1. 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

2. 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

3. Chronic HBV Prevalence in the Asian-American Community San Francisco (2001–2006)
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. 2007;46: Slide courtesy of Robert Gish, MD.

4. California Pacific Medical Center Experience San Francisco (2008–2009)
Participants screened (N = 2118)
Chronic HBV infection: 3.4%
Men: 1.5x more likely to have chronic HBV infection
>60 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 30–June 4, 2009; Chicago, Ill. Abstract W1811.

5. Primary Liver Cancer Mortality Asian/Pacific Islanders (2000–2004)
Rank of Primary Liver Cancer Mortality Among All Cancer Sites in Asians/Pacific Islanders and Subgroups in the Greater San Francisco Bay Area
Men
Women
Asian/Pacific Islander
3rd
6th
Chinese
2nd
Filipino
5th
7th
Japanese
Korean
4th
Vietnamese
Slide courtesy of Robert Gish, MD.

6. 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

7. 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 Area’s 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)

8. 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

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

10. 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.

11. Tools to Use in Encouraging Hepatitis B Screening, Diagnosing, and Follow-up Care
Sample of Pledge used by SF Hep B Free

12. Patient Ask Form

13. Remember
B informed
B screened
B treated if indicated
B vaccinated if not immune and not infected
B a team!