1045. Community-based Hepatitis B Screening, Vaccination, and Linkage to Care of Foreign-born Persons Residing in the United States, Philadelphia and Seattle, May 2012–May 2013
Session: Poster Abstract Session: Hepatitis Viruses
Friday, October 9, 2015
Room: Poster Hall
Background:  Of the estimated 2 million persons with chronic hepatitis B (CHB) infection in the United States, ~90% are from high (≥8% hepatitis B surface antigen [HBsAg]) or intermediate (2-7%) prevalence countries in Asia and Africa. Most persons are unaware of their CHB infection; without diagnosis and treatment, about 15-25% will die from cirrhosis or hepatocellular carcinoma. To reduce hepatitis B virus (HBV)-related morbidity and mortality, and implement national guidelines, CDC funds programs to improve testing, vaccination, and linkage to care. 

Methods:  Three funded community–based organizations (CBO) in two cities conducted outreach to encourage testing among persons aged ≥18 years from African or Asian countries with ≥2% prevalence or U.S.-born persons not vaccinated in infancy having a parent from a country with ≥8% prevalence. The goal was to test 2000 persons. For persons tested during 2012–2013, data on demographics, HBsAg and anti-hepatitis B surface antibody (HBsAb) test results, vaccination, and referral to and receipt of care were analyzed to identify opportunities for intervention.


Results:  Among 1,666 persons tested, the median age was 52 years (range 18-96), 1,041 (63%) were female, 1,498 (90%) were Asian/Pacific Islander, 1,490 (89%) did not speak English as a primary language, and 1,028 (62%) did not have a regular physician.  Most participants were from Vietnam (36%) and China (25%).  CHB prevalence was 7% (Figure).  After adjustment for age, sex, and country of birth in Asia, being male (Prevalence Ratio [PR]=1.58, CI=1.12, 2.23), aged 18-29 years (PR=2.26, CI=1.23, 4.14), and born in China (PR=4.00, CI=1.27-12.56) were strongly associated with infection. Medical appointments were made for 72/121 (48%) infected persons and 46/72 (64%) attended the first appointment. Of 541 susceptible persons, 61 (11%) received 3 doses of vaccine; the reason for incomplete series was unknown in 96/193 (50%) persons without a third dose.


Conclusion:  Participating CBOs served as effective venues for HBV testing and identifying persons with CHB infection, although improvements in linkage to care and completion of vaccine series are needed. Close collaboration among CBOs and providers of HBV management could enhance care and prevention in hepatitis B.

Figure: Hepatitis B Screening, vaccination, and Linkage to Care Outcomes* HBsAg positive
** HBsAg and anti-HBsAb negative
***HBsAg negative and HBsAb positive
**** Insufficient sample, missing result

Kiren Mitruka, MD, MPH, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, Brittney Baack, MPH, Center for Disease Control and Prevention, Atlanta, GA, Chari Cohen, MPH, Hepatitis B Foundation, Doylestown, PA, Kim Nguyen, MSW, Hepatitis B Coalition of Washington, WithinReach, Seattle, WA, Michael Ninburg, MA, Hepatitis Education Project, Seattle, WA and Kathy Byrd, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA


K. Mitruka, None

B. Baack, None

C. Cohen, None

K. Nguyen, None

M. Ninburg, None

K. Byrd, None

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