1. An Educational Resource Developed by CHIPO (Coalition Against Hepatitis for People of African Origin) Name Title Date Hepatitis B in People of African Origin

2. Hepatitis B  About the virus  Disease burden  Prevention and management CHIPO activities Today’s Agenda Hepatitis B in People of African Origin

3. HEPATITIS B

4. Why are we talking about hepatitis B? Hepatitis B is very common among African immigrants Most people who are infected are not aware The disease continues to spread, but it can be prevented and treated

5. What is my liver? A large and important organ in your body Lies behind the lower-right part of your ribs

6. What does the liver do? Helps digest food Produces blood clotting factors Stores vitamins and minerals Breaks down toxins Helps fight infections Helps process drugs Regulates the body’s energy Builds muscle

7. Case 1: Meet Olu Olu is 24-year old man who immigrated from Nigeria 4 years ago He has not seen a doctor since arriving in the U.S. He attends a health fair and takes a simple blood test for hepatitis B Two weeks later, he receives a letter in the mail informing him that he tested positive for chronic hepatitis B

8. What is hepatitis? Inflammation of the liver Causes: viruses, obesity, alcohol Some common hepatitis viruses are hepatitis A, B, and C  The only thing they have in common is that they can infect the liver! Hepatitis can lead to scarring of the liver (fibrosis, cirrhosis), liver cancer, and liver failure

9. What is hepatitis B virus (HBV)? Cause of the most common and most serious liver infection in the world Can cause acute (short-lived) or chronic (long-term) infection There is no cure for chronic HBV, but there are treatments! HBV is preventable with a safe and effective vaccine

10. What are acute and chronic HBV? Acute The first 6 months after someone is exposed to HBV Chronic When the HBV remains in the person’s body for over six months

11. Who has chronic HBV? Up to 2.2 million people living in the US have chronic (lifelong) HBV infection. 1,2 In the US, immigrants from countries where a lot of people have HBV account for more than 50% of all people with HBV. People with HBV might not look or feel sick. People who have chronic HBV infection can spread the virus to others, even if they have no symptoms. 1.CDC. Viral hepatitis statistics & surveillance. http://www.cdc.gov/hepatitis/Statistics/index.htm. Accessed October 22, 2014. 2.Kowdley KV et al. Hepatology. 2012;56(2):422-433.

12. Where is HBV found? Worldwide: 2 billion infections (1/3 of all people) In the US: 2 million Americans chronically infected High infection rates in Africa!

13. How do you get HBV? From mother to child  During the labor and delivery process due to blood exchange  Most common route worldwide Sexual transmission Direct blood contact  Sharing needles; piercing; tattooing  Unsterile medical equipment  Household contact— sharing razors, toothbrushes, earrings, or nail clippers with an infected person  Traditional scarification or circumcision Hepatitis B is NOT transmitted by hugging; coughing; sneezing; urine; tears; breast milk; eating food prepared by an infected individual; sharing utensils, cups, or bowls; or casual contact.

14. What are the symptoms? 70% of infected individuals have NO symptoms The other 30% might have:  Fever  Tiredness  Loss of appetite  Abdominal pain  Diarrhea  Dark urine  Light-colored stools  Jaundice (yellow skin and eyes) Not everyone has symptoms. A person can still have liver damage or pass the virus to others even without symptoms.

15. Back to Olu Olu just received his test results in the mail He had no symptoms and was not aware of anyone in his family having hepatitis Not knowing much about hepatitis, he put the results away to research later The health care workers from the fair contact Olu through the local African community center They explain the long-term outcomes of HBV, and the options for care and treatment Olu does not have insurance, but the health workers connect him with a local free clinic for his first appointment

16. What happens with chronic HBV? Up to 700,000 deaths each year across the globe (10th leading cause of death) HBV-related deaths primarily due to:  Cirrhosis (scarring of the liver)  Primary liver cancer  Liver failure Up to 25% of chronically infected individuals can die early from HBV-related liver disease.

17. Do African immigrants have HBV? In some African communities in the US, between 5% and 18% of people have chronic HBV Those of West African origin have the highest infection rates (13.2%) Most do not know that they are infected  This is due to the silent nature of the disease, lack of disease awareness, and limited healthcare access Not knowing your status puts you at a much greater risk for cirrhosis or liver cancer if you are infected!

