Hepatitis B Prevention for Asian Americans in New York City Charles B. Wang Community Health Center Thomas Tsang, MD, MPH Asian American Pacific Islander National Health Summit, September th 2006

Charles B. Wang Community Health Center Mission To be a leader in providing quality, culturally relevant, and affordable health care and education, and advocate on behalf of the social needs of underserved Asian Americans. History and Description Established in 1971 Federally Qualified Health Center 2 locations in Manhattan, 1 in Flushing Total of ~140,000 patient visits annually 70% of patients insured though federal programs (Medicaid, Medicare, CHP), 28% are uninsured, 2% have private insurance Bilingual and bicultural services Comprehensive Primary and Specialty Care

Asian American Community in New York City 787,047 Asians in New York City –75% of all AAPI in NY State –54% increase since 1990 –78% foreign born –46% (361,531) Chinese 31% of all Chinatown residents lived below the poverty line 60% of Chinatown adults ( 25yrs) do not have a high school diploma 45% have less than 9th grade education 60% of Asian adults in NYC are limited- English proficient Source:US Census Bureau The Asian Population: Website: Asian American Federation of New York. New York City Asian American Census Brief. Website:

DOH Program: Screening Household Contacts (2002 – Current) Collaboration with NYC Dept of Health and Mental Hygiene Program Goal To provide education, screening and vaccination to household members of pregnant women who tested positive for HBsAg –Targeted group of high-risk individuals that is often hard to reach Over last 4 years: –Among pregnant women at CBWCHC HBsAg positive rate consistent at about 16% –Total of 1,823 household contacts screened HBsAg positive rate consistent at about 20%

Funded by the New York City Council Large-scale collaboration of NYC health centers and CBOs Currently in 3 rd program year Program Goal To provide a comprehensive hepatitis B program for uninsured Asian Americans living in NYC –Large-scale no cost/low cost hepatitis B screenings –No cost/low cost hepatitis B vaccinations –Evaluation and treatment for those with CHB Asian American Hepatitis B Program (2004 – 2007)

AAHBP Screening Results (CBWCHC only) Patient Status n (# screened) HBsAg + / HBsAb - (Carriers) HBsAg - / HBsAb - (Need Vaccination) HBsAg - / HBsAb + (Immune) 2004 – (17%)198(32%)322(51%) 2005 – (24%)266(32%)357(44%) 2006 – 2007 (Current) 248(33%)6(25%)10(42%) Total1,474315(21%)470(32%)689(47%)

Partnership with the Association of Asian Pacific Community Health Organizations (AAPCHO) and Bristol Myers Squibb (BMS) Chronic Care Model* applied as conceptual framework to a largely immigrant community that faces social, cultural, linguistically, and financial barriers to quality care Designed to serve as a model for a multifaceted approach to hepatitis B intervention 3 Areas of Focus, 4 Primary Objectives –Comprehensive care management for CHB patients –Outreach and education to a community with limited English proficiency –Increasing awareness of the impact of hepatitis B in the AAPI community through local, regional, and national advocacy efforts (AAPCHO) B Healthy Model Care Program (2006) B Healthy Model Care Program (2006) * Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1:2-4.

B Healthy Model Care Program 5 Primary Objectives B Healthy Model Care Program 5 Primary Objectives Comprehensive care management for CHB patients –Objective #1: To train primary care physicians on new management issues related to hepatitis B infection On-site provider training seminars (case studies) conducted by various leaders in hepatitis B management –Objective #2: To encourage high-quality CHB care at CBWCHC Hepatitis B flow sheets

B Healthy Model Care Program 5 Primary Objectives B Healthy Model Care Program 5 Primary Objectives Comprehensive care management for CHB patients –Objective #3: To develop an enabling service to improve access to hepatitis B treatment and management services for AAPIs with CHB Bilingual case managers Database for clinical tracking (missed vaccines) and enabling services tracking (summarizes progress)

B Healthy Model Care Program 5 Primary Objectives B Healthy Model Care Program 5 Primary Objectives Comprehensive care management for CHB patients –Objective #4: To provide community education and support for hepatitis B carriers and their families Developed culturally and linguistically appropriate educational materials –Brochure focusing on importance of screening, vaccination, and risk of perinatal transmission –Two 10-minute videos: perspective of a patient with CHB, perspective of a family member of a patient with CHB Monthly radio programs were aired on popular Chinese stations

B Healthy Model Care Program 5 Primary Objectives B Healthy Model Care Program 5 Primary Objectives Comprehensive care management for CHB patients –Objective #4 (contd) Support groups –Three sessions (90 minutes each) »#1, patients only (5): Overview of Hepatitis B »#2, patients only (5): Living with Chronic Hepatitis B »#3, patients and family (8): Family Life & Coping with Hepatitis B –Patients encouraged to gain knowledge from speakers, facilitators and other patients –Assist in developing and improving coping skills –Increase confidence and acceptance of their liver disease through the knowledge that they are not alone

Educating & Empowering Patients Importance of education –Many misperceptions about hepatitis B –Many unaware of the seriousness of a chronic infection Importance of empowerment –Self-management greatly affects disease control and outcomes –Empower the patient through information, emotional support and strategies for living with chronic illness

Conclusions Unmet need in large-scale hepatitis B screenings among the Asian community Role for case-management and follow up in screening programs for vaccination and evaluation for treatment Role of case-management and chronic disease model needs to be evaluated Targeted clinical and educational interventions should be created for high risk populations