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Zhou K, Lee A, Wong C, Rangnekar AS, Chen A, Ajokubi J, Keller AI, Smith CI, Hitawala AA, Mironova M, Gopalakrishna H, Norman-Wheeler J, Ghany MG, Dodge JL, Terrault NA, Hsu CC. Immigration Factors and Monitoring of Chronic Hepatitis B Infection Among Foreign-Born: The FOCUS-HBV Multicentre Cohort. Aliment Pharmacol Ther 2025; 61:1913-1922. [PMID: 40202373 DOI: 10.1111/apt.70123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/12/2025] [Accepted: 03/24/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND Immigrants are the largest subgroup living with chronic hepatitis B (HBV) infection in the United States. It is not well understood how immigration and associated social and cultural factors impact adherence to HBV monitoring. METHODS We conducted a multicentre multilingual survey among foreign-born adults with chronic HBV between 7/2021 and 4/2023. Participants were surveyed regarding (1) immigration factors, (2) acculturation and language preferences, (3) social determinants of health and (4) HBV-related clinical factors. The primary outcome was optimal adherence, defined as 100% of the time with at least annual testing of HBV DNA, ALT and ultrasound while under care. Logistic regression was used to examine survey factors associated with the outcome. RESULTS Two hundred and seventy-four foreign-born patients with HBV (median 57 years, 57% male) from 32 birth countries were included. Thirteen per cent had immigrated within the past 10 years, and 62% were US citizens. Nearly all (92%) reported seeing a specialist for HBV, with 72% currently on treatment. 44% of participants had optimal adherence to monitoring over a median of 6 years (2-7) under care. Factors associated with more optimal adherence on multivariate testing included non-English survey language (OR 2.32, 95% CI 1.15-4.66), non-US citizens (OR 2.05, 95% CI 1.01-4.15) and higher education (college vs. high school or less: OR 2.39, 95% CI 1.09-5.24). Medicare insurance (vs. private) was associated with less optimal adherence (OR 0.42, 95% CI 0.19-0.94). CONCLUSION Adherence to long-term monitoring is suboptimal among a diverse cohort of immigrants with chronic HBV. More efforts to engage and retain immigrants in care are needed.
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Affiliation(s)
- Kali Zhou
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ariel Lee
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christopher Wong
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Amol S Rangnekar
- Medstar Georgetown Transplant Institute, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Ariana Chen
- University of Michigan, Ann Arbor, Michigan, USA
| | - James Ajokubi
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Andrea I Keller
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Coleman I Smith
- Medstar Georgetown Transplant Institute, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Asif A Hitawala
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Mironova
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Harish Gopalakrishna
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jaha Norman-Wheeler
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Marc G Ghany
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer L Dodge
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Norah A Terrault
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christine C Hsu
- Medstar Georgetown Transplant Institute, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Lamichhane R, Adhikari P, Pathak BD, Rai A, Ojha P, Maharjan K, Ruche HS, Saha M. Knowledge, attitude, and practice towards Hepatitis B and vaccination status of pre-clinical medical students at Sylhet Women's Medical College, Bangladesh. PLoS One 2024; 19:e0310443. [PMID: 39585861 PMCID: PMC11588231 DOI: 10.1371/journal.pone.0310443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/31/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Hepatitis B is a global health problem with high morbidity and mortality. The risk of transmission is more common among health care personnels and medical students during their professional health trainings. Vaccination is the most effective means of prevention. The main objective of this study was to determine the level of knowledge, attitude, and practice regarding Hepatitis B and vaccination among pre-clinical students in a medical college. MATERIALS AND METHODS A web-based, single-center, descriptive cross-sectional study was conducted among pre-clinical medical students in Bangladesh from April 28, 2024, to May 4, 2024. The whole sampling technique method was used taking the entire population for our study. Data were collected using a self-administered questionnaire and analyzed using JMP Pro V17 Statistical Software. RESULTS Sixty-one (34%) students were vaccinated against Hepatitis B, of whom 18% received all three doses with a booster dose. The most common reason for non-vaccination was lack of awareness of one's vaccination status (43%). The median knowledge, attitude, and practice (KAP) scores were 54 (50-60), 19 (17-21) and 20 (19-23) respectively, and they were moderately positively correlated. Forty-six (25.98%) students had a good overall KAP score (≥ 102). CONCLUSION Only one-third of the students had been vaccinated, and the commonest reason for non-vaccination was lack of awareness of one's vaccination status. Nearly one-fourth of the participants had good knowledge, attitude, and practice related to Hepatitis B. Therefore, education regarding Hepatitis B infection, risk factors, and importance of vaccination is a must among pre-clinical medical students in Bangladesh.
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Affiliation(s)
- Ramesh Lamichhane
- Department of Gastroenterology and Hepatology, Jalalabad Ragib Rabeya Medical College, Sylhet, Bangladesh
| | - Pritha Adhikari
- Department of Pediatrics, Nepalgunj Medical College, Nepalgunj, Nepal
| | - Bishnu Deep Pathak
- Department of Gastroenterology and Hepatology, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Aashika Rai
- Department of Gastroenterology and Hepatology, Sylhet Women’s Medical College, Sylhet, Bangladesh
| | - Pratikshya Ojha
- Department of Gastroenterology and Hepatology, Sylhet Women’s Medical College, Sylhet, Bangladesh
| | - Kripa Maharjan
- Department of Gastroenterology and Hepatology, Sylhet Women’s Medical College, Sylhet, Bangladesh
| | - Hamida Sultana Ruche
- Department of Gastroenterology and Hepatology, Sylhet Women’s Medical College, Sylhet, Bangladesh
| | - Madhusudan Saha
- Department of Gastroenterology and Hepatology, Sylhet Women’s Medical College, Sylhet, Bangladesh
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Cama E, Brener L, Horwitz R, Broady TR, Khoi Vu HM, Jin D, Wu KOE, Treloar C. Factors associated with hepatitis B knowledge among people of Vietnamese ethnicity in Australia. PSYCHOL HEALTH MED 2024; 29:1536-1547. [PMID: 38762748 DOI: 10.1080/13548506.2024.2350703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
Despite high hepatitis B (HBV) prevalence among people of Vietnamese ethnicity in Australia and elsewhere, there is limited research on levels of HBV knowledge and factors associated with such knowledge. The aim of this study was to examine HBV knowledge and associated demographic and attitudinal factors among people of Vietnamese ethnicity in Australia. People of Vietnamese ethnicity (n = 966) were recruited through community events and social media groups to complete online surveys measuring HBV knowledge, attitudes towards HBV, levels of mistrust in Western medicine, and demographic characteristics. Findings of this study indicate that levels of knowledge are mixed, with gaps in knowledge related to transmission and treatment of the virus. Those with greater knowledge of HBV tended to be older, have higher levels of formal education, have been tested for HBV, and know someone living with HBV. Those with lower levels of knowledge tended to have more negative attitudes towards the virus and greater levels of mistrust in Western medicine. Given that health literacy is connected to effective communication from health providers, we suggest that there is a need for the development of health promotion and education resources targeted at people of Vietnamese ethnicity and translated into Vietnamese. We propose that such resources be developed in consultation with Vietnamese communities and health providers to ensure that they are culturally appropriate and sensitive to people of Vietnamese ethnicity living in Australia.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Robyn Horwitz
- Centre for Social Research in Health, UNSW Sydney, Australia
| | | | | | - Defeng Jin
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - K O E Wu
