A pilot intervention to increase linkage-to-care among hepatitis B infected Asian and African Immigrants

Background: Nearly 80% of Asian Americans (AA) in Chicago were born in countries with intermediate-high endemic rates of chronic hepatitis B (CHB).  In 2008, we developed the hepatitis education and prevention program (HEPP) to address this disproportionate burden of CHB among these Asian and African immigrant communities.  HEPP uses a community health worker (CHW) model to increase hepatitis B education, screening and immunization but despite these targeted programs, adequate follow up care for infected individuals has been suboptimal.

Objective: The goal of our intervention is to increase linkage to care for CHB individuals through a community health worker to patient navigator (PN) handoff system.

Methods: PNs will be selected and trained by the community-based organizations and placed in local health centers where they will interface with both healthcare providers and bicultural, bilingual CHWs.  A training program will be developed that will provide both the CHWs and PNs with community and hospital context to enhance the patient experience from community-based screening through hospital-based follow up care. Our goal is to perform at least 1000 screenings in the target population and to assess the impact of the PN intervention on adequate follow up care.

Results: Over the past year, we screened 758 community members and found 59 (7.8%) with active hepatitis B infection. While 71% were referred for further care, only 59% made initial visits. These individuals did not participate in the intervention arm, which we will present as this study progresses.

Discussion: To our knowledge, this is the first hepatitis B community-placed hospital-based patient navigation program to be instituted nationally. If successful, this model may be implemented nationally to decrease the unnecessary morbidity and mortality from CHB among high-risk Asian and African populations.