PREVAC B Management of hepatitis B prevention among migrants AASLD, San Francisco, 2008 AUBERT Jean-Pierre DI PUMPO Alexandrine SANTANA Pascale GERVAIS Anne 3 GERVIH

What is prevention of hepatitis B? 1. People who carry no hepatitis B marker have to be vaccinated 2. everybody should receive information about this disease and its transmission – …BUT … – The messages to deliver differ from one group to another: HBs AG carriers (‘HB carriers’) People with no HBV marker (‘HB free’) People protected against HBV, by vaccination or infection) (‘HB protected’) * Chevalier P et al. Exercer 2008

How can GPs manage HBV prevention? In theory, three main serologic groups of people regarding HBV (HBV free, HBV carriers, HBV protected)…. – but actually up to 54 different serologic profiles can be found within medical files (including many incomplete profiles!) Development of an internet program, – to help doctors manage prevention, – To help doctors decide wich prevention skill has to be used internet-accessible information leaflets for patients, targeting each serologic profile (uploaded by doctor)

Endpoints Primary endpoints 1. Is it possible for GPs to manage full HBV prevention strategies (targeted information and vaccination when required) among migrant people with help of an internet- based program? 2. What are the factors that influence such strategies? Secondary endpoints 1. What are HBV markers prevalences among those populations?

Method 26 GP investigators,related to health networks of northen Paris (high rates of migrants). Data prior to 31/12/2007 are presented 373 migrant patients included: Inclusion criteria People born in subsaharian Africa, or Asia Aged >18 Assessing one of the investigators between 5/11/2007 and 29/2/2008 Exclusion criteria If HIV carrier: Not immuno depressed (CD4 cells count<350/mm3)

Results WITH HELP OF THE INTERNET-ACCESSIBLE PROGRAM – 92% patients received information and/or vaccination (when required) from their GP – 89% patients were given information leaflet, targeting their own serologic status, by their GP – Social precarity is related to failure of vaccination strategy (p=0.02) – High education level is related to success of vaccination strategy (p=0.01) 74% of HBV carriers 100% of vaccinated people 54% of patients with anti HBc alone 82% of HBV contact, non-carrier 74% of people with no HBV marker

Prevalences PREVALENCES: HBV carriers: 11% HBV Contact non-carriers: 36 % Vaccinated :28% No HBV marker : 25% PREDICTIVE FACTORS FOR CONTACT: Africa/ Asia p=0,002 Mali, Ivory Coast, Congo/ other countries in Africa p=0,0002 Age more than 40 p=0,04 Less than 5 years of school p=0,01

Anti HBc Antibody alone: an issue for managing prevention of HBV What’s the problem? Patient has one of the following résults: Case 1: Hbs AG neg, anti HBs AB neg, anti HBc AB pos Case 2: Hbs AG neg, anti HBs AB not available, anti HBc AB pos There is no consensus within guidelines – Vaccinate (one-shot) or not? How did we solve the problem? We decided to give the investigator the choice Case 1 : make an injection or consider the patient is protected Case 2: complete serology or consider the patient is protected What do GPs do? 14% complete serology 32% decide the patient is protected 47% vaccinate 7% missing data

Conclusion : With help of an internet-based program, GP can manage full prevention of hepatitis B transmission (information targeting patient’s serologic status, and vaccination when required) preliminary results Isolated anti HBC AB requires clear guidelines Prevalences of HBV carriage are quite superior to previous available datas