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Cama E, Brener L, Broady T, Horwitz R, Jin D, Vu HMK, Wu KOE, Treloar C. Hepatitis B screening and knowledge among Chinese and Vietnamese students in Australia. PLoS One 2024; 19:e0299224. [PMID: 38437224 PMCID: PMC10911618 DOI: 10.1371/journal.pone.0299224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Research has shown that there are significant gaps in hepatitis B knowledge among migrant communities who are at risk of hepatitis B, such as Chinese and Vietnamese communities. Many students studying within Australia come from countries with high prevalence of hepatitis B. However, there is very little research examining hepatitis B knowledge, screening, or vaccination among university students in Australia or worldwide. The aim of this paper was to measure both levels of and demographic differences in hepatitis B screening and knowledge among Chinese and Vietnamese students in Australia. Online surveys were completed by 112 Chinese- and 95 Vietnamese-identifying students in Australia, measuring knowledge of hepatitis B, engagement in screening and vaccination, and demographic characteristics. Results show that although engagement in screening and vaccination for hepatitis B was high, there were significant gaps in knowledge around transmission of hepatitis B. There were also some key demographic differences in screening and knowledge. For instance, those born in Australia were more likely to have been screened compared to those born Mainland China, Hong Kong, or Vietnam. Chinese students born in Australia had lower levels of knowledge compared to those born in Mainland China or Hong Kong. Among both samples, knowing someone living with hepatitis B was associated with higher levels of knowledge. Findings underscore the need for education-based interventions to address the significant gaps that exist in knowledge around hepatitis B, with a specific need for culturally appropriate resources in a range of languages to cater to the diverse communities who may be at risk of hepatitis B.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Robyn Horwitz
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Defeng Jin
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Hoang Minh Khoi Vu
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - K. O. E. Wu
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
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Venkatesh V, Pati GK, Uthansingh K, Mallick P, Narayan J, Mishra D, Sahu MK. Knowledge, Awareness and Prevalence of Hepatitis B Among Urban Slum Dwellers and Residents of Social Welfare Home: A Cross sectional Study From Eastern India. J Clin Exp Hepatol 2023; 13:31-36. [PMID: 36647417 PMCID: PMC9840071 DOI: 10.1016/j.jceh.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background/aims In view of limited data on the knowledge and awareness of hepatitis B virus (HBV) and the available preventive strategies at the community level, it was aimed to analyse the knowledge and awareness of HBV in the community. Methods A cross-sectional questionnaire-based survey was conducted among residents of an urban slum and a social welfare home in Bhubaneswar, Odisha, from October 2019 to April 2021. The prevalence of HBV infection was also measured by testing the serum positivity for hepatitis B surface antigen using rapid point-of-care test kits. The statistical analysis was done by using the software SPSS version 20. Results A total of 370 individuals (mean age 38.7 ± 14.9 years, males: 55.1%) were assessed. Although 18.1% (67) had good knowledge, only 16.7% (62) had good awareness about HBV. Approximately 14.8% (55) knew that a vaccine is available in the country for HBV, and 6.2% (23) identified themselves as being vaccinated. Educational status was a significant independent predictor of knowledge and awareness such that people with education level of matriculation and above had odds of 11.05 (95% confidence interval: 5.3-22.7) and 14.7 (95% confidence interval: 6.5-33.1) for having good knowledge and awareness regarding HBV, respectively. A total of 10 participants tested positive for hepatitis B surface antigen contributing to a point prevalence rate of 2.7%. The proportion of individuals with an education status of matriculation and above was higher in the slum area when compared with the welfare home (67% vs 33%; P < 0.001), the knowledge (71.6% vs 28.4%; P < 0.001) and so was the awareness (71% vs 29%; P < 0.001) about HBV as well. Conclusion The relatively low figures of knowledge and awareness identified in our study undermine the need for intensification of health education and promotion activities regarding the prevalence of hepatitis B infection on a large scale at the community level.
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Affiliation(s)
- Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Girish K Pati
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Kanishka Uthansingh
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Pradeep Mallick
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Jimmy Narayan
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Debakanta Mishra
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Manoj K Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
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Martin P, Nguyen MH, Dieterich DT, Lau DTY, Janssen HLA, Peters MG, Jacobson IM. Treatment Algorithm for Managing Chronic Hepatitis B Virus Infection in the United States: 2021 Update. Clin Gastroenterol Hepatol 2022; 20:1766-1775. [PMID: 34329775 DOI: 10.1016/j.cgh.2021.07.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Chronic hepatitis B (CHB) infection remains the most frequent etiology of hepatocellular carcinoma globally as well as a major cause of cirrhosis. Despite vaccination, substantial numbers of persons have already been infected with hepatitis B virus and remain at risk of progressive liver disease. METHODS In 2004, a CHB management algorithm was developed by a panel of North American hepatologists, which was subsequently updated in 2006, 2008, and 2015. Since the most recent version, several developments have altered the management of CHB. Tenofovir alafenamide, with a more favorable safety profile than tenofovir disoproxil fumarate, has been introduced as an initial antiviral choice as well as an alternative for long-term therapy. Quantitation of hepatitis B surface antigen is becoming more widely available in clinical practice, with implications for monitoring response to treatment. Additionally, there has been a shift in how the natural history of CHB is perceived, as newer evidence has challenged the concept that during the immunotolerant phase of infection disease progression is not a concern. Finally, recent analyses indicate that in the United States, the average age of patients with CHB has increased, implying that the presence of comorbidities, including metabolic liver disease, increasing use of biologics associated with aging will increasingly affect disease management. RESULTS This updated algorithm is intended to serve as a guide to manage CHB while new antiviral strategies are developed. CONCLUSIONS Recommendations have been based on evidence from the scientific literature, when possible, as well as clinical experience and consensus expert opinion. Points of continued debate and areas of research need are also described.
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Affiliation(s)
- Paul Martin
- Division of Digestive Health and Liver Diseases, University of Miami School of Medicine, Miami, Florida.
| | - Mindie H Nguyen
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California
| | | | - Daryl T-Y Lau
- Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Harry L A Janssen
- Toronto Centre for Liver Diseases, University Health Network, Toronto, Canada
| | - Marion G Peters
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Ira M Jacobson
- Division of Gastroenterology, NYU Langone Health, New York, New York
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Ma GX, Zhu L, Lu W, Tan Y, Truehart J, Johnson C, Handorf E, Nguyen MT, Yeh MC, Wang MQ. Examining the Influencing Factors of Chronic Hepatitis B Monitoring Behaviors among Asian Americans: Application of the Information-Motivation-Behavioral Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4642. [PMID: 35457509 PMCID: PMC9027209 DOI: 10.3390/ijerph19084642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/07/2023]
Abstract
Background: Compared to non-Hispanic whites, Asian Americans are 60% more likely to die from the disease. Doctor visitation for chronic hepatitis B (CHB) infection every six months is an effective approach to preventing liver cancer. Methods: This study utilized baseline data from an ongoing randomized controlled clinical trial aimed at improving long-term adherence to CHB monitoring/treatment. Guided by the information-motivation-behavioral skills (IMB) model, we examined factors associated with CHB monitoring adherence among Asian Americans with CHB. Multivariable logistic regression was conducted to test the associations. Results: The analysis sample consisted of 382 participants. Multivariable logistic regression showed that HBV knowledge (OR = 1.24, p < 0.01) and CHB-management motivation (OR = 1.06, p < 0.05) are significant predictors of having a doctor’s visit in the past six months. Both factors were positively associated with the likelihood of having had blood tests for HBV in the past six months. Conclusion: We found that greater HBV-related knowledge and CHB-management motivation are significantly associated with performing CHB-monitoring behaviors in the past six months. The findings have critical implications for the development and implementation of evidence-based interventions for CHB monitoring and liver cancer prevention in the Asian American community.
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Affiliation(s)
- Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
- Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, PA 19120, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
| | - Jade Truehart
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
| | - Cicely Johnson
- Center for Cancer Health Disparities Research (CCHDR), Hunter College, City University of New York, New York, NY 10065, USA;
| | - Elizabeth Handorf
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA; (E.H.); (M.T.N.)
| | - Minhhuyen T. Nguyen
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA; (E.H.); (M.T.N.)
