Chronic HBV infection and community-based services for high-risk Asians and Pacific Islanders

Chari A. Cohen

doi:10.17918/etd-6304

Chronic hepatitis B (HBV) infection is a significant cause of morbidity and mortality in the U.S., and results in considerable health disparities for Asians and Pacific Islander Americans (APIs). There are still multiple knowledge gaps regarding HBV in APIs, including information on factors associated with HBV infection and immunity in foreign-born APIs. Particularly in Philadelphia, the epidemiological landscape of chronic HBV infection in high-risk API communities remains largely unknown, making it difficult to develop appropriately targeted interventions. Community-based screening and linkage to care can play an important role in improving low HBV diagnosis rates and generating a more complete understanding of HBV infection in high-risk ethnic communities. However, there are no recommended strategies for addressing HBV infection at the community level, which has limited the success of community-based programs throughout the U.S. This project used a mixed-methods approach to: determine the factors associated with HBV infection and protection (immunity) among APIs in Philadelphia who participated in community-based screening; and to understand the processes, challenges and strategies for conducting enhanced community-based screening and linkage to care. The study included quantitative analysis of survey and seroprevalence data from 2,047 foreign-born and 2nd generation APIs residing in Philadelphia; and qualitative analysis of narratives, focus groups and interviews from two sites that conducted enhanced community-based HBV programming. Controlling for all other variables (at p<0.5), infected individuals in the sample tended to be male, between the ages of 18-29, disclosed that they had been previously tested for HBV, had a high school diploma or less, and had either a family member with HBV or HCC, or lived with an infected person; protected individuals in the sample tended to be between the ages of 18-29 and born in Korea; susceptible individuals tended to be over age 55, with no family history of HBV, no previous HBV test, and born in a country with no (or a limited) national HBV vaccine program. Not controlling for other variables, being born in China was significantly associated with being linked to care. Results of the qualitative analysis revealed that having a diverse community stakeholder committee was important to the success of enhanced community-based HBV programming. Including stakeholders in all planning stages, and offering ongoing opportunities for training and relationship development helped maintain stakeholder engagement. Limited time, funding, HBV knowledge, bi-lingual resources, and a lack of language capable free health clinics served as challenges to HBV screening, vaccination and linkage to care. Service integration, advanced planning, and having an understanding of community needs were identified strategies to improve programmatic outcomes. Identified challenges with data collection included length of the survey instrument, as well as limited staff time and training needs. The results of this project can be used to guide future community-based interventions in Philadelphia and around the U.S., to successfully improve HBV-related screening, vaccination and linkage to care for high-risk and infected API communities.

Chronic HBV infection and community-based services for high-risk Asians and Pacific Islanders

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Chronic HBV infection and community-based services for high-risk Asians and Pacific Islanders

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