A Model for Involving the Community in Hepatitis Healthcare

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A Model for Involving the Community in Hepatitis
Healthcare

• Robert Gish, MD
• Medical Director, Center for Hepatobiliary
  Disease
• and Abdominal Transplantation
• Chief of Hepatology, Professor of Medicine
• University of California San Diego
• San Diego, California
• Ted Fang, BA
• Director of the Asian Week Foundation
• Co-Founder and Steering Committee Member of the
• Hep B Free Campaign
• San Francisco, California

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Hepatitis B Screening in San Francisco

• Programmatic objective
• To screen every Asian/Pacific Islander (240k
  people) in San Francisco
• A collaborative program coordinated by San
  Francisco Department of Public Health
• California Pacific Medical Center (CPMC)
  objective
• To offer free screening for 10,000 people

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Chronic HBV Prevalence in the Asian-American
CommunitySan Francisco (20012006)
65.4
44.8
Prevalence ()
8.9
Chronic HBV Positive
Chronic HBV Positive Unaware of Status
At Risk Lack of Protective Antibodies
Lin SY, et al. Hepatology. 2007461034-1040.Slid
e courtesy of Robert Gish, MD.
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California Pacific Medical Center Experience San
Francisco (20082009)

• Participants screened (N 2118)
• Chronic HBV infection 3.4
• Men 1.5x more likely to have chronic HBV
  infection
• gt60 years of age 3x more likely have chronic HBV
  infection than younger individuals
• People reporting previous HBV vaccination
• Lacked protective antibodies 32.5
• Chronic HBV infection 1.1
• Asian/Pacific Islanders screened
• Chronic HBV infection 3.3
• Born in endemic regions 4.6x more likely to have
  chronic HBV infection than US-born Asian/Pacific
  Islanders
• No chronic HBV infection
• Lacked protective antibodies (at risk for future
  infection) 51

Tana M, et al. DDW 2009 May 30June 4, 2009
Chicago, Ill. Abstract W1811.
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Primary Liver Cancer MortalityAsian/Pacific
Islanders (20002004)
Rank of Primary Liver Cancer Mortality AmongAll
Cancer Sites in Asians/Pacific Islanders
andSubgroups in the Greater San Francisco Bay
Area
Men Women
Asian/Pacific Islander 3rd 6th
Chinese 2nd 6th
Filipino 5th 7th
Japanese 6th 7th
Korean 4th 5th
Vietnamese 2nd 3rd
Slide courtesy of Robert Gish, MD.
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San Francisco Hep B Free

• Campaign goals
• To create public and healthcare provider
  awareness about the importance of testing and
  vaccinating Asians/Pacific Islanders for
  hepatitis B
• To promote routine hepatitis B testing and
  vaccination within the primary care medical
  community
• To ensure access to treatment for chronically
  infected individuals
• Strategies
• Public awareness
• Provider education
• Screening/vaccination/follow-up/referral to care

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San Francisco Hep B Free Background

• Why target San Francisco?
• Home to 250,000 Asians (one third of city
  population)
• Estimated 10 are chronic hepatitis B carriers
• Hepatocellular carcinoma is the leading cause of
  cancer deaths in Asian men in San Francisco
• Hepatitis B is one of top 5 causes of premature
  mortality in San Francisco Bay Areas Asian
  population
• Highly at-risk unvaccinated population
  susceptible to hepatitis B
• First-generation immigrants
• People born before 1986 (government mandate to
  vaccinate newborns against hepatitis B)

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San Francisco Hep B Free

• An innovative collaboration of public/private
  partners
• Unmatched across the country
• Galvanized multiple constituents for
  sustainability
• Effective response to major local public health
  concern
• Partners encompass entire healthcare sector,
  universities, legislators, foundations, major
  corporations, community-based organizations
  (CBOs), major corporations, and news agencies
• www.sfhepbfree.org

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Key Accomplishments

1. Seven public access low-cost screening and
   vaccination sites
2. Standardized registration forms adopted by all
   sites
3. SF Dept Public Health Hep B Chronic Registry
   follows up on 50 of cases
4. Flowchart developed for diagnosis
5. CME, non-CME, and Community Education
   presentations
6. SF State University and SF City College establish
   Hep B Free initiatives on campus
7. Pro bono services from largest Asian ad agency in
   United States
8. SF Giants prioritize hepatitis B as one of their
   major causes
9. Evaluation headed up by SF State University
   faculty
10. Asian/Pacific Islander community galvanized
    behind this effort
11. State and national recognition (OMH, HSS) as
    model program
12. Replication begun on smaller scale in Santa
    Clara, at UC Berkeley
13. Interest in replication from San Mateo County,
    Philadelphia, New York City, Los Angeles,
    Arizona

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San Francisco Hep B Free Logic Model
With permission from Ted Fang, Janet Zola,
Meredith Bergin Bailey, Paula Fleisher, Stuart
Fong, Christine Sato, Tung Nguyen, Judith
Ottoson, Lawrence Green.
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Tools to Use in Encouraging Hepatitis B
Screening, Diagnosing, and Follow-up Care

• Sample of Pledge used by SF Hep B Free
• http//www.sfhepbfree.org/files/education_clinicia
  ns/Clinician_HonorRoll_Form.pdf

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Patient Ask Form
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Remember

• B informed
• B screened
• B treated if indicated
• B vaccinated if not immune and not infected
• B a team!