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10065, USA;
| | - Min Qi Wang
- School of Public Health, University of Maryland, College Park, MD 20742, USA;
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Ye Q, Kam LY, Yeo YH, Dang N, Huang DQ, Cheung R, Nguyen MH. Substantial gaps in evaluation and treatment of patients with hepatitis B in the US. J Hepatol 2022; 76:63-74. [PMID: 34474097 DOI: 10.1016/j.jhep.2021.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/20/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The occurrence of HBV-associated liver complications is reduced by antiviral therapy. However, prior studies using local institutional cohorts have suggested that evaluation and treatment are suboptimal. We aimed to determine the proportion of patients with chronic HBV infection who received adequate evaluation, were treatment eligible, and received antiviral treatment using a large, nationwide cohort. METHODS This retrospective analysis utilized claims data of approximately 73 million enrollees across the US from Optum's de-identified Clinformatics® Data Mart Database, 2003-2019. Adults observed for ≥6 months before and after an index diagnosis of chronic HBV infection were identified via ICD-9/ICD-10 codes, with the diagnosis confirmed by positive HBsAg, HBeAg or HBV DNA PCR. RESULTS We included 12,608 eligible patients in the study analysis (mean age 45.7 years, 52.1% male, 54.6% Asian, 18.1% Caucasian, 10.5% African American). About half of the cohort (n = 6,559, 52.3%) did not have a complete laboratory evaluation (defined as having HBeAg, HBV DNA, and ALT tests) and only 72.4% (n = 9,129) had an "adequate" evaluation (at least HBV DNA and ALT) during the entire study period. Of those with an adequate evaluation, 11.2% were treatment eligible by AASLD criteria and 13.9% by EASL criteria; 60.4% of AASLD eligible patients and 54.3% of EASL eligible patients received treatment within 12 months from becoming eligible. CONCLUSIONS Half of patients with chronic HBV infection in the US with private insurance did not have a complete laboratory assessment. Over one-third of treatment-eligible patients did not receive antiviral therapy. Patients who visited a specialist had a higher chance of receiving adequate evaluation and treatment. Urgent intervention is needed to identify and address the barriers to optimal care. LAY SUMMARY In this study, we used a national database that includes laboratory data in addition to medical and pharmacy claims data to assess the current real-world management of chronic HBV infection in the US. Among the 12,608 patients with chronic HBV infection included in our study, 52.3% never had a complete laboratory evaluation and only 73% had an adequate evaluation. Among those who were treatment eligible according to major society guidelines, only 60.4% and 54.3% received treatment within 12 months, respectively.
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Affiliation(s)
- Qing Ye
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States; The Third Central Clinical College of Tianjin Medical University, Tianjin, China; Department of Hepatology of the Third Central Hospital of Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Leslie Y Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States; Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Nolan Dang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States
| | - Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States; Department of Epidemiology and Population Health, Stanford, California, United States.
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Pham C, Sin MK. Use of Electronic Health Records at Federally Qualified Health Centers: a Potent Tool to Increase Viral Hepatitis Screening and Address the Climbing Incidence of Liver Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1093-1097. [PMID: 32242302 DOI: 10.1007/s13187-020-01741-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Viral hepatitis B and C are among the leading causes of acute and chronic liver disease in the USA. The nature of chronic liver disease is often asymptomatic. This is problematic because the majority of individuals living with chronic hepatitis B and chronic hepatitis C do not know that they are infected and can communicate the disease to others. Furthermore, early disease recognition and treatment have been shown to improve long-term outcomes and decrease healthcare cost. These diseases affect vulnerable populations disproportionately. Asian Americans and Pacific Islanders are more likely than the general US population to have CHB, and the baby boomer generation is more likely than any other age group to have CHC. Federally Qualified Health Centers play a vital role in providing comprehensive primary care to medically underserved populations. Utilization of electronic health records reminders in Federally Qualified Health Centers results in increased screening, reduced provider screening bias and improved opportunity for management of patients living with chronic viral hepatitis. Electronic health records technology is a potent tool kit to aggressively screen, treat, and prevent viral hepatitis, ultimately, leading to decreased incidence of liver cancer.
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Affiliation(s)
- Christina Pham
- Hepatology Nurse Practitioner, VA San Diego, 3350 La Jolla Village Dr. ,Building 1, Rm 3186A, San Diego, CA, 92037, USA
| | - Mo-Kyung Sin
- Seattle University College of Nursing, 901 12th Ave, P.O. Box 222000, Seattle, WA, 98122-1090, USA.
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Sannathimmappa MB, Nambiar V, Arvindakshan R. Hepatitis B: Knowledge and awareness among preclinical year medical students. Avicenna J Med 2021; 9:43-47. [PMID: 31143696 PMCID: PMC6530272 DOI: 10.4103/ajm.ajm_164_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objective Hepatitis B is an occupational health hazard to health-care workers. The complete knowledge of hepatitis B virus (HBV) transmission and prevention is indispensable for medical students. This study was conducted to assess the knowledge and awareness of hepatitis B among preclinical year medical students. Materials and Methods This is a descriptive cross-sectional study. A predesigned self-administered questionnaire concerning hepatitis B knowledge and awareness was distributed to all the preclinical year medical students. The data were collected, tabulated, and analyzed by Microsoft Excel and Statistical Package for the Social Sciences (SPSS) software, version 22. The results were expressed in numbers and percentages. Results Of 251 students, only 132 students voluntarily participated in the study. Majority of the students (84.8%) were aware of HBV infection. Many students knew that blood transfusion (81.1%) and use of contaminated needles and syringes (74.2%) are major modes of transmission. However, less than 30% of the students had knowledge about other modes of transmission. More than 50% of the students lacked in their knowledge about clinical features and complications of hepatitis B infection. Majority of students (72.7%) were aware of HBV vaccination. However, many students did not know their vaccination status, whereas only 23.5% of the students were fully immunized. Conclusion This study revealed lack of complete knowledge regarding hepatitis B among preclinical year medical students. They are at high risk of acquiring HBV infection during their clinical practice, later in life. Hence, implementation of well-structured education program in the first year itself is needed to create complete awareness among medical students about hepatitis B.
