Integrating hepatitis B, hepatitis C and HIV screening into tuberculosis entry screening for migrants in the Netherlands, 2013 to 2015.

We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV) screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCV-positive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI): 2.37-8.29) and 0.99% (2/203; 95% CI: 0.27-3.52), respectively, all infections were newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI: 0.07-2.18), 1.17% (3/256; 95% CI: 0.40-3.39) and 0.39% (1/256; 95% CI: 0.07-2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR) = 5.45; 95% CI: 1.12-26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; OR = 0.04; 95% CI: 0.00-0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis screening. Prescreening selection of migrants based on risk factors merits further exploration.

[Study on health-seeking behavior and influencing factors among Chinese hepatitis B surface antigen positive adults].

OBJECTIVE: To analyze the characteristics of health-seeking behaviors and related influencing factors of the community-based hepatitis B surface antigen (HBsAg) positive adults, in China. METHODS: Based on the cohort formed by the HBsAg positive patients, in the national sero-survey project in 2006, we conducted a follow-up programs in 2010 and 2014. In the latest follow-up project, we carried out a cross-sectional study to collect information on health-seeking behaviors of the patients. Questionnaires would include information on clinic visits, diagnosis, regular physical examination and treatments,etc. We used the SPSS 18.0 software for data analysis. RESULTS: Totally, 2 478 HBsAg positive adults (≥18 years old) were followed through, with 34.4% (853/2 478) of them had visited the doctors and diagnosed after they were informed the status of HBsAg positivity, in the 2006-sero-survey program. Among patients who ever visiting the clinic, 51.2% (372/727) of them underwent at least medical examination once a year, with 31.5% (229/727) of them received treatment. Furthermore, 34.5% (79/229) of the treated patients adopted the traditional Chinese medicine or medicine for ' liver protection'. 56.8% (130/229) of the treated patients received antiviral drugs. Data from the binary logistic regression showed that the major influencing factors on clinic visits would include: age, level of education received and residencial areas (rural/urban). CONCLUSIONS: Consciousness on health was low in those community-based HBsAg positive people. Standerdized management and clinical treatment programs should be set up accordingly.

Attitudes toward hepatitis B virus among Vietnamese, Chinese and Korean Americans in the Houston area, Texas.

We explored attitudes about prevention, screening and treatment of hepatitis B virus (HBV) infection in Chinese, Korean and Vietnamese communities. We use qualitative methods in 12 focus groups (n = 113) of adults who self-reported their ethnicity to be Chinese, Korean, or Vietnamese. We use grounded theory (i.e., consensus-building between co-coders about recurring, emerging themes) for analysis. Diet, nutrition, fatigue and stress were misidentified as HBV causes. Improving hygiene, diet, exercise, and holistic methods were misidentified as viable HBV prevention methods. Common screening problems included not affording test and not understanding test results. Participants shared reasons for using complementary and alternative medicine--when Western medicine fails or becomes unaffordable. Participants sought information from medical providers and fellow community members, but also from the internet. Many of the attitudes and opinions that emerged may deter participation in HBV screening, prevention and treatment, insofar as community members may factor them into healthcare decision-making, choose alternative but ineffective methods of prevention and treatment, and undervalue the benefits of screening. More patient education in both traditional and new media is necessary for clarifying transmission, screening and treatment misunderstandings.

A comprehensive screening and treatment model for reducing disparities in hepatitis B.

Chronic hepatitis B affects Asian Americans at a much higher rate than the general US population. Appropriate care can limit morbidity and mortality from hepatitis B. However, access to care for many Asian Americans and other immigrant groups is limited by their lack of knowledge about the disease, as well as cultural, linguistic, and financial challenges. This article describes the results of BfreeNYC, a New York City pilot program that, from 2004 to 2008, provided hepatitis B community education and awareness, free screening and vaccinations, and free or low-cost treatment primarily to immigrants from Asia, but also to residents from other racial and ethnic minority groups. The program was the largest citywide screening program in the United States, reaching nearly 9,000 people, and the only one providing comprehensive care to those who were infected. During the program, new hepatitis B cases reported annually from predominantly Asian neighborhoods in the city increased 34 percent. More than two thousand people were vaccinated, and 1,162 of the 1,632 people who tested positive for hepatitis B received care from the program's clinical services. Our analysis found that the program was effective in reaching the target population and providing care. Although follow-up care data will be needed to demonstrate long-term cost-effectiveness, the program may serve as a useful prototype for addressing hepatitis B disparities in communities across the United States.

Medical care of hepatitis B among Asian American populations: perspectives from three provider groups.

BACKGROUND: Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer. OBJECTIVE: Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities. DESIGN: We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach. PARTICIPANTS: We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test. APPROACH: We used grounded theory methods to analyze focus group transcripts. RESULTS: Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers. CONCLUSIONS: More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.

