A Model for Involving the Community in Hepatitis Healthcare Robert Gish, MD Medical Director, Center for Hepatobiliary Disease and Abdominal Transplantation Chief of Hepatology, Professor of Medicine University of California San Diego San Diego, California Ted Fang, BA Director of the Asian Week Foundation Co-Founder and Steering Committee Member of the Hep B Free Campaign San Francisco, California

Hepatitis B Screening in San Francisco Programmatic objective To screen every Asian/Pacific Islander (~240k people) in San Francisco A collaborative program coordinated by San Francisco Department of Public Health California Pacific Medical Center (CPMC) objective To offer free screening for 10,000 people

Chronic HBV Prevalence in the Asian-American Community San Francisco (2001–2006) 65.4% 44.8% Prevalence (%) 8.9% Chronic HBV Positive Chronic HBV Positive Unaware of Status At Risk Lack of Protective Antibodies Lin SY, et al. Hepatology. 2007;46:1034-1040. Slide courtesy of Robert Gish, MD.

California Pacific Medical Center Experience San Francisco (2008–2009) Participants screened (N = 2118) Chronic HBV infection: 3.4% Men: 1.5x more likely to have chronic HBV infection >60 years of age: 3x more likely have chronic HBV infection than younger individuals People reporting previous HBV vaccination Lacked protective antibodies: 32.5% Chronic HBV infection: 1.1% Asian/Pacific Islanders screened Chronic HBV infection: 3.3% Born in endemic regions: 4.6x more likely to have chronic HBV infection than US-born Asian/Pacific Islanders No chronic HBV infection Lacked protective antibodies (at risk for future infection): 51% Tana M, et al. DDW 2009; May 30–June 4, 2009; Chicago, Ill. Abstract W1811.

Primary Liver Cancer Mortality Asian/Pacific Islanders (2000–2004) Rank of Primary Liver Cancer Mortality Among All Cancer Sites in Asians/Pacific Islanders and Subgroups in the Greater San Francisco Bay Area Men Women Asian/Pacific Islander 3rd 6th Chinese 2nd Filipino 5th 7th Japanese Korean 4th Vietnamese Slide courtesy of Robert Gish, MD.

San Francisco Hep B Free Campaign goals To create public and healthcare provider awareness about the importance of testing and vaccinating Asians/Pacific Islanders for hepatitis B To promote routine hepatitis B testing and vaccination within the primary care medical community To ensure access to treatment for chronically infected individuals Strategies Public awareness Provider education Screening/vaccination/follow-up/referral to care

San Francisco Hep B Free Background Why target San Francisco? Home to 250,000 Asians (one third of city population) Estimated 10% are chronic hepatitis B carriers Hepatocellular carcinoma is the leading cause of cancer deaths in Asian men in San Francisco Hepatitis B is one of top 5 causes of premature mortality in San Francisco Bay Area’s Asian population Highly at-risk unvaccinated population susceptible to hepatitis B – First-generation immigrants – People born before 1986 (government mandate to vaccinate newborns against hepatitis B)

San Francisco Hep B Free An innovative collaboration of public/private partners Unmatched across the country Galvanized multiple constituents for sustainability Effective response to major local public health concern Partners encompass entire healthcare sector, universities, legislators, foundations, major corporations, community-based organizations (CBOs), major corporations, and news agencies www.sfhepbfree.org

Key Accomplishments Seven public access low-cost screening and vaccination sites Standardized registration forms adopted by all sites SF Dept Public Health Hep B Chronic Registry follows up on 50% of cases Flowchart developed for diagnosis CME, non-CME, and Community Education presentations SF State University and SF City College establish Hep B Free initiatives on campus Pro bono services from largest Asian ad agency in United States SF Giants prioritize hepatitis B as one of their major causes Evaluation headed up by SF State University faculty Asian/Pacific Islander community galvanized behind this effort State and national recognition (OMH, HSS) as model program Replication begun on smaller scale in Santa Clara, at UC Berkeley Interest in replication from San Mateo County, Philadelphia, New York City, Los Angeles, Arizona

San Francisco Hep B Free Logic Model With permission from Ted Fang, Janet Zola, Meredith Bergin Bailey, Paula Fleisher, Stuart Fong, Christine Sato, Tung Nguyen, Judith Ottoson, Lawrence Green.

Tools to Use in Encouraging Hepatitis B Screening, Diagnosing, and Follow-up Care Sample of Pledge used by SF Hep B Free http://www.sfhepbfree.org/files/education_clinicians/Clinician_HonorRoll_Form.pdf

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Remember B informed B screened B treated if indicated B vaccinated if not immune and not infected B a team!