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Affiliation(s)
- Mohan B Sannathimmappa
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sultanate of Oman
| | - Vinod Nambiar
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sultanate of Oman
| | - Rajeev Arvindakshan
- Department of Community and Family Medicine, All India Institute of Medical Sciences and Research Centre, Mangalagiri, Andhra Pradesh
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11
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Vu M, Huynh VN, Berg CJ, Allen CG, Nguyen PLH, Tran NA, Srivanjarean Y, Escoffery C. Hepatitis B Testing Among Vietnamese in Metropolitan Atlanta: The Role of Healthcare-Related and Acculturation-Related Factors. J Community Health 2021; 46:767-776. [PMID: 33180219 PMCID: PMC8113341 DOI: 10.1007/s10900-020-00947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Compared to other racial/ethnic groups, U.S. Vietnamese have higher Hepatitis B infection prevalence, which is a major liver cancer risk factor. Increased testing could reduce this disparity. It is critical to understand subgroups of U.S. Vietnamese least likely to have been tested for Hepatitis B and design appropriate interventions. We examined healthcare- and acculturation-related factors influencing Hepatitis B testing among U.S. Vietnamese. METHODS Survey data of 100 U.S. Vietnamese attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Healthcare-related predictors included insurance and past 2-year checkup. Acculturation-related predictors included Vancouver Acculturation Index, percentage of lifetime in the U.S., and Vietnamese and English fluency. We conducted a multiple logistic regression controlling for age, sex, education, and household income. RESULTS The sample was an average 37.5 years old and 61.6% female. Insurance coverage was reported by 83.0%. Average percentage of lifetime in the U.S. was 56.8%. Seventy percent reported having received Hepatitis B testing. Hepatitis B testing was associated with health insurance (aOR = 2.61, 95% CI = [1.05-6.47], p = .04) but not any acculturation-related predictors CONCLUSION: Improving insurance coverage and options can be a strategy to increase Hepatitis B testing among U.S. Vietnamese. More education regarding Hepatitis B (e.g., via community-based, culturally-appropriate, lay health worker-led programs) is needed to ensure that individuals are aware of their testing status and pursue appropriate healthcare decisions.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Victoria N Huynh
- Emory College of Arts & Sciences, Emory University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C, USA
| | - Caitlin G Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | | | - Ngoc-Anh Tran
- Nguyen Hue High School for the Gifted, Hanoi, Vietnam
| | | | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
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12
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Yeo YH, Nguyen MH. Review article: current gaps and opportunities in HBV prevention, testing and linkage to care in the United States-a call for action. Aliment Pharmacol Ther 2021; 53:63-78. [PMID: 33222252 DOI: 10.1111/apt.16125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/01/2020] [Accepted: 10/06/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has set an elimination goal for hepatitis B virus (HBV) by 2030, so a comprehensive review of current HBV testing and care gaps are needed to help formulate solutions and opportunities for action. AIMS To summarise current gaps and barriers, and to propose solutions for HBV prevention, testing and linkage to care in the United States METHODS: Relevant guidelines and studies were reviewed including a systematic review of HCC surveillance adherence. RESULTS A total of 64.5 million (95% CI, 61.3-67.5) high-risk US adults had no evidence of HBV immunity. Only 18.6% (95% CI, 13.5-29.9) of privately insured patients with HBV infection have been diagnosed. Among those with known HBV infection, linkage to care rate (33.3%-57%) was poor and the adherence to guidelines regarding anti-viral therapy (30.66% [95% CI, 30.28-31.03]) and HCC surveillance (8%-87%, from a systematic review) were poor with even more concerning data for care and treatment retention. The causes are complex and include lack of access to medical care, lack of physician knowledge, lack of patient health literacy and awareness, linguistic and cultural barriers and fear of stigma. CONCLUSIONS A 'scale-up' effort is needed to optimise the care continuum to achieve the WHO 2030 targets. As targeted screening policy has leftover 80% of patients undiagnosed, we advocate for universal screening which can help to remove barriers regarding stigma. More active and system level interventions are also needed to improve linkage to care for patients with HBV infection.
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Affiliation(s)
- Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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13
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A Patient-Centered Hepatitis B Virus (HBV) Educational Intervention Improves HBV Care Among Underserved Safety-Net Populations. J Clin Gastroenterol 2020; 54:642-647. [PMID: 31688365 PMCID: PMC7744280 DOI: 10.1097/mcg.0000000000001276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
GOALS To evaluate the impact of a prospective patient-centered hepatitis B virus (HBV) educational intervention on improving HBV care. BACKGROUND Improving patients' HBV knowledge has the potential to improve adherence to HBV monitoring and management, particularly among underserved safety-net populations. METHODS Consecutive chronic HBV adults at a single-center safety-net liver clinic were recruited from July 2017 to July 2018 to evaluate the impact of an in-person, language concordant formal HBV educational intervention on improvements in HBV knowledge and HBV management: appropriate HBV clinic follow-up (≥1 visit/year), HBV laboratory monitoring (≥1 HBV viral load and alanine aminotransferase test/year), hepatocellular carcinoma surveillance (≥1 liver imaging test/year among eligible patients), and HBV treatment among treatment eligible patients. HBV knowledge and management were assessed before and after the intervention and compared with age-matched and sex-matched HBV controls who did not receive an education. RESULTS Among 102 patients with chronic HBV (54.9% men; mean age, 52.0±13.8), HBV education improved HBV knowledge scores by 25% (P<0.001), HBV clinic follow-up from 25.5% to 81.4% (P<0.001), HBV laboratory monitoring from 62.8% to 77.5% (P=0.02), and appropriate HBV treatment from 71.5% to 98.5% (P<0.001). Compared with 102 HBV controls, receiving HBV education was associated with higher rates of HBV clinic follow-up (81.4% vs. 39.2%; odds ratio, 7.02; 95% confidence interval, 3.64-13.56; P<0.001) and appropriate HBV laboratory monitoring (77.5% vs. 42.2%; odds ratio, 4.94, 95% confidence interval, 2.64-9.24; P<0.001). CONCLUSION A formal, in-person, language concordant educational intervention leads to significant improvements in HBV knowledge, resulting in improved HBV monitoring and appropriate HBV treatment.
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14
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Ispas S, So S, Toy M. Barriers to Disease Monitoring and Liver Cancer Surveillance Among Patients with Chronic Hepatitis B in the United States. J Community Health 2020; 44:610-625. [PMID: 30539329 DOI: 10.1007/s10900-018-00604-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic hepatitis B infection (CHB) is a condition that needs ongoing care such as monitoring for liver enzymes (ALT) and HBV DNA tests in treated and untreated patients, and annual imaging evaluation for liver cancer. Although follow-up care and treatment might seem straight forward, an estimated two-thirds of those who are aware of their infection are not seeing a health care provider, and more than half of those who are eligible for treatment do not receive it. This study aimed to compile and examine studies related to the barriers of disease monitoring, treatment, and liver cancer surveillance for CHB patients in the United States (US). A total of 4439 studies on monitoring and surveillance of CHB published between 2007 and 2018 were identified through a search of electronic databases. After critical assessment, the authors included 42 studies, divided into categories: 'patient-related barriers'; 'provider-related barriers'; and 'system-related barriers'. Among the patient-related barriers, one of the most frequent factors invoked in failing to have adequate surveillance was lack of patient's knowledge. In the provider-related barrier category, a lack of disease knowledge and adherence to guidelines was frequently reported. For the system-related barrier category, the only recurrent mention was a lack of clarity in guidelines or lack of guidelines from certain national institutions. This review summarizes and highlights the need for long-term disease management improvement of chronic hepatitis B infection for patients and healthcare providers that care for them.
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Affiliation(s)
- Simona Ispas
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA, 94304-5787, USA
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA, 94304-5787, USA
| | - Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA, 94304-5787, USA.
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15
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Ogawa E, Yeo YH, Dang N, Le MH, Jeong D, Tran S, Henry L, Cheung R, Nguyen MH. Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States. JAMA Netw Open 2020; 3:e201844. [PMID: 32271388 PMCID: PMC7146097 DOI: 10.1001/jamanetworkopen.2020.1844] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment. OBJECTIVE To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020. MAIN OUTCOMES AND MEASURES The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma. RESULTS Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma. CONCLUSIONS AND RELEVANCE In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease.
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Affiliation(s)
- Eiichi Ogawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Nolan Dang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Michael H. Le
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Donghak Jeong
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Sally Tran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
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16
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Lee AW, Jacobs W, Chan E, Nguyen B, Hua DN, Ho JN, Yuen P, Van Nguyen T. Insight into hepatitis B prevalence and risk factors among Vietnamese Americans: a cross-sectional analysis of data from a community-based screening program. BMJ Open 2019; 9:e029616. [PMID: 31455706 PMCID: PMC6720462 DOI: 10.1136/bmjopen-2019-029616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aims of our study were to describe current hepatitis B prevalence among Vietnamese Americans and to examine predictors of hepatitis B risk in this specific ethnic community. DESIGN Cross-sectional analysis of data from a community-based screening program. SETTING This analysis was based on hepatitis screening community events in Southern California. PARTICIPANTS 2508 Vietnamese Americans in Southern California. OUTCOME MEASURES Serological tests for hepatitis B surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody were used to classify participants as one of four hepatitis B infection statuses: currently infected, previously infected, susceptible, or immune due to a previous hepatitis B vaccination. RESULTS Across 2508 participants, 9.0% were currently infected with hepatitis B and 17.7% were at risk for hepatitis B. Females and those reporting a previous hepatitis B vaccination were at significant decreased risk of hepatitis B (OR=0.48, 95% CI 0.33 to 0.69 and OR=0.53, 95% CI 0.31 to 0.93, respectively) whereas those born outside of the USA and with a family history of the disease showed substantial increased risk (OR=13.36, 95% CI 1.62 to 110.05 and OR=4.68, 95% CI 2.66 to 8.22, respectively). Among those who reported a previous hepatitis B vaccination, less than half (42.9%) possessed the protective antibodies that result from a hepatitis B vaccination. CONCLUSIONS Vietnamese Americans remain disproportionately burdened by hepatitis B. Public health efforts that focus on improving hepatitis B awareness and vaccination knowledge and that are tailored to specific high-risk subgroups, such as immigrants and those with infected family members, could help in addressing the disease's burden in this high-prevalence population.
