1. Jessica P. Hwang, MD, MPH M.D. Anderson Cancer Center M.D. Anderson Cancer Center Department of General Internal Medicine September 15, 2006 Hepatitis B & C Screening in Houston A Collaboration between Academia and the API Community

2. 2nd largest state of the USA 2nd largest state of the USA Population: 20,851,820 Population: 20,851,820 Asian: 644,193 (3.1% of Texas) Asian: 644,193 (3.1% of Texas) Vietnamese: 143,352 (22.3% of Asian) Vietnamese: 143,352 (22.3% of Asian) Indian: 142,689 (22.2% of Asian) Indian: 142,689 (22.2% of Asian) Chinese: 120,776 (18.8% of Asian) Chinese: 120,776 (18.8% of Asian) Filipino: 75,226 (11.7% of Asian) Filipino: 75,226 (11.7% of Asian) Korean: 54,300 (8.4% of Asian) Korean: 54,300 (8.4% of Asian) Cambodian: 8,225 (1.3% of Asian) Cambodian: 8,225 (1.3% of Asian) APIs in Texas U.S. Census Bureau, Census 2000 Summary File 1

3. APIs in Houston Largest city in Texas Fourth largest in the United States Eighth largest API community Population in Harris County and Fort Bend County: 3,755,030 Asian in Harris County and Fort Bend County: 235,615 (6.3% of Houston) Vietnamese: 63,785 (27.1% of Asian) Indian: 53,751 (22.8% of Asian) Chinese: 51,017 (21.7% of Asian) Filipino: 23,831 (10.1% of Asian) Korean: 10,881 (4.6% of Asian) Cambodian: 2,536 (1.1% of Asian) U.S. Census Bureau, Census 2000 Summary File 1

4. Hepatitis B and C Screening Alief Health Fair

5.  Provides health screenings and information on health and education  Fourth annual fair, August 2006  Over 100 agencies offering free services or information  Medically underserved, multilingual, multicultural area  70% of the school children on the free or reduced lunch program  Attendance this year - 2,200 people Alief Health Fair

6. Sponsors of this program:   Government U.S. Congressman Al Green TX Senator Rodney Ellis TX State Representative Hubert Vo Houston City Council Members: M.J. Khan & Shelley Sekula-Gibbs, M.D.   Faith-based Notre Dame Church Wilcrest Baptist Church   Medical West Houston Medical Center Community Health Choice Y-ME National MD Anderson Cancer Center Texas Liver Coalition Hope Clinic Alief Health Fair

7. Alief Health Fair Hepatitis Screening  Saturday, August 5, 2006  9:00 am to 2:00 pm  Recruitment: word of mouth, articles in local newspaper, radio  Sponsors: Texas Liver Coalition HOPE Clinic HOPE Clinic University of Texas M.D. Anderson Cancer Center University of Texas M.D. Anderson Cancer Center

8.  NCI-designated comprehensive cancer center  74,000 patient this year  <2% API patients  75 API (10%) with hepatocellular carcinoma  1992-2004  Overall survival (7.4 months)  Survival with therapy (9.3 months)  Survival without therapy (3.9 months) Screening Partners: MDACC

9. HBV Qualitative Study To describe the HBV burden in Houston and plan effective strategies to reduce that burden To describe the HBV burden in Houston and plan effective strategies to reduce that burden To conduct focus groups with Houston Chinese, Korean, and Vietnamese communities To conduct focus groups with Houston Chinese, Korean, and Vietnamese communities To describe HBV knowledge and attitudes To describe HBV knowledge and attitudes Screening Partners: MDACC

10. Screening Partners: Texas Liver Coalition Founded in 1995 Founded in 1995 Non-profit organization with the mission to educate, Non-profit organization with the mission to educate, support and comfort people with liver disease and support and comfort people with liver disease and their families their families  Offers phone and Internet help lines  Educational programs and screening  Physician education about liver disease  Support groups throughout Texas

11. Screening Partners: Texas Liver Coalition  Advance Liver Therapies John Vierling, MD AASLD President  Funding from St. Luke’s Episcopal Charities Hepatitis screening in the API community

12. Screening Partners: HOPE Clinic  HOPE Clinic – “Helping Other People through Encouragement”  The Hope clinic is now certified as a FQHC (Federally Qualified Health Center) look-alike  Open 4 days a week  Founded by Asian American Health Coalition  Located in Chinese Community Center  Executive Director  Medical Director  Nurse Manager

13. Collaboration Texas Liver Coalition Texas Liver Coalition Funding Funding Labs, phlebotomy Labs, phlebotomy M.D. Anderson Cancer Center M.D. Anderson Cancer Center Project coordination Project coordination Patient education during health fair Patient education during health fair Contact patients (telephone, letters, reminders) Contact patients (telephone, letters, reminders) HOPE Clinic HOPE Clinic Followup of positive patients Followup of positive patients

14. Screening Labs Quest Laboratory Quest Laboratory HBsAg, anti-HBs, anti-HBc HBsAg, anti-HBs, anti-HBc HCV HCV Panel costs $44/person Panel costs $44/person

15. 118 Asian participants (N=205; 57.6%) 118 Asian participants (N=205; 57.6%) 65 Chinese (55.1%) 65 Chinese (55.1%) 39 Vietnamese (33.1%) 39 Vietnamese (33.1%) 14 Other Asians (11.8%) 14 Other Asians (11.8%) HBsAg positive (n=12; 10.2% of total Asians) HBsAg positive (n=12; 10.2% of total Asians) HCV positive (n=7; 5.9% of total Asians) HCV positive (n=7; 5.9% of total Asians) Vietnamese (n=6; 15.4% of total Vietnamese) Vietnamese (n=6; 15.4% of total Vietnamese) Screening Results

17. Screening Results (Cont.)

20. Patients Follow-up All positives contacted by MDACC All positives contacted by MDACC Letters mailed out by MDACC Letters mailed out by MDACC All positives seen at HOPE clinic All positives seen at HOPE clinic HBsAg+: referral list HBsAg+: referral list Anti-HBc+: one dose vaccine, repeat serologies in 6 weeks Anti-HBc+: one dose vaccine, repeat serologies in 6 weeks Anti-HCV+: confirmatory test (PCR) Anti-HCV+: confirmatory test (PCR)

21. Future Directions City of Houston HBV Surveillance City of Houston HBV Surveillance Options for uninsured patients Options for uninsured patients Physician education Physician education

22. Thank You! Texas Liver Coalition: Heather Guerrero, John Vierling, Dave Erickson Texas Liver Coalition: Heather Guerrero, John Vierling, Dave Erickson HOPE Clinic: Karen Tso, Beverly Gor, Catherine Tsai HOPE Clinic: Karen Tso, Beverly Gor, Catherine Tsai MDACC: Jing Peng, Peyton Moon, Maria Suarez MDACC: Jing Peng, Peyton Moon, Maria Suarez University of Houston: Jenny Yi University of Houston: Jenny Yi