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 [email protected]Trust for America’s Health Congressional Briefing October 14, 2010
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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
– Internal Medicine and specialties, Pediatrics, Women’s Health, Mental Health, Dental, Social Work
36,000 patients for 201,000 visits in 2008
CBWCHC Patients, by Insurance Status
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
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).
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
– Men more at risk of cancer and less likely to access health care, families lose primary wage-earner
What are we trying to prevent?
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
FQHCs Reach the Communities at Risk
• Can reach the communities at risk– Geographically located to reach vulnerable groups– Provide linguistically and culturally effective care