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, California, USA
| | - Wura Jacobs
- Department of Kinesiology, California State University, Stanislaus, Turlock, California, USA
| | - Elena Chan
- Department of Public Health, California State University, Fullerton, California, USA
| | - Becky Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
| | - Dung N Hua
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
| | - John N Ho
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
| | - Priscilla Yuen
- Department of Public Health, California State University, Fullerton, California, USA
| | - Thai Van Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
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17
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Kong LN, Zhu WF, Li L, Lei QS, Wang T, Li YL. Self-management behaviors in adults with chronic hepatitis B: A structural equation model. Int J Nurs Stud 2019; 116:103382. [PMID: 31402047 DOI: 10.1016/j.ijnurstu.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications. OBJECTIVES To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B. DESIGN A cross-sectional study. SETTINGS Hepatology units in two hospitals in Chongqing, China. PARTICIPANTS A total of 306 patients with chronic hepatitis B were recruited. METHODS Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data. RESULTS The final model showed good model fit. Social support directly influenced self-management behaviors (β = 0.19, p < 0.01), and indirectly influenced self-management behaviors (β = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (β = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (β = 0.12, p < 0.05) through self-efficacy. CONCLUSIONS Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.
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Affiliation(s)
- Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing, PR China; School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Wen-Fen Zhu
- School of Nursing, Chongqing Medical University, Chongqing, PR China
| | - Lin Li
- Department of Liver Disease, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, PR China
| | - Qing-Song Lei
- Department of Oncology Radiotherapy Center, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, PR China
| | - Tian Wang
- Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yi-Lan Li
- Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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18
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Davies EL, Fielding S, Noble G, Okpo E. "It's just in that sea of things that I never cared about": perception of hepatitis B amongst university students in Aberdeen, North-East Scotland. BMC Public Health 2019; 19:332. [PMID: 30898127 PMCID: PMC6429810 DOI: 10.1186/s12889-019-6654-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background A significant proportion of international students at UK universities are from regions with medium to high hepatitis B prevalence rates. Understanding the perception of students regarding hepatitis B infection is crucial for the development of appropriate information and services for this population group. Methods Twenty semi-structured interviews were conducted with students from the University of Aberdeen. The following key areas were covered: knowledge, awareness, practices including testing, cultural and social aspects and general attitudes to health information and services. Interviews were transcribed verbatim and coded using a framework analysis approach. Results The participants acknowledged hepatitis B to be a serious disease yet did not consider themselves to be at risk. They felt able to go to their General Practitioner if concerned about hepatitis B but emphasised that there was no indication that this was required. There was a general lack of knowledge about the disease including confusion over other types of hepatitis. This was linked to the perceived lack of attention given to hepatitis B in, for example, sexual health education and disease awareness raising campaigns. The participants expressed a desire for information on hepatitis B to be relevant to the student population, easy to understand, socially acceptable and easily accessible on student portals and social media platforms. Conclusions Our study suggests that students in Aberdeen, North East Scotland lack knowledge and awareness of hepatitis B and do not perceive themselves as being at risk of hepatitis B infection. There is a need for more tailored hepatitis B messages to be incorporated into a range of contexts with clearer risk communication for the student population.
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Affiliation(s)
- Emma L Davies
- Public Health, NHS Grampian and University of Aberdeen, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK.
| | - Shona Fielding
- Institute of Applied Health Sciences, NHS Grampian and University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Emmanuel Okpo
- Public Health, NHS Grampian and University of Aberdeen, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK.,Institute of Applied Health Sciences, NHS Grampian and University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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19
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Brock C, Yi Y, Papaluca T, Lucas B, Angus PW, Taylor D, Leung C. Exploring the feasibility of targeted chronic hepatitis B screening in the emergency department: A pilot study. Emerg Med Australas 2018; 30:864-866. [PMID: 29885209 DOI: 10.1111/1742-6723.13118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the feasibility of an ED chronic hepatitis B (CHB) screening programme. METHODS Adult patients born in intermediate-high CHB prevalent regions completed a pre-screening questionnaire and were offered CHB testing. ED staff were surveyed to gauge potential barriers to the programme. RESULTS Eighty patients demonstrated limited knowledge of hepatitis B virus transmission and perceived many barriers to screening. Among 65 tested for CHB, no new cases were detected but 36 (55.4%, 95% CI 42.6-67.5) were susceptible to infection. Staff supported the programme but reported potential barriers. CONCLUSION Targeted ED CHB screening is feasible but effectiveness and cost-effectiveness need further exploration.
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Affiliation(s)
- Catherine Brock
- Department of Medicine, Austin Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yuan Yi
- Department of Medicine, Austin Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Papaluca
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia
| | - Benjamin Lucas
- Department of Geospatial Sciences and Mathematics, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
| | - Peter W Angus
- Department of Medicine, Austin Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia
| | - David Taylor
- Department of Medicine, Austin Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Christopher Leung
- Department of Medicine, Austin Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia
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20
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Lee M, Zhu L, Wang MQ, Wei Z, Tan Y, Nguyen MT, Ogunwobi OO, Ma GX. Psychosocial Predictors of HBV Screening Behavior among Vietnamese Americans. Am J Health Behav 2017; 41:561-570. [PMID: 28760178 PMCID: PMC5633084 DOI: 10.5993/ajhb.41.5.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We evaluated the influence of psychosocial factors on HBV screening. METHODS Sample consisted of 1716 Vietnamese participants in our previous HBV intervention trial, recruited from 36 community-based organizations in Pennsylvania, New Jersey, and New York City between 2009 and 2014. Using the Health Belief Model and Social Cognitive Theory, we measured self-efficacy, knowledge, perceived barriers, perceived benefits, perceived severity, and risk susceptibility. Analysis of covariance was used to compare pre- and post-intervention changes of psychosocial variables. Structural equation modeling was used to explore the direct and indirect effects of the psychosocial variables on HBV screening. RESULTS Knowledge, self-efficacy, perceived benefits, and perceived barriers were directly associated with HBV screening; knowledge had the strongest effect. Perceived severity and risk susceptibility had indirect association with HBV screening through other variables. Indirect paths among the 6 psychosocial variables were also identified. CONCLUSION To promote HBV screening among Vietnamese Americans, intervention efforts should focus on increasing knowledge, self-efficacy, and perceived benefits, decreasing perceived barriers, and accounting for the dynamic cognitive processing.