The problem with using computer programmes to assign ethnicity: immigration decreases sensitivity.

OBJECTIVES: It is recognized that ethnic group is important in describing differences in infection and disease, but is often not routinely available to surveillance systems. Computerized programmes, such as NamPehchan, can assign ethnicity according to name; however, sensitivity and positive predictive value (PPV) can vary. The aim of this study was to assess whether the sensitivity and PPV of NamPehchan had changed, after an observation that surnames previously associated with South Asians were increasingly reported as Black. STUDY DESIGN: Cross-sectional. METHODS: NamPehchan was used to classify women as South Asian using name, and compared with the gold standard (midwife-reported ethnicity). Sensitivity and PPV were calculated overall and by year. Frequency of infection by ethnic group was estimated. RESULTS: A total of 627 women positive for hepatitis B surface antigen were identified. The majority were from minority ethnic groups, particularly Asian. The overall sensitivity of NamPehchan was 74.5% and PPV was 68.5%. Almost 50% of Black African women were classified as South Asian by NamPehchan. CONCLUSIONS: Immigration from African countries has reduced the sensitivity of NamPehchan in this group. Care is needed when using NamPehchan for groups which include Africans from Muslim areas, as misclassification is likely to occur.

'Honoring tradition, accepting new ways': development of a hepatitis B control intervention for Vietnamese immigrants.

BACKGROUND: Chronic hepatitis B infection rates among Vietnamese-American adults range from 7 to 14%. Carriers of HBV are over 200 times more likely to develop liver cancer than non-carriers, and Vietnamese males have the highest liver cancer incidence rate of any ethnic group in the USA (41.8 per 100,000). Culturally and linguistically appropriate interventions are necessary to increase hepatitis B knowledge, serologic testing, and vaccination rates among Vietnamese immigrants. METHODS: The authors engaged in qualitative data collection to inform the development of intervention materials including a video, pamphlet, and barrier-specific counseling guidelines. Bilingual research assistants conducted 25 open-ended qualitative interviews and six focus groups focusing on hepatitis B and liver cancer with a convenience sample of Vietnamese-American men and women living in the Seattle area. RESULTS: Qualitative findings include beliefs about liver illness and health influenced by traditional Vietnamese and traditional Chinese medicine theory; beliefs about hepatitis B transmission and causes embedded in personal experiences and socio-historical circumstances; and the value of health and a positive attitude. The video portrays a Vietnamese immigrant family struggling with the new knowledge that their healthy-appearing son is a hepatitis B carrier. Print materials address knowledge resources and misconceptions about hepatitis B revealed in the qualitative data. DISCUSSION: Qualitative research provides valuable insight into unanticipated issues influencing health beliefs and behaviors relevant to specific populations and is essential to the development of effective health education materials, which necessarily draw upon local social and cultural contexts. The methods used in this study to develop culturally informed hepatitis B intervention materials for Vietnamese-Americans translate well for the development of education outreach programs targeting Vietnamese and other immigrants elsewhere.

Prevalence, risk factors and genotype distribution of HCV and HBV infection in the tribal population: a community based study in south India.

Viral hepatitis caused by the hepatitis C virus (HCV) and hepatitis B virus (HBV) represents a major public health problem in India. These viruses share common modes of transmission, such as parenteral routes. We aimed to assess the exposure of a tribal population to these viruses in south India. The present study was carried out on serum samples from 890 individuals (526 males and 324 females) belonging to the Lambada tribe residing in the state of Andhra Pradesh, south India. Anti-HCV antibody and hepatitis B surface antigen (HBsAg) status in the sera were analyzed using commercially available enzyme immunoassays (Abbott Labs, Chicago, IL). HCV-RNA and HBV-DNA in the sera was tested by reverse transcriptase polymerase chain reaction (RT-PCR) and PCR, respectively. The infecting genotype of HCV was determined using type-specific primers corresponding to the NS5 region of the virus. Out of the 890 samples, 18 (2.02%; male 11/526; female 7/364) were positive for HCV-RNA by RT-PCR and, 17 of them were positive for anti-HCV antibody. Genotyping of HCV isolates from the 18 individuals positive for HCV-RNA revealed that 66.67% (12/18) were infected with type 1 of HCV and its variants; while in the remaining (6/18), the infecting genotype was found to be type 3 and its variants. A total of 46 samples (5.16%; males 28/526; female 18/364) were positive for HBsAg; while 11 were positive only for HBV-DNA, 9 were positive for both hepatitis B e antigen (HBeAg) and HBV-DNA. Cultural practices such as tattooing, traditional medicine (e.g. blood-letting), rituals (e.g. scarification), body-piercing etc are the potential sources of spread of infection in this tribe. None of the samples analyzed revealed co-infection with the 2 viruses.