The Costs and Logistics of Community HBV Screening Programs

Char i Cohen, DrPH, MPH Director of Publ ic Health , Hepat it is B Foundat ion

U.S. Institute of Medicine National Strategy on the Elimination of Hepatitis B & C

November 30, 2015

Low rates of HBV screening in the U.S.

1.4-2M

200,000-300,000

50,000

400,000-600,000

350,000-500,000

0

500,000

1,000,000

1,500,000

2,000,000

Number of Chronic HBVInfections

Number Aware of theirInfection

Number Potentially Eligiblefor Treatment

Number Entering into Care Number of Annual HBVPrescriptions

Low Estimate High Estimate

Cohen C, Holmberg S, McMahon BJ, Block JM, Brosgart CL, Gish RG, London WT, Block TM. (2011). Is chronic hepatitis B being undertreated in the United States? Journal of Viral Hepatitis, 18, 377-383.

Call to Action: Community Response

In 2012, the Hepatitis B Foundation partnered with AAPCHO to establish Hep B United as the

first national hepatitis B coalition. Currently, there are local member coalitions in 24 cities and 14 states which collectively reach 3.5 million high-

risk APIs.

Annual Hep B United National Summit 2014

Hep B United Know Hep B Campaign

The CDC’s national hepatitis B campaign materials, co-branded with Hep B United.

Community-Based HBV Screening Programs

Community-Based HBV Programming Successes

• Success in educating and screening large proportions of high-risk, underserved, hard to reach groups • Ideal for screening high-risk individuals/communities who do not access care

• Individual coalitions screen between 200-5,000 individuals each year and educate far more

• Effective in linking infected individuals with appropriate follow-up medical care • Can be as effective as clinic-based screening, with targeted, individualized strategies to

enhance patient navigation1

However, there are many challenges and constraints that community programs face.

1. Chandrasekar E, Kaur R, Song A, Kim KE. (2015). A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings. Journal of Multidisciplinary Healthcare, 8(1–9).

Challenges with Community-Based HBV Programming

Strategies for Overcoming Challenges • Ensure community trust and engagement

• Promote diversity among coalition partners

• Train and engage partners

• Ensure convenience and neutrality of events; cultural and linguistic competency

• Use theory-driven strategies to affect knowledge, attitudes, beliefs, stigma and

lead to behavior change

• Integrate into existing services and programs

• Ensure adequate infrastructure and planning

• Engage community clinics and clinical champions

Unaddressed Challenges

How can we ensure sustainability of community-based HBV screening and linkage to care?

Ongoing Resources Limitations • Funding • Buy-in • Staff • Vaccine • Referral sites for healthcare • Translation

Costs of Community-Based HBV Screening

Program Outcomes, Costs and Cost-Effectiveness Measures1

Personnel, education, promotion of events, translation, participant recruitment, partnerships, event sites, phlebotomy, materials/equipment, and lab fees (with additional costs for linkage to care and vaccination).

Rein, D. B., Lesesne, S. B., Leese, P. J., & Weinbaum, C. M. (2010). Community-based hepatitis B screening programs in the United States in 2008. J Viral Hepat, 17(1), 28-33.

The Role of Community-Based Programming in the Elimination of HBV Infection in the U.S. • Community-based HBV programming will play a critical role in eliminating chronic HBV infection

in the U.S., including promoting prevention, and reducing morbidity, mortality and health disparities

• These programs can be highly effective and sustainable, if they are appropriately resourced • Implementation of best practices and coordination of efforts can foster efficacy and cost-efficiency

• Community programs will need continued capacity building/training/technical assistance, and increased funding for program success

• Community programs cannot be burdened with the entirety of the issue. HBV screening needs to take place within medical homes, clinics, & other primary care settings.

• Community coalitions also serve as strong advocates for increased prioritization of HBV at the local and national levels.

Thank You

Hepatitis B Foundation Public Health Research Department

Chari Cohen, DrPH, MPH * Kate Moraras, MPH

Pavitri Dwivedi, MPH * Gang Chen, MD, PhD

Public Health Advisors: Alison Evans, ScD and W. Thomas London, MD

Executive Director: Joan Block, RN, BSN

For more information, please contact Chari Cohen at Chari.cohen @hepb.org or call (215) 489-4930