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Affiliation(s)
- Minsun Lee
- Postdoctoral Associate, Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Lin Zhu
- Postdoctoral Associate, Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Min Qi Wang
- Professor, Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD
| | - Zhengyu Wei
- Research Associate, Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | | | - Minhhuyen T Nguyen
- Director, Section of Clinical Gastroenterology, Department of Medicine, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Olorunseun O Ogunwobi
- Associate Professor, Department of Biological Sciences, Hunter College of the City University of New York, New York, NY
| | - Grace X Ma
- Associate Dean for Health Disparities, Director, Center for Asian Health, Laura H. Carnell Professor and Professor in Clinical Sciences, Lewis Katz School of Medicine, Temple University Philadelphia, PA;,
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21
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Vedio A, Liu EZH, Lee ACK, Salway S. Improving access to health care for chronic hepatitis B among migrant Chinese populations: A systematic mixed methods review of barriers and enablers. J Viral Hepat 2017; 24:526-540. [PMID: 28092419 PMCID: PMC5516707 DOI: 10.1111/jvh.12673] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Abstract
Migrant Chinese populations in Western countries have a high prevalence of chronic hepatitis B but often experience poor access to health care and late diagnosis. This systematic review aimed to identify obstacles and supports to timely and appropriate health service use among these populations. Systematic searches resulted in 48 relevant studies published between 1996 and 2015. Data extraction and synthesis were informed by models of healthcare access that highlight the interplay of patient, provider and health system factors. There was strong consistent evidence of low levels of knowledge among patients and community members; but interventions that were primarily focused on increasing knowledge had only modest positive effects on testing and/or vaccination. There was strong consistent evidence that Chinese migrants tend to misunderstand the need for health care for hepatitis B and have low satisfaction with services. Stigma was consistently associated with hepatitis B, and there was weak but consistent evidence of stigma acting as a barrier to care. However, available evidence on the effects of providing culturally appropriate services for hepatitis B on increasing uptake is limited. There was strong consistent evidence that health professionals miss opportunities for testing and vaccination. Practitioner education interventions may be important, but evidence of effectiveness is limited. A simple prompt in patient records for primary care physicians improved the uptake of testing, and a dedicated service increased targeted vaccination coverage for newborns. Further development and more rigorous evaluation of more holistic approaches that address patient, provider and system obstacles are needed.
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Affiliation(s)
- A. Vedio
- Department of Infection and Tropical MedicineSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - E. Z. H. Liu
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - A. C. K. Lee
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - S. Salway
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Strong C, Hur K, Kim F, Pan J, Tran S, Juon HS. Sociodemographic characteristics, knowledge and prevalence of viral hepatitis infection among Vietnamese Americans at community screenings. J Immigr Minor Health 2016; 17:298-301. [PMID: 24715472 DOI: 10.1007/s10903-014-0015-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Few studies have investigated the prevalence of hepatitis B virus (HBV) and C virus (HCV) infection among Vietnamese Americans (VAs). The purpose of this paper is to assess the prevalence of HBV and HCV infection, identify the sociodemographic characteristics of the HBV infected population and the level of HBV knowledge among VAs in the Baltimore-Washington metropolitan areas with data from a health fair in 2011. A total of 617 VAs received serological testing for HBV and HCV, and 329 completed a survey of HBV knowledge assessment. About 9% were infected with HBV and 5% with HCV. Vietnamese Americans younger than 30 years had the highest HBV prevalence (13.1%) followed by those age 41-50 years (12.1%). The prevalence of HCV infection was particularly higher among those older than 70 years old (13.9%). Misunderstanding HBV as a food-borne disease is prevalent among VAs. Efforts to develop public health screening and education programs targeting this population are warranted.
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Affiliation(s)
- Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Zeng F, Guo P, Huang Y, Xin W, Du Z, Zhu S, Deng Y, Zhang D, Hao Y. Epidemiology of hepatitis B virus infection: results from a community-based study of 0.15 million residents in South China. Sci Rep 2016; 6:36186. [PMID: 27819332 PMCID: PMC5098154 DOI: 10.1038/srep36186] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/10/2016] [Indexed: 02/05/2023] Open
Abstract
Limited information is available about the current epidemic status of hepatitis B virus (HBV) in Guangdong province in South China, where hepatitis B is endemic. We sought to provide an up-to-date assessment of hepatitis B prevalence in a large population through a community-based study. A total of 169,211 local residents were recruited using the stratified cluster random sampling method from 2014 to 2015, and each participant's information was collected using an interviewer-administered questionnaire. Accordingly, the prevalence of hepatitis B surface antigen (HBsAg) in the total population was 8.76%. HBsAg prevalence was lowest (0.29%) among children aged 0-12 years and highest (12.71%) among those aged 23-59 years. Moreover, the prevalence (8.82%) in males approximately equalled that (8.65%) in females (P > 0.05). Overall, vaccination was effective in preventing HBV infection, regardless of age. Among adults aged 23-59 years, male sex tended to keep the HBsAg persistence. However, reduced persistence for participants with occasional physical exercise and drinking was observed. For participants older than 59 years, a history of prior surgery placed people at high risk for infection. Although Guangdong has successfully decreased the HBsAg prevalence among children, it is urgent to expand vaccination to adults, and employ interventions to reduce the infection risk.
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Affiliation(s)
- Fangfang Zeng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Pi Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yun Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wei Xin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Shuming Zhu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yu Deng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Dingmei Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
- Laboratory of Health Informatics, Guangdong Key Laboratory of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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25
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Stewart SL, Kwong SL, Bowlus CL, Nguyen TT, Maxwell AE, Bastani R, Chak EW, Chen Jr MS. Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012. World J Gastroenterol 2016; 22:8584-8595. [PMID: 27784971 PMCID: PMC5064040 DOI: 10.3748/wjg.v22.i38.8584] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/16/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry.
METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic (n = 8500), Chinese (n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese (n = 2063), Filipino (n = 1479), Korean (n = 1099), Japanese (n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian (n = 233), South Asian (n = 190), Hawai`ian/Pacific Islander (n = 172), Thai (n = 95), and Other Asian (n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.
RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.
CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.
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Jeon JH. Evaluation of a smartphone application for self-care performance of patients with chronic hepatitis B: A randomized controlled trial. Appl Nurs Res 2016; 32:182-189. [PMID: 27969026 DOI: 10.1016/j.apnr.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023]
Abstract
AIM To verify the usefulness of a smartphone application (App) for facilitating self-care in patients with chronic hepatitis B (CHB). BACKGROUND CHB is a global health problem, and patients with CHB need to routinely perform self-care. Health-related smartphone apps could help users self-manage their disease. METHODS Fifty-three CHB patients were assessed in this randomized controlled before-and-after experimental study. The patients were randomly and equally assigned to groups that did (n=26) or did not (n=27) use the smartphone app for 12weeks. The experimental and control groups were analyzed for differences in disease knowledge, self-efficacy, and self-care before and after use of the smartphone app. RESULTS After intervention, patients who used the app displayed significantly increased disease knowledge compared with the control group (p=.015). Self-efficacy and self-care also significantly increased in the experimental group (p=0.006 and 0.001, respectively). CONCLUSION The smartphone app can be useful for increasing self-care in CHB patients. ABBREVIATIONS App: application, CHB: chronic hepatitis B, CVI: content validity.
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Affiliation(s)
- Jae Hee Jeon
- Department of Nursing, Semyung University, Jecheon, Chungbuk 390-711, Republic of Korea.
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Zacharias T, Wang W, Dao D, Wojciechowski H, Lee WM, Do S, Singal AG. HBV Outreach Programs Significantly Increase Knowledge and Vaccination Rates Among Asian Pacific Islanders. J Community Health 2016; 40:619-24. [PMID: 25476035 DOI: 10.1007/s10900-014-9975-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis B virus (HBV) testing and vaccination rates remain low among Asian-American/Pacific Islanders (APIs) despite high rates of HBV infection. The aim of our study was to assess the effectiveness of an outreach campaign to increase HBV knowledge, testing, and vaccination among a cohort of APIs. Vietnamese Americans were invited to participate in a free HBV screening and vaccination outreach program though pubic service announcements. Attendees completed a survey to assess barriers to vaccination and HBV-related knowledge before and after a 30-min education session by a bilingual board-certified gastroenterologist. Among 98 participants, 100% (22/22) of HBV naïve patients were provided a HBV vaccination series at no cost and over 75% (14/18) of HBV-infected patients were connected to further medical care. Notable reported barriers to prior testing and/or vaccination were cost of the vaccine, concern about missing work for evaluation, and lack of provider recommendation. Knowledge levels about HBV risk factors, potential consequences, and treatment options were poor at baseline but significantly increased after the education session (49 vs. 64%, p < 0.001). Outreach campaigns linked with education can successfully address several barriers to HBV testing and offer an approach to improve HBV awareness and prevention among difficult-to-reach populations.
