The Costs and Logistics of Community HBV Screening Programs
Char i Cohen, DrPH, MPH Director of Publ ic Health , Hepat it is B Foundat ion
U.S. Institute of Medicine National Strategy on the Elimination of Hepatitis B & C
November 30, 2015
Low rates of HBV screening in the U.S.
1.4-2M
200,000-300,000
50,000
400,000-600,000
350,000-500,000
0
500,000
1,000,000
1,500,000
2,000,000
Number of Chronic HBVInfections
Number Aware of theirInfection
Number Potentially Eligiblefor Treatment
Number Entering into Care Number of Annual HBVPrescriptions
Low Estimate High Estimate
Cohen C, Holmberg S, McMahon BJ, Block JM, Brosgart CL, Gish RG, London WT, Block TM. (2011). Is chronic hepatitis B being undertreated in the United States? Journal of Viral Hepatitis, 18, 377-383.
Call to Action: Community Response
In 2012, the Hepatitis B Foundation partnered with AAPCHO to establish Hep B United as the
first national hepatitis B coalition. Currently, there are local member coalitions in 24 cities and 14 states which collectively reach 3.5 million high-
risk APIs.
Annual Hep B United National Summit 2014
Hep B United Know Hep B Campaign
The CDC’s national hepatitis B campaign materials, co-branded with Hep B United.
Community-Based HBV Programming Successes
• Success in educating and screening large proportions of high-risk, underserved, hard to reach groups • Ideal for screening high-risk individuals/communities who do not access care
• Individual coalitions screen between 200-5,000 individuals each year and educate far more
• Effective in linking infected individuals with appropriate follow-up medical care • Can be as effective as clinic-based screening, with targeted, individualized strategies to
enhance patient navigation1
However, there are many challenges and constraints that community programs face.
1. Chandrasekar E, Kaur R, Song A, Kim KE. (2015). A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings. Journal of Multidisciplinary Healthcare, 8(1–9).
Strategies for Overcoming Challenges • Ensure community trust and engagement
• Promote diversity among coalition partners
• Train and engage partners
• Ensure convenience and neutrality of events; cultural and linguistic competency
• Use theory-driven strategies to affect knowledge, attitudes, beliefs, stigma and
lead to behavior change
• Integrate into existing services and programs
• Ensure adequate infrastructure and planning
• Engage community clinics and clinical champions
Unaddressed Challenges
How can we ensure sustainability of community-based HBV screening and linkage to care?
Ongoing Resources Limitations • Funding • Buy-in • Staff • Vaccine • Referral sites for healthcare • Translation
Costs of Community-Based HBV Screening
Program Outcomes, Costs and Cost-Effectiveness Measures1
Personnel, education, promotion of events, translation, participant recruitment, partnerships, event sites, phlebotomy, materials/equipment, and lab fees (with additional costs for linkage to care and vaccination).
Rein, D. B., Lesesne, S. B., Leese, P. J., & Weinbaum, C. M. (2010). Community-based hepatitis B screening programs in the United States in 2008. J Viral Hepat, 17(1), 28-33.
The Role of Community-Based Programming in the Elimination of HBV Infection in the U.S. • Community-based HBV programming will play a critical role in eliminating chronic HBV infection
in the U.S., including promoting prevention, and reducing morbidity, mortality and health disparities
• These programs can be highly effective and sustainable, if they are appropriately resourced • Implementation of best practices and coordination of efforts can foster efficacy and cost-efficiency
• Community programs will need continued capacity building/training/technical assistance, and increased funding for program success
• Community programs cannot be burdened with the entirety of the issue. HBV screening needs to take place within medical homes, clinics, & other primary care settings.
• Community coalitions also serve as strong advocates for increased prioritization of HBV at the local and national levels.
Thank You
Hepatitis B Foundation Public Health Research Department
Chari Cohen, DrPH, MPH * Kate Moraras, MPH
Pavitri Dwivedi, MPH * Gang Chen, MD, PhD
Public Health Advisors: Alison Evans, ScD and W. Thomas London, MD
Executive Director: Joan Block, RN, BSN
For more information, please contact Chari Cohen at Chari.cohen @hepb.org or call (215) 489-4930