Hepatitis B on the Frontline:Experience of a New York City

Community Health Center

Su Wang, MD, MPHAssistant Director of Medical Affairs

Charles B. Wang Community Health CenterNew York, NY

swang1@cbwchc.org

Trust for America’s Health Congressional BriefingOctober 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

36,000 patients for 201,000 visits in 2008

CBWCHC Patients, by Insurance Status

High Prevalence of HBV in Our Community

CBWCHC Community Screening Partners Years #

Screened%

HBV+

Community-based screening

CAMS, CAIPA, Oxford, GSK, NYC DOHMH

2000-2003 2100 11-16%

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 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

patients1

– Stigma issues persist

• Screening/Diagnosis Prevention– HBV is 50x 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. 13th 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 1990s• 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!

• 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

What are we trying to prevent?

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