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 preventable 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
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

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
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).

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