141st APHA Annual Meeting and Exposition

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286114
Novel community-based hepatitis b screening program among African immigrants


Monday, November 4, 2013 : 11:32 a.m. - 11:50 a.m.

Demetri Blanas, MD MPH, Department of Health Evidence and Policy, Institute for Family Health, New York, NY
Hari Shankar, 4th year medical student, Division of Liver Diseases, Mount Sinai School of Medicine, New York, NY
Saria Izzeldin, MD-MPH Candidate, MSIV, Mailman school of Public Health, Columbia University, New York, NY
Alice Clomegah, Testing center, African Services Committee, New York, NY
Mulusew Bekele, MPH, Director of Health Services, African Services Committee, New York, NY
Motahar Basam, BA, Hepatitis Program, African Services Committee Research Intern, New York, NY
Scott L. Friedman, MD, Division of Liver Diseases, Mount Sinai School of Medicine, New York, NY
Douglas T. Dieterich, MD, Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY
Ponni V. Perumalswami, MD, Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY
     
Background: Approximately 2.2 million people in the United States are chronically infected with hepatitis B virus (CHB), of whom 1.3 million (60%) are foreign-born. Objectives were to estimate the prevalence of CHB among African-born NYC residents, determine the role of known risk factors and identify new ones, and test the effectiveness of a community-based screening and linkage-to-care program using culturally-targeted patient navigators (PN).

Methods: Between October 2011 and January 2013, our team administered a written questionnaire assessing demographics and risk factors and conducted serological hepatitis B testing for 422 African-born NYC residents. Patients with positive diagnoses were informed, counseled and linked to care at Mount Sinai Hospital via a PN.

Results: The overall prevalence of HBsAg was 11.6% (n=422), and 56.6% (n=239) were non-immune. Men were more likely to be positive for HBsAg than women (13.5% vs 5.2%, p=0.026), and were also more likely than women to have had HBV exposure (78.5% vs 56.3%, p=0.000), for which body piercings (p = 0.017) and tattooing (p= 0.032) were the only significant risk factors. All 49 positive patients were informed of their results by a culturally-targeted PN and 36 (73.4%) attended follow-up at Mount Sinai. Of two participants who were recommended for treatment and navigated to a partnering federally qualified health center, one began treatment.

Conclusions: High CHB prevalence among African immigrants underscores a need for further screening in this population. This study also shows a significant opportunity for vaccination in this population, and demonstrates the effectiveness of culturally-targeted PNs in linking at-risk Africans to hepatitis care.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Describe the need for further hepatitis screening in at-risk African populations living in the United States Describe the role of culturally-targeted patient navigators in facilitating access to hepatitis care for at-risk African persons

Keyword(s): Access to Health Care, Hepatitis B

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Demetri Blanas is an intern in the Harlem Residency in Family Medicine at the Institute for Family Health. He received a BA from Columbia University, an MD and MPH from the Mount Sinai School of Medicine, and is a National Health Service Corps Scholar. He also completed a Doris Duke Clinical Research Fellowship at the African Services Committee and has published on malaria control in West Africa and HIV among African-born US residents.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3136.0: Bloodborne and Sexually Transmitted Infections (Infectious Disease Epidemiology)