Hepatitis B on the Frontline: Experience of a New York City Community Health Center Su Wang, MD, MPH Assistant Director of Medical Affairs Charles B. Wang Community Health Center New York, NY swang 1@cbwchc. org Trust for America’s Health Congressional Briefing October 14, 2010
Hepatitis B: Health Disparity in the US § Asian Americans make up >50% of all Hepatitis B in US § ~1 out of 10 Asian Americans has HBV § Other countries of origin § 22% from Latin America § 13% from Africa § 7. 5% from Europe § 1 of 4 with CHB may develop cirrhosis or liver cancer § Potentially preventable now, with antiviral medication § >$1 billion/year spent on HBV hospitalizations in US
Charles B. Wang Community Health Center (CBWCHC) • Federally Qualified Health Center established in 1971 • Located in Chinatown, Manhattan & Flushing, Queens • 98% served in language other than English – Mandarin, Cantonese, Fujianese, Korean, Vietnamese • Comprehensive Care: – Internal Medicine and specialties, Pediatrics, Women’s Health, Mental Health, Dental, Social Work
CBWCHC Patients, by Insurance Status 36, 000 patients for 201, 000 visits in 2008
High Prevalence of HBV in Our Community CBWCHC Community Screening Partners Years Community-based screening CAMS, CAIPA, Oxford, GSK, NYC DOHMH 2000 -2003 2100 1116% Asian-American Hepatitis B Program (AAHBP) NYC City Council, NYU, NYC DOHMH, HHC 2004 -2008 3000 24% Hepatitis B family (Household contacts of HBV+ individuals) Robin Hood Foundation, NYC DOHMH 2006 -2008 1200 20% Perinatal household contacts NYC DOHMH 2008 current 170 25% B Free NYC Gilead, BMS, NYU 2009 current 700 13% Total # Screened % HBV+ 6670
Need to Increase HBV Screening • 1/3 with chronic hepatitis B are unaware (not yet diagnosed) – Need PCP education to increase screening – Only 50% of Asian MDs report screening all their Asian patients 1 – Stigma issues persist • Screening/Diagnosis Prevention – HBV is 50 x more infectious than HIV – Recommend condom use, partner and household contact vaccination – Regular monitoring of disease prevent progression D Chu, ASF Lok, TT Tran, and others. Hepatitis B Virus (HBV) Screening Practices of Asian-American Primary Care Physicians (PCPs) Who Treat Asian Adults Living in the United States. 13 th International Symposium on Viral Hepatitis and Liver Disease (ISVHLD). Washington, DC. March 20 -24, 2009. Abstract OP-61/330 (Oral).
Increase HBV Vaccination: Safe and Effective • Part of childhood vaccination series since 1990 s • Many adults are not protected – Need immunization strategy for adults – In our community screenings, 30 -40% needed vaccination • Not covered by all insurance companies • Vaccine gratis through DOH via Section 317 but doesn’t cover administration costs HBV can be prevented!
What are we trying to prevent? • Chronic HBV (CBWCHC registry= 4500 patients) – Lifelong disease – Routine medical visits (every 3 -12 months), blood tests, potential life-long antiviral medication ($) – Potential of infecting others, stigma/shame, fear of telling partners and household members • Cirrhosis/Liver Cancer – Specialist visit, hospitalization, liver resection, transplant ($$) – Days lost work, disability, high mortality – Men more at risk of cancer and less likely to access health care, families lose primary wage-earner
Preventing Perinatal Transmission is Crucial • 35 -50% with HBV were infected by mothers around childbirth • Birth dose of vaccine + immunoglobulin (HBIG) effective at preventing transmission from mother – Decreases transmission from 90% to 5 -15% – Many gaps/misses in identification of HBV women and coordinating their care from PCP, OB, Hospital, Pediatrician and DOH – 1, 000 babies/yr in US still get HBV from their mothers
FQHCs Reach the Communities at Risk • Can reach the communities at risk – Geographically located to reach vulnerable groups – Provide linguistically and culturally effective care • Offer sliding scale costs for uninsured; affordable services (blood test, ultrasound, meds) • Able to screen and provide important linkage to care – Follow up with medical personnel and other support services medical home – Infrastructure to vaccinate
Hepatitis B: Frontline Gaps and Needs • Funding – Screening/vaccination- invest in prevention – Support for medical services for HBV patients • Routine bloodtests and ultrasounds • Affordable medication- helps w compliance – Invest in chronic care model of health care delivery • Case Management, Patient navigators, Improved HIT • Hep B Care Program- patient education/self tracking • Education – Public- increase screening, decrease stigma – Provider- equip PCP’s serving high risk groups to screen and monitor/treat HBV
Hepatitis B is a Winnable Battle. . We have the tools Now is the time Our patients thank you Thanks to Trust for America’s Health & American Association for the Study of Liver Diseases for their collaborative report
Hepatitis B Registry Form
Case Management Database
Patient Hep B Care Tracker
HBV Outreach
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