1. Hepatitis B on the Frontline: Experience of a New York City Community Health Center Su Wang, MD, MPH Assistant Director of Medical Affairs Charles B. Wang Community Health Center New York, NY swang1@cbwchc.org Trust for America’s Health Congressional Briefing October 14, 2010

2. 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 preventabl e now, with antiviral medication  >$1 billion/year spent on HBV hospitalizations in US

3. 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

4. 36,000 patients for 201,000 visits in 2008 CBWCHC Patients, by Insurance Status

5. High Prevalence of HBV in Our Community CBWCHC Community Screening PartnersYears # Screened % HBV+ Community-based screening CAMS, CAIPA, Oxford, GSK, NYC DOHMH 2000-2003 210011- 16% Asian-American Hepatitis B Program (AAHBP) NYC City Council, NYU, NYC DOHMH, HHC 2004-2008 300024% Hepatitis B family (Household contacts of HBV+ individuals) Robin Hood Foundation, NYC DOHMH 2006-2008 120020% Perinatal household contacts NYC DOHMH2008- current 17025% B Free NYC Gilead, BMS, NYU2009- current 70013% Total6670

6. 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 patients 1 –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).

7. 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!

8. 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?

9. 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

10. 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

11. 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

12. 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

13. Hepatitis B Registry Form

14. Case Management Database

15. Patient Hep B Care Tracker

16. HBV Outreach