Hepatitis B Testing and Vaccination of Asian Americans in a Community Setting
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Transcript of Hepatitis B Testing and Vaccination of Asian Americans in a Community Setting
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
415-554-2790
Jordan Su, MBAAsian Liver Center at Stanford University
650-736-1883