18. Olu, cont’d Olu has some liver damage, and his doctor recommends that he start treatment. He applies for free HBV medication and begins taking his daily pill a few weeks later. He knows that he will have to keep taking his medication for at least a few years to keep his liver healthy. He is committed to visiting his doctor every few months to check the health of his liver. He also needs to take care of his liver by eating better, resting more, and avoiding alcohol. Olu brings in his family to be tested for HBV, and vaccinated if necessary. Now that Olu knows his status, he can take better care of himself and his family members.

19. Case 2: William William is originally from Ghana; he lives in the US. He saw doctors regularly. No one tested him for HBV. He took a life insurance exam and found he had chronic HBV. He had no symptoms! His wife and children were not infected; they were vaccinated. Now he is followed by a liver doctor and takes much better care of himself. Because he was tested, William’s outlook is very good.

20. Why haven’t I heard about HBV? Because it is difficult to collect health information in many areas of Africa, the entire epidemic is not well understood. Nevertheless, it is estimated that there are more than 50 million people chronically infected in Africa.  12 million will die prematurely from HBV-related liver disease Most infections are acquired in childhood (under 5 years).

21. How can we prevent HBV infection? Get tested for HBV Get vaccinated against HBV  The 3-dose vaccine is safe and effective  It will prevent someone from getting HBV if they are not already infected If you are a carrier, seek testing and vaccines for children and close family members Spread the word about the importance of being tested!

22. Is HBV treatable? Yes. There is no cure, but there are treatments. The treatments, taken as a daily pill, slow down the virus in the blood and can help prevent liver damage— great news! Every infected person needs routine care by a knowledgeable provider.  This includes regular (every 6 to 12 months) checkups to look at liver health and how much virus there is and to screen for liver damage and liver cancer.

23. How can I be tested? Most doctors do not screen their high-risk patients for hepatitis B because they are not aware of the risks. If you or your parents come from Africa, you should ask to be tested. If you don’t have a doctor, visit the website for the Health Resources and Services Administration (HRSA) : http://findahealthcenter.hrsa.gov http://findahealthcenter.hrsa.gov Getting tested is simple! By knowing your status, you can stay healthy and get treatment if you need it!

24. Patient resources Hepatitis B: Are You At Risk? Information for People From Africa  Available for download from the CDC: http://www.cdc.gov/hepatitis/HBV/PDFs/HepBAtRisk-Africa.pdf http://www.cdc.gov/hepatitis/HBV/PDFs/HepBAtRisk-Africa.pdf Hepatitis B and Your Family: Information for People From Africa  Available for download from the CDC: http://www.cdc.gov/hepatitis/HBV/PDFs/HepBandYourFamily- Africa.pdf http://www.cdc.gov/hepatitis/HBV/PDFs/HepBandYourFamily- Africa.pdf Hepatitis B Foundation: www.hepb.orgwww.hepb.org Hep B United: www.hepbunited.orgwww.hepbunited.org

25. CHIPO

26. CHIPO, meaning “gift” in the Shona language, seeks to promote hepatitis B education among African immigrants, healthcare providers, and organizations serving this community through raising awareness, developing local and national partnerships, and advocating for increased screening and improved linkage to care services. We currently have more than 30 coalition partners around the US dedicated to addressing viral hepatitis in African communities. CHIPO, Coalition Against Hepatitis in People of African Origin. CHIPO mission

27. Primary goals of CHIPO Discuss issues and identify solutions to improve the diagnosis and treatment of HBV among African immigrants Engage and further educate healthcare, service, and other providers about the importance of HBV testing, prevention, and timely treatment Create and support a workgroup of people concerned about hepatitis B in African immigrant communities Ensure that the African immigrant population is represented in HBV programs regionally and nationally

28. CHIPO contacts Chari Cohen, Chair Chari.Cohen@hepb.org (215) 489 ‐ 4900 Susannah Amiteye, Vice ‐ Chair Susannah@Amiteye.com (518) 281-8176

29. THANK YOU!