Hepatitis B Prevention for Asian Americans in New York City

1. Hepatitis B Prevention for Asian Americans in New York City Charles B. Wang Community Health Center Thomas Tsang, MD, MPH Asian American Pacific Islander National Health Summit, September 14-16th 2006

2. Charles B. Wang Community Health Center Mission To be a leader in providing quality, culturally relevant, and affordable health care and education, and advocate on behalf of the social needs of underserved Asian Americans. History and Description • Established in 1971 • Federally Qualified Health Center • 2 locations in Manhattan, 1 in Flushing • Total of ~140,000 patient visits annually • 70% of patients insured though federal programs (Medicaid, Medicare, CHP), 28% are uninsured, 2% have private insurance • Bilingual and bicultural services • Comprehensive Primary and Specialty Care

3. Asian American Communityin New York City • 787,047 Asians in New York City • 75% of all AAPI in NY State • 54% increase since 1990 • 78% foreign born • 46% (361,531) Chinese • 31% of all Chinatown residents lived below the poverty line • 60% of Chinatown adults (≥ 25yrs) do not have a high school diploma • 45% have less than 9th grade education • 60% of Asian adults in NYC are limited-English proficient Source: US Census Bureau 2000. The Asian Population: 2000. Website: http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf Asian American Federation of New York. New York City Asian American Census Brief. Website: http://www.aafny.org/cic/briefs/newyorkbrief.pdf

4. DOH Program: Screening Household Contacts(2002 – Current) • Collaboration with NYC Dept of Health and Mental Hygiene • Program Goal To provide education, screening and vaccination to household members of pregnant women who tested positive for HBsAg • Targeted group of high-risk individuals that is often hard to reach • Over last 4 years: • Among pregnant women at CBWCHCHBsAg positive rate consistent at about 16% • Total of 1,823 household contacts screenedHBsAg positive rate consistent at about 20%

5. Asian American Hepatitis B Program(2004 – 2007) • Funded by the New York City Council • Large-scale collaboration of NYC health centers and CBOs • Currently in 3rd program year • Program Goal To provide a comprehensive hepatitis B program for uninsured Asian Americans living in NYC • Large-scale no cost/low cost hepatitis B screenings • No cost/low cost hepatitis B vaccinations • Evaluation and treatment for those with CHB

6. AAHBP Screening Results(CBWCHC only)

7. “B” Healthy Model Care Program(2006) • Partnership with the Association of Asian Pacific Community Health Organizations (AAPCHO) and Bristol Myers Squibb (BMS) • Chronic Care Model* applied as conceptual framework to a largely immigrant community that faces social, cultural, linguistically, and financial barriers to quality care • Designed to serve as a model for a multifaceted approach to hepatitis B intervention • 3Areas of Focus, 4 Primary Objectives • Comprehensive care management for CHB patients • Outreach and education to a community with limited English proficiency • Increasing awareness of the impact of hepatitis B in the AAPI community through local, regional, and national advocacy efforts (AAPCHO) * Wagner EH. Chronic disease management: What will it take to improve care for chronic illness?Effective Clinical Practice. 1998;1:2-4.

8. “B” Healthy Model Care Program5 Primary Objectives • Comprehensive care management for CHB patients • Objective #1: To train primary care physicians on new management issues related to hepatitis B infection • On-site provider training seminars (case studies) conducted by various leaders in hepatitis B management • Objective #2: To encourage high-quality CHB care at CBWCHC • Hepatitis B flow sheets

9. “B” Healthy Model Care Program5 Primary Objectives • Comprehensive care management for CHB patients • Objective #3: To develop an enabling service to improve access to hepatitis B treatment and management services for AAPIs with CHB • Bilingual case managers • Database for clinical tracking (missed vaccines) and enabling services tracking (summarizes progress)

10. “B” Healthy Model Care Program5 Primary Objectives • Comprehensive care management for CHB patients • Objective #4: To provide community education and support for hepatitis B carriers and their families • Developed culturally and linguistically appropriate educational materials • Brochure focusing on importance of screening, vaccination, and risk of perinatal transmission • Two 10-minute videos: perspective of a patient with CHB, perspective of a family member of a patient with CHB • Monthly radio programs were aired on popular Chinese stations

11. “B” Healthy Model Care Program5 Primary Objectives • Comprehensive care management for CHB patients • Objective #4 (cont’d) • Support groups • Three sessions (90 minutes each) • #1, patients only (5): Overview of Hepatitis B • #2, patients only (5): Living with Chronic Hepatitis B • #3, patients and family (8): Family Life & Coping with Hepatitis B • Patients encouraged to gain knowledge from speakers, facilitators and other patients • Assist in developing and improving coping skills • Increase confidence and acceptance of their liver disease through the knowledge that they are not alone

12. Educating & Empowering Patients • Importance of education • Many misperceptions about hepatitis B • Many unaware of the seriousness of a chronic infection • Importance of empowerment • Self-management greatly affects disease control and outcomes • Empower the patient through information, emotional support and strategies for living with chronic illness

13. Conclusions • Unmet need in large-scale hepatitis B screenings among the Asian community • Role for case-management and follow up in screening programs for vaccination and evaluation for treatment • Role of case-management and chronic disease model needs to be evaluated • Targeted clinical and educational interventions should be created for high risk populations