Novel community-based hepatitis b screening program among African immigrants

Background: Approximately 2.2 million people in the United States are chronically infected with hepatitis B virus (CHB), of whom 1.3 million (60%) are foreign-born. Objectives were to estimate the prevalence of CHB among African-born NYC residents, determine the role of known risk factors and identify new ones, and test the effectiveness of a community-based screening and linkage-to-care program using culturally-targeted patient navigators (PN).

Methods: Between October 2011 and January 2013, our team administered a written questionnaire assessing demographics and risk factors and conducted serological hepatitis B testing for 422 African-born NYC residents. Patients with positive diagnoses were informed, counseled and linked to care at Mount Sinai Hospital via a PN.

Results: The overall prevalence of HBsAg was 11.6% (n=422), and 56.6% (n=239) were non-immune. Men were more likely to be positive for HBsAg than women (13.5% vs 5.2%, p=0.026), and were also more likely than women to have had HBV exposure (78.5% vs 56.3%, p=0.000), for which body piercings (p = 0.017) and tattooing (p= 0.032) were the only significant risk factors. All 49 positive patients were informed of their results by a culturally-targeted PN and 36 (73.4%) attended follow-up at Mount Sinai. Of two participants who were recommended for treatment and navigated to a partnering federally qualified health center, one began treatment.

Conclusions: High CHB prevalence among African immigrants underscores a need for further screening in this population. This study also shows a significant opportunity for vaccination in this population, and demonstrates the effectiveness of culturally-targeted PNs in linking at-risk Africans to hepatitis care.