The Hepatitis B Initiative--Boston, MA

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

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

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 • Harvard’s 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 • Postering • Near clinic sites

17. Outreach:(3) Evaluation • Clinic numbers * * * 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 Age Groups <183% Other16.1% 65+4% Caucasian23.2% South Asian4.3% unanswered 19-2510% Hispanic4.3% 50-6411% 40-4920% Chinese69.6% 26-3948%

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] Q1: I can tell if people are infected with hepatitis B because they always look sick. [Correct answer: False] Unanswered 9.8% Unanswered 15.1% True 15.1% True 53.5% False 48.4% 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 3rd shot • -At least give patient 2nd 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