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Affiliation(s)
- Tresa Zacharias
- Division of Digestive and Liver Diseases, Department of Internal Medicine, Dedman Scholar of Clinical Care, University of Texas Southwestern Medical Center, 5959 Harry Hines Blvd, POB 1, Suite 420, Dallas, TX, 75390-8887, USA
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Hepatitis B Stigma and Knowledge among Vietnamese in Ho Chi Minh City and Chicago. Can J Gastroenterol Hepatol 2016; 2016:1910292. [PMID: 28101498 PMCID: PMC5214171 DOI: 10.1155/2016/1910292] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/07/2016] [Indexed: 12/15/2022] Open
Abstract
Stigma regarding viral hepatitis and liver disease has psychological and social consequences including causing negative self-image, disrupting relationships, and providing a barrier to prevention, testing, and treatment. The aim of this study was to characterize and compare HBV knowledge and stigma in Vietnamese in Ho Chi Minh City and Chicago and to begin to evaluate the cultural context of HBV stigma. Methods. A written survey including knowledge questions and a validated HBV stigma questionnaire was distributed to Vietnamese in Ho Chi Minh City and Chicago. 842 surveys from Ho Chi Minh City and 170 from Chicago were analyzed. Results. Vietnamese living in Chicago had better understanding of HBV transmission and that HBV can cause chronic infection and liver cancer. Vietnamese in Chicago had higher stigma scores on a broad range of items including guilt and shame about HBV and were more likely to feel that persons with HBV can bring harm to others and should be isolated. Conclusions. Vietnamese in Ho Chi Minh City and Chicago have knowledge deficits about HBV, particularly regarding modes of transmission. Persons in Ho Chi Minh City expressed lower levels of HBV stigma than Vietnamese living in Chicago, likely reflecting changing cultural attitudes in Vietnam. Culturally appropriate educational initiatives are needed to address the problem of HBV stigma.
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29
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Hepatitis B Awareness and Knowledge in Asian Communities in British Columbia. Can J Gastroenterol Hepatol 2016; 2016:4278724. [PMID: 27446839 PMCID: PMC4904637 DOI: 10.1155/2016/4278724] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/09/2015] [Indexed: 01/13/2023] Open
Abstract
Background. Our study examined hepatitis B virus (HBV) awareness and knowledge in Asian communities in British Columbia (BC). Methods. A statistical random sample representation of Chinese, Korean, Filipino, South Asian, and Southeast Asian populations in Greater Vancouver was surveyed by telephone. Multiple logistic regression analysis was performed to identify predictors of HBV knowledge. Results. General awareness of HBV was reported in 78.8% (798/1013). HBV awareness was the highest in Chinese (89%) and Filipino (88%) populations and the lowest in the South Asian (56%) population. "Reasonable" knowledge of HBV was elicited in 76.8% (778/1013). Higher HBV knowledge was associated with younger age (p = 0.014), higher education (p < 0.0001), Chinese ethnicity (p < 0.0001), and use of media (p = 0.01) and Internet (p = 0.024) for health information. Compared to the Chinese (OR = 1.0) population, "reasonable" knowledge of HBV was lower in Korean (OR = 0.3, 95% CI: 0.1-0.5), Filipino (OR = 0.3, 95% CI: 0.2-0.6), South Asian (OR = 0.3, 95% CI: 0.2-0.4), and Southeast Asian (OR = 0.3, 95% CI: 0.1-0.6) populations. 54.8% (555/1013) felt that HBV education was inadequate and 80.1% (811/1013) preferred HBV education in their native languages. Conclusion. Compared to the Chinese population, other Asian communities in BC have lower HBV awareness and knowledge. Public education should target older and less educated and Korean, Filipino, South Asian, and Southeast Asian populations in their native languages via media and Internet.
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Martin P, Lau DTY, Nguyen MH, Janssen HLA, Dieterich DT, Peters MG, Jacobson IM. A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2015 Update. Clin Gastroenterol Hepatol 2015; 13:2071-87.e16. [PMID: 26188135 DOI: 10.1016/j.cgh.2015.07.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/01/2015] [Accepted: 07/09/2015] [Indexed: 02/07/2023]
Abstract
Chronic hepatitis B (CHB) continues to be an important public health problem worldwide, including in the United States. An algorithm for managing CHB was developed by a panel of United States hepatologists in 2004 and subsequently updated in 2006 and 2008. Since 2008, additional data on long-term safety and efficacy of licensed therapies have become available and have better defined therapeutic options for CHB. The evidence indicates that potent antiviral therapy can lead to regression of extensive fibrosis or even cirrhosis, thus potentially altering the natural history of CHB. In addition, appropriate choice of antiviral agent can minimize the risk of resistance. This updated algorithm for managing CHB is based primarily on evidence from the scientific literature. Where data were lacking, the panel relied on clinical experience and consensus expert opinion. The primary aim of antiviral therapy for CHB is durable suppression of serum hepatitis B virus (HBV) DNA to low or undetectable levels. CHB patients who have HBV DNA >2000 IU/mL, elevated alanine aminotransferase level, and any degree of fibrosis should receive antiviral therapy regardless of their hepatitis B e antigen status. CHB patients with HBV DNA >2000 IU/mL and elevated alanine aminotransferase level but no evidence of fibrosis may also be considered for antiviral therapy. Approved antiviral therapies for CHB are interferon alfa-2b, peginterferon alfa-2a, lamivudine, adefovir, entecavir, telbivudine, and tenofovir, although the preferred first-line treatment choices are peginterferon alfa-2a, entecavir, and tenofovir. In determining choice of therapy, considerations include efficacy, safety, rate of resistance, method of administration, duration, and cost.
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Affiliation(s)
- Paul Martin
- Division of Hepatology, University of Miami School of Medicine, Miami, Florida.
| | - Daryl T-Y Lau
- Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - Harry L A Janssen
- Toronto Centre for Liver Diseases, University Health Network, Toronto, Canada
| | | | - Marion G Peters
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Ira M Jacobson
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York
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Vu VD, Do A, Nguyen NH, Kim LH, Trinh HN, Nguyen HA, Nguyen KK, Nguyen M, Huynh A, Nguyen MH. Long-term follow-up and suboptimal treatment rates of treatment-eligible chronic hepatitis B patients in diverse practice settings: a gap in linkage to care. BMJ Open Gastroenterol 2015; 2:e000060. [PMID: 26543565 PMCID: PMC4620589 DOI: 10.1136/bmjgast-2015-000060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 12/15/2022] Open
Abstract
Background and aims Despite available effective therapies, only a minority of patients with chronic hepatitis B (CHB) receive treatment. Our goal is to study treatment rates and time to treatment initiation in patients who meet treatment criteria on long-term follow-up. Methods We performed a retrospective cohort study of 608 consecutive treatment-eligible patients with CHB (by 2008 US Panel or 2009 American Association for the Study of Liver Disease (AASLD) criteria) at a US community gastroenterology clinic and a university liver clinic between 2007 and 2011. Patients were observed until they started treatment or last follow-up if untreated. Results Mean age was 44 and most were Asian (96%) with community patients being younger and having lower alanine aminotransferase (ALT) levels. A total of 62% started treatment, and 38% remained untreated after median follow-up of 17 months (IQR=1–40 months). Overall, treatment rate was significantly higher at university liver clinic than in the community (66.7% vs 59.9%, p=0.01). In multivariate analysis, older age (HR 1.02, p=0.002), male gender (HR 1.37, p=0.02), and baseline ALT >45 U/L for males and >29 U/L for females (HR 2.24, p<0.0001) were significant predictors of treatment initiation, but not practice setting. Conclusions Approximately 40% of treatment-eligible patients still have not started treatment on longer follow-up. Treatment rates were higher at university clinics, but practice setting was not a predictor for treatment, but older age, male gender, and higher ALT levels were. Further studies are needed to determine the barriers for treatment initiation and to improve treatment rates in treatment-eligible patients.
