1. The Hepatitis B Initiative--Boston, MA Evelyn Lilly--Executive Director Christie Hershey, Ph.D.--Director

2. Hepatitis B Initiative (HBI) HBI is a student-run organization that aims to mobilize students to help communities prevent hepatitis B and its consequences among at-risk groups, particularly Asian Americans and Pacific Islanders (AAPIs). Founded in 1997 By Leslie Hsu (HSPH) & Michael Tran (HMS) Non-profit student-run organization -Medical, public health, graduate, & undergraduate students -Many Boston-area universities

3. HBI Activities HBI accomplishes its mission by: –(1) developing culturally and linguistically appropriate outreach materials on hepatitis B –(2) collaborating with existing community resources to launch educational campaigns, and –(3) providing free screenings and vaccinations.

4. Hepatitis B Initiative (HBI) Funding (1) Asian Health Initiative--Tufts New England Medical Center (2) Centers for Medicare and Medicaid Services (CMS) (3) Local Mini-grants Donations -Blood Tests: Quest, South Cove/BIDMC, Dorchester House -Vaccines: Massachusetts Immunization Program, Merck, South Cove, Dorchester House

5. Hepatitis B: Epidemiology Centers for Disease Control (CDC)

6. Chronic Hepatitis B (By Ethnicity, Boston) Per 100,000 Population Taken from the Boston Public Health Commission, Communicable Disease Control Division, 2004

7. Chronic Hepatitis B (By Neighborhood, Boston) Per 100,000 Population Taken from the Boston Public Health Commission, Communicable Disease Control Division, 2004 n<5 Highest incidence of chronic hepatitis B: Chinatown & Dorchester, MA

8. HBI Target Population Initially targeted the adolescent population to catch-up Now target the adult population, particularly recent immigrants Main groups: -Chinese -Vietnamese Additional group: -Korean

9. Hepatitis B Clinics South Cove Community Health Center in Chinatown, MA The Sharewood Project in Malden, MA Dorchester House Multi-service Center in Dorchester, MA Work with 3 established clinics/free care sites to provide free screenings and vaccinations Clinic sessions 2-4 times per month at each site

10. Hepatitis B Clinics continued HBI registers and tracks all patients Volunteers provide hepatitis B education & counsel patients on screening results Volunteers speak Mandarin, Cantonese, and Vietnamese, among other languages At the Sharewood clinic, medical students can draw blood and give vaccines Refer infected patients for follow-up care

11. Outreach: (1) Material Development Language brochures English Chinese Vietnamese Korean Japanese

12. Outreach: (1) Material Development Bilingual advertisements

13. Outreach: (2) Venues Presentations –YMCA –E.S.L. classes Vietnamese-American Civic Association Harvards Phillips Brooks House Association Chinatown Committee

14. Outreach: (2) Venues Faith-based –Churches –Temples

15. Outreach: (2) Venues Tabling –Community festivals –Health fairs –Restaurants –Ethnic Asian markets

16. Outreach: (2) Venues Advertisements –Radio –Newspaper –Local TV channels –Organization website www.hepbinitiative.org www.hepbinitiative.org Postering –Near clinic sites

17. Outreach: (3) Evaluation Clinic numbers ScreenedVaccinated Sharewood760187 South Cove597146 *Dorchester47*7 * * * Not complete year

18. Outreach: (3) Evaluation Clinic forms include outreach question

19. Outreach: (3) Evaluation Referral forms from physician outreach packets

20. Outreach: (3) Evaluation Educational surveys at outreach events Dragon Boat Festival: 116 surveys completed (62 in English and 54 in Chinese) Ethnicity Other 16.1% Caucasian 23.2% Chinese 69.6% South Asian 4.3% Hispanic 4.3% Age Groups 26-39 48% 40-49 20% 19-25 10% 50-64 11% 65+ 4% <18 3% unanswered

21. Example of Educational Survey Analysis continued Q8: Though it rarely happens, the hepatitis B vaccine can cause people to get infected with hepatitis B. [Correct answer: False] False 48.4% True 53.5% Unanswered 15.1% Q1: I can tell if people are infected with hepatitis B because they always look sick. [Correct answer: False] Unanswered 9.8% True 15.1% False 92.8%

22. Challenges & Lessons Learned Student turnover/continuity problem Solutions -Advisors (physician, fiscal agent, community member, founder) -Encourage multi-year directors -Archival of information (director handbook with lessons learned, CDs of materials, positional e-mail accounts) -Coordinator (apprentice) system Completion of 3-vaccine series Problem/Solutions -Some patients leave the country before 3 rd shot -At least give patient 2 nd shot -Give patients documentation of first 2 shots -Improve reminder calls/mailings

23. Challenges & Lessons Learned Limited time for effective surveys -Pro: work with community organizations, which target the same population we do and already have their trust -Con: we are only given a limited amount of time as one part of their classes/events Solutions -Attempt pre & post surveys whenever possible -Target the survey to the specific event -Use to educate vs. collect information Captive audiences are key -E.g. ESL class vs. large Chinatown festival -Do not require promotional items to attract people

24. Future Directions & Improvement Better survey design & implementation -more statistically useful Hire an administrative assistant Expand services -new clinic/outreach targeting Vietnamese population Find new, untapped outreach venues Expand target population -Korean, Japanese and Indian outreach

25. Thank you! The Boston Hepatitis B Initiative Board of Directors with our 2006 Jade Forum speakers