Chronic Hepatitis B in Chinese Immigrants: Assessing Barriers to Health Care Access

Chronic hepatitis B (HBV) and liver cancer are the largest health disparities for APIs in the U.S. Community screening programs improve awareness of infection; however, it is unknown whether API individuals screened at community events can access follow-up care. Without medical management, up to 25% will die prematurely from HBV-related disease. Preliminary results of a retrospective study of Chinese foreign-born HBV-infected individuals in Philadelphia offer useful information about the gap between diagnosis and entry into care. Among infected individuals, 64% saw a doctor since they were screened (12-48 months previously). Of these, 80% had health insurance, 69% found a doctor who spoke their language, 60% saw their HBV doctor twice a year, and 25% received treatment. Of those who had not seen a doctor, reported barriers included having no health insurance (67%), not realizing that having HBV would cause health problems (77%), not being told to see a doctor (67%), and not finding a doctor who spoke their language (45%). Of all participants, 83% reported needing information about HBV, 71% wanted to be more informed of the negative outcomes of HBV (though 83% were aware that HBV could cause liver cancer and death), and 42% felt they needed more adequate health insurance coverage. These early results indicate that HBV knowledge, health insurance, and language are barriers to care. Community screening programs should provide comprehensive HBV information, and follow-up to those who test positive for HBV, to help them access care. A case-management approach to assisting infected individuals will be discussed.