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Affiliation(s)
- Vinh D Vu
- Division of Gastroenterology and Hepatology , Stanford University Medical Center , Palo Alto, California , USA
| | - Ailinh Do
- Division of Gastroenterology and Hepatology , Stanford University Medical Center , Palo Alto, California , USA
| | - Nghia H Nguyen
- School of Medicine, University of California , San Diego, California , USA
| | - Lily H Kim
- Division of Gastroenterology and Hepatology , Stanford University Medical Center , Palo Alto, California , USA
| | - Huy N Trinh
- San Jose Gastroenterology , San Jose, California , USA
| | - Huy A Nguyen
- San Jose Gastroenterology , San Jose, California , USA
| | | | - My Nguyen
- San Jose Gastroenterology , San Jose, California , USA
| | - Andrew Huynh
- San Jose Gastroenterology , San Jose, California , USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology , Stanford University Medical Center , Palo Alto, California , USA
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Pollack HJ, Kwon SC, Wang SH, Wyatt LC, Trinh-Shevrin C. Chronic hepatitis B and liver cancer risks among Asian immigrants in New York City: Results from a large, community-based screening, evaluation, and treatment program. Cancer Epidemiol Biomarkers Prev 2015; 23:2229-39. [PMID: 25368398 DOI: 10.1158/1055-9965.epi-14-0491] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection, the predominant cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects Asian Americans. Limited data exist on the variability and characteristics of infection that determine disease progression risk within U.S. Asian ethnic subgroups. METHODS Retrospective analyses were conducted on a large, community-based HBV screening and treatment program in New York City (NYC). From 2004 to 2008, the program enrolled 7,272 Asian-born individuals. Determinants of HBV seroprevalence were calculated and risk factors for HCC progression were compared across Asian subgroups. RESULTS Among newly tested individuals, 13% were HBV positive. Seroprevalence varied significantly with age, gender, education, birthplace, and family history of infection. Chinese-born individuals, particularly from the Fujian province, had the highest seroprevalence (23.2% and 33.1%, respectively). Clinical and virologic characteristics placed HBV-infected individuals at significant risk for HCC. Significant differences in HCC risk existed among Asian subgroups in bivariate analysis, including age, gender, HBV viral load, and HBeAg status. Differences in HBV genotype and family history of HCC may further HCC risk among subgroups. CONCLUSIONS Asian immigrants in NYC have a high prevalence of HBV infection and are at significant risk of disease progression and HCC. Although heterogeneity in HBV seroprevalence was found by Asian subgroups, HCC risk among infected individuals was primarily explained by age and gender differences. Country and province of birth, age, and gender may further explain seroprevalence differences. IMPACT Findings provide estimates of HBV burden in Asian ethnic subgroups and identify high-risk groups to target for screening and treatment that can prevent HCC.
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Affiliation(s)
- Henry J Pollack
- Department of Pediatrics, New York University School of Medicine, New York, New York.
| | - Simona C Kwon
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Su H Wang
- Saint Barnabas Medical Center, Center for Asian Health, Livingston, New Jersey. Formerly at Charles B. Wang Community Health Center, New York, New York
| | - Laura C Wyatt
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of Medicine, New York, New York
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Trinh-Shevrin C, Nadkarni S, Park R, Islam N, Kwon SC. Defining an integrative approach for health promotion and disease prevention: a population health equity framework. J Health Care Poor Underserved 2015; 26:146-63. [PMID: 25981095 PMCID: PMC4530990 DOI: 10.1353/hpu.2015.0067] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Eliminating health disparities in racial/ethnic minority and underserved populations requires a paradigm shift from biomedical approaches that are disease-focused to a health equity framework that aims to achieve optimal health for all by targeting social and structural determinants of health. We describe the concepts and parallel approaches that underpin an integrative population health equity framework and present the experience of NYU Center for the Study of Asian American Health (CSAAH) in applying the framework to guide its work. Applying an integrative framework has deepened our community engagement efforts, our understanding of the multi-level contextual factors that influence health, and our capacity to advance health equity for Asian American communities through action-oriented research and policy. This framework and experience is applicable to researchers and community members working with other underserved populations.
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Affiliation(s)
- Chau Trinh-Shevrin
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Smiti Nadkarni
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Rebecca Park
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Nadia Islam
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Simona C. Kwon
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
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Dai M, Xiao GM, Wang FL, Zhang JS, Li YM, Yang HZ. Changes in serum alanine aminotransferase levels in telbivudine versus lamivudine treatment for chronic hepatitis B: a meta-analysis. J Int Med Res 2015; 43:161-72. [PMID: 25687498 DOI: 10.1177/0300060514556664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE A meta-analysis to compare the efficacy and safety of telbivudine (TBV) and lamivudine (LAM) in patients with chronic hepatitis B (CHB), assessed via changes in serum alanine aminotransferase (ALT) levels. METHOD The electronic literature databases PubMed®, Embase®, Web of Science, Cochrane Library, CISCOM, CINAHL, Google Scholar, China BioMedicine and China National Knowledge Infrastructure were searched for relevant studies. The effect of TBV and LAM treatment on serum ALT was assessed using standard mean differences (SMDs) and 95% confidence intervals (CI). RESULTS The meta-analysis included six studies (TBV n = 202; LAM, n = 208). Post-treatment ALT levels were significantly lower than pretreatment values for both TBV and LAM (TBV: SMD = 3.00, 95%CI 1.91, 4.09; LAM: SMD = 2.33, 95%CI 1.58, 3.07). Post-treatment ALT was significantly lower after treatment with TBV than LAM (SMD = 0.58, 95%CI 0.21, 0.94). CONCLUSION Both LAM and TBV are effective in normalizing ALT levels in patients with CHB, but TBV may be a better choice due to its lower rates of drug resistance.
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Affiliation(s)
- Min Dai
- Department of Traditional Chinese Medicine, Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ge-Min Xiao
- Department of Traditional Chinese Medicine, Hospital of Sun Yat-sen University, Guangzhou, China
| | - Feng-Lin Wang
- Department of Traditional Chinese Medicine, Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiong-Shan Zhang
- Department of Traditional Chinese Medicine, Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang-Mei Li
- Department of Traditional Chinese Medicine, Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong-Zhi Yang
- Department of Traditional Chinese Medicine, Hospital of Sun Yat-sen University, Guangzhou, China
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Chronic hepatitis B treatment eligibility and actual treatment rates in patients in community gastroenterology and primary care settings. J Clin Gastroenterol 2015; 49:145-9. [PMID: 25014233 DOI: 10.1097/mcg.0000000000000132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
GOALS This study aims to compare the eligibility and treatment rates of patients evaluated by gastroenterology [gastrointestinal (GI)] specialists for chronic hepatitis B (CHB) and patients followed by their primary care physicians (PCPs) only. BACKGROUND Guidelines have been devised to direct the care of patients with CHB but data on the application of these guidelines, especially in primary care settings, has been limited to date. STUDY Consecutive CHB patients were enrolled retrospectively from several community clinics in the San Francisco Bay Area: 2 GI referral clinics, 3 primary care clinics, and a multispecialty medical center. Patients were classified as group 1 if they saw a gastroenterologist for CHB within 6 months of presentation or as group 2 if they only saw PCPs. Eligibility according to AASLD 2009 and US Panel 2008 guidelines was determined using clinical and laboratory data available within 6 months of presentation. RESULTS Patients in group 2 had lower eligibility rates according to both US Panel 2008 (32% vs. 51%, P < 0.001) and AASLD 2009 (8% vs. 24%, P < 0.001) guidelines. GI specialists treated US Panel-eligible patients more readily than PCPs (45% vs. 25%, P < 0.001), and treatment rates in AASLD-eligible patients suggested a similar trend (68% vs. 50%, P = 0.080). CONCLUSIONS GI specialists were more likely than PCPs to see patients who were treatment eligible, and also more likely to initiate antiviral therapy. However, there are still a considerable number of patients from both settings who did not receive treatment despite being eligible.
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