Hepatitis B Testing and Vaccination of Asian Americans in a Community Setting

Janet Zola, MPH

Asian American and Pacific Islander Summit

September 15, 2006

Authors

San Francisco Department of Public Health Communicable Disease Prevention Unit

Janet Zola, MPHAmy Pine, MPHPath Fu, BS

Asian Liver Center at Stanford UniversitySamuel So, MD, FACSJordan Su, MBAEric Sue, BS

Background

SF Population: 780,000– API Population: 254,000 (33%)– Chinese American: 156,000 (20%)

Now have a chronic hepatitis B registry SF one of a handful of CA jurisdictions able

to purchase adult hepatitis vaccine

3 For Life Project Description

Partnership between Asian Liver Center at Stanford University and San Francisco Department of Public Health (SFDPH)

Community Partner: neighborhood YMCA Low-cost hepatitis A and B vaccination, including

hepatitis B testing 1st and 3rd Saturday every month (September 2004 –

September 2005) Target group – Foreign born Chinese American

OptionsCost for

Regular

Cost for Non-SF Residen

t

Cost for SF

Resident

Description of

vaccination series

Hepatitis A vaccination series

+ HBsAg, HBsAb*

$164 $90 $45 2 shots 6 months

apart

Hepatitis B vaccination series

+ HBsAg, HBsAb*

$254 $180 $60 3 shotsAt 0, 1, 6 months

Hepatitis A & B vaccination series

+ HBsAg, HBsAb*

$344 $270 $90 3 shotsAt 0, 1, 6 months

3 for Life Pricing Structure

3 for Life Volunteers

Extensive volunteer effort– ALC recruited and trained

over 120 volunteers (16-66 yrs) via local universities and

high schools Mostly bilingual

– 10-15 volunteers needed on any given Saturday

– ~1,300 total volunteer hours

3 for Life Marketing Tools

Well attended press conference with local dignitaries

Flyers (English/Chinese) Paid PSAs (typically 2 days before event):

– Chinese newspapers – Chinese television– Cantonese/Mandarin Chinese radio stations

Press Conference

Marketing Successes

3 for Life Project Findings

# %

Total Clients Served

1211

Total API Clients 1095 90.4%

Total Shots administered

3004

Completion Rate 88.6%

3 for Life Testing ResultsAPI Only: n= 1095 (1007 tested)

•All tested participants received result letters w/in 2-3 weeks explaining results and offering recommendations

•HBsAg Positive 10.2%

• ~20% women of child bearing age

•HBsAb Positive 40.1%

• ~ immune

•HBsAg/HBsAb Negative 49.7%

• ~ vulnerable to infection

3 For Life Project Demographics

Income Level

Less than $20,000 36.2%

$20,000 - $40,000 31.9%

$40,000 - $60,000 12.2%

Over $60,000 9.5%

Gender

Male 51.2%

Female 48.7%

3 For Life Participant Demographics API Only: n= 1095

Average age 46 yrs (range 18-88)

Ages 18-45 yrs45.6% Foreign Born 84.4%

Health Provider for regular check-up:

Provider Used N %

Western Medical Doctor

584 53.3%

TCM Doctor 66 6.0%

Health Clinic 74 9.9%

Other 55 5.2%

Health Provider seen when ill:

Provider Used N %

Western Medical doctor

631 57.6%

TCM Doctor 167 15.3%

Health Clinic 72 6.7%

Other 55 4.8%

3 for Life Participant Demographics API Only: n= 1095

3 for Life Survey Findings API Only: n= 1095

Currently have health insurance 53.7%

Claimed to have been tested before 20.9%

Don’t know if tested before 19.7%

3 for Life Survey Findings API Only: n= 1095

Did your doctor ever suggest HBV testing?

Yes16.3%

No58% of positives

61.6%

Don’t Know21.2%

Missing7.8%

Did your doctor ever suggest HBV vaccination?

Yes8.3%

No44.6%

Don’t Know16.7%

Missing37.2%

3 for Life Project Costs

Personnel $55,589 Operations: Non-Medical

– Advertising $27,254– Design $ 7,000– Food $ 5,607– Equipment $ 5,925– Postage $ 1,563– Supplies $10,362– Travel $ 8,434– Misc/Other $11,148– Total

$77,629

Operations: Medical– Hep A Vaccine $14,893– Hep B Vaccine $ 8,366– Combo A/B Vax $67,508– Medical Supplies $ 3,759– Testing $28,015– Total $122,541

Total Exp $255,459

Total Revenue $98,325 TOTAL ($157,434)

Results Summary

Over 1200 people tested More than 3000 shots administered 10% tested positive for chronic HBV 40% tested positive for immunity 50% of at risk for infection Vaccination completion rate = 89%!

Lessons Learned

Public/Private partnership very effective Local Media Works

– Culturally and linguistically appropriate Target population responsive People willing to pay for service of value Education on chronic HBV infection is

needed for both target population AND primary care medical providers

Lessons Learned (continued)

Target outreach toward 18-45 year olds Limit vaccinations to hepatitis B Important to test for both HBsAg and HBsAb Build in follow-up for HBsAg positives Create effective education and counseling

opportunities

3 for Life Project Goals

Raise awareness among target population, and health care providers, about:

– Prevalence and risks of HBV and liver cancer in Asian community

– Importance of hepatitis B testing, vaccination and appropriate monitoring of chronically infected

Gain information about barriers regarding hepatitis B testing and vaccination for Asian adults.

Create a model that can be replicated

Successes

Project findings disseminated at 17 venues, 7 of them National Conferences

Three replications of model:– Los Angeles / Honolulu / San Francisco (UCSF)

Outreach and education to local primary care providers focus of current efforts

Developing tools to assist with testing protocols Working with community partners to increase

awareness and understanding

Contact Information

Janet Zola, MPHSan Francisco Dept. of Public Health

Janet.zola@sfdph.org

415-554-2790

Jordan Su, MBAAsian Liver Center at Stanford University

Jordansu@standford.edu

650-736-1883