apha slides tfah hep b & c wang slides[1]
TRANSCRIPT
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Hepatitis B on the Frontline:Experience of a New York City
Community Health Center
Su Wang, MD, MPHAssistant Director of Medical Affairs
Charles B. Wang Community Health CenterNew York, NY
Trust for America’s Health Congressional BriefingOctober 14, 2010
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Hepatitis B: Health Disparity in the US
Asian Americans make up >50% of all Hepatitis B in US ~1 out of 10 Asian Americans has HBV
Other countries of origin 22% from Latin America 13% from Africa 7.5% from Europe
1 of 4 with CHB may develop cirrhosis or liver cancer Potentially preventable now, with antiviral medication
>$1 billion/year spent on HBV hospitalizations in US
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Charles B. Wang Community Health Center (CBWCHC)
• Federally Qualified Health Center established in 1971
• Located in Chinatown, Manhattan & Flushing, Queens
• 98% served in language other than English
– Mandarin, Cantonese, Fujianese, Korean, Vietnamese
• Comprehensive Care:
– Internal Medicine and specialties, Pediatrics, Women’s Health, Mental Health, Dental, Social Work
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36,000 patients for 201,000 visits in 2008
CBWCHC Patients, by Insurance Status
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High Prevalence of HBV in Our Community
CBWCHC Community Screening Partners Years #
Screened%
HBV+
Community-based screening
CAMS, CAIPA, Oxford, GSK, NYC DOHMH
2000-2003 2100 11-16%
Asian-American Hepatitis B Program (AAHBP)
NYC City Council, NYU, NYC DOHMH, HHC
2004-2008 3000 24%
Hepatitis B family (Household contacts of HBV+ individuals)
Robin Hood Foundation, NYC DOHMH
2006-2008 1200 20%
Perinatal household contacts
NYC DOHMH 2008-current
170 25%
B Free NYC Gilead, BMS, NYU 2009-current
700 13%
Total 6670
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Need to Increase HBV Screening
• 1/3 with chronic hepatitis B are unaware (not yet diagnosed)– Need PCP education to increase screening– Only 50% of Asian MDs report screening all their Asian
patients1
– Stigma issues persist
• Screening/Diagnosis Prevention– HBV is 50x more infectious than HIV– Recommend condom use, partner and household contact
vaccination– Regular monitoring of disease prevent progression
D Chu, ASF Lok, TT Tran, and others. Hepatitis B Virus (HBV) Screening Practices of Asian-American Primary Care Physicians (PCPs) Who Treat Asian Adults Living in the United States. 13th International Symposium on Viral Hepatitis and Liver Disease (ISVHLD). Washington, DC. March 20-24, 2009. Abstract OP-61/330 (Oral).
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Increase HBV Vaccination: Safe and Effective
• Part of childhood vaccination series since 1990s• Many adults are not protected
– Need immunization strategy for adults
– In our community screenings, 30-40% needed vaccination
• Not covered by all insurance companies• Vaccine gratis through DOH via Section 317 but
doesn’t cover administration costs
HBV can be prevented!
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• Chronic HBV (CBWCHC registry= 4500 patients)– Lifelong disease
– Routine medical visits (every 3-12 months), blood tests, potential life-long antiviral medication ($)
– Potential of infecting others, stigma/shame, fear of telling partners and household members
• Cirrhosis/Liver Cancer– Specialist visit, hospitalization, liver resection,
transplant ($$)
– Days lost work, disability, high mortality
– Men more at risk of cancer and less likely to access health care, families lose primary wage-earner
What are we trying to prevent?
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Preventing Perinatal Transmission is Crucial
• 35-50% with HBV were infected by mothers around childbirth
• Birth dose of vaccine + immunoglobulin (HBIG) effective at preventing transmission from mother– Decreases transmission from 90% to 5-15%– Many gaps/misses in identification of HBV women and
coordinating their care from PCP, OB, Hospital, Pediatrician and DOH
– 1,000 babies/yr in US still get HBV from their mothers
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FQHCs Reach the Communities at Risk
• Can reach the communities at risk– Geographically located to reach vulnerable groups– Provide linguistically and culturally effective care
• Offer sliding scale costs for uninsured; affordable services (blood test, ultrasound, meds)
• Able to screen and provide important linkage to care – Follow up with medical personnel and other support services
medical home– Infrastructure to vaccinate
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Hepatitis B: Frontline Gaps and Needs
• Funding– Screening/vaccination- invest in prevention– Support for medical services for HBV patients
• Routine bloodtests and ultrasounds
• Affordable medication- helps w compliance
– Invest in chronic care model of health care delivery• Case Management, Patient navigators, Improved HIT
• Hep B Care Program- patient education/self tracking
• Education– Public- increase screening, decrease stigma– Provider- equip PCP’s serving high risk groups to screen
and monitor/treat HBV
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Hepatitis B is a Winnable Battle....
We have the tools
Now is the time
Our patients thank you
Thanks to
Trust for America’s Health &
American Association for the Study of Liver Diseases
for their collaborative report
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Hepatitis B Registry Form
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Case Management Database
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Patient Hep B Care Tracker
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HBV Outreach