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Anyiwe K