HBeAg/anti-HBe and HBV DNA. Patients with CHB were contacted 6 months later to determine whether they received follow-up care. We compared serological patterns of these individuals with CHB to patients with CHB who were seen for the first time (treatment na├»ve) by community gastroenterologists during the study period. Prevalence of CHB was 5.2%. About 99% patients with CHB were foreign-born, and only 27% could read/write English. 297 (77%) patients with CHB could be reached 6 months after diagnosis; 43% did not receive follow-up care, mostly because of lack of medical insurance. 

RESULTS:
Patients with CHB followed by gastroenterologists were more likely to have insurance (69% vs 26%, P < 0.0001). 90% patients with CHB at screening were HBeAg negative/anti-HBe positive with 62% having inactive disease compared to only 30% of patients seen by gastroenterologists (P < 0.0001). Among CHB participants, 13% met criteria for treatment compared to 51% of patients with CHB (P < 0.0001). 

CONCLUSIONS:
Only a small number of CHB screening participants require antiviral therapy. Lack of medical insurance is the main reason for most patients with CHB not seeking follow-up care after screening.
J Viral Hepat. 2013 Aug;20(8):575-81. doi: 10.1111/jvh.12073. Epub 2013 Mar 25.

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