Barriers and Strategies for Enhanced Community-Based Programming for Chronic Hepatitis B Infection: Lessons Learned from Philadelphia, Pa

Chronic hepatitis B virus (HBV) is a serious liver infection affecting 350 million people worldwide and 2 million Americans. Unmanaged, HBV can lead to premature death due to cirrhosis, liver failure and liver cancer in 25% of infected individuals. In the US, Asians, Pacific Islanders, and Africans are disproportionately burdened by HBV. In Philadelphia’s diverse high-risk communities, HBV prevalence is between 4% and 23%. Most infected individuals in Philadelphia have little or no access to HBV services. Hep B United Philadelphia, a community coalition dedicated to improving health outcomes by increasing HBV awareness, vaccination, screening and linkage to care, was created to address this gap. Over 75 organizational partners worked to develop a free, culturally and linguistically appropriate, community-informed program which included a multi-platform awareness campaign; in-person health education; HBV screening; HBV vaccination via a mobile clinic; and patient navigation for infected individuals. After 24 months, the program was evaluated to identify processes, barriers, and successful implementation strategies. Interviews were conducted among program leadership, and a focus group was conducted among community coalition partners. Data were recorded, transcribed and analyzed via nVivo 10, under the tenets of grounded theory analysis. Emergent themes were related to coalition structure, community stakeholder participation, program sustainability, and resource limitations. Barriers included maintaining community engagement, managing multi-lingual events and conducting successful patient navigation. Strategies to overcome barriers included enhanced coordination and integration of services. Study results can be used by others interested in conducting enhanced community programming for HBV in high-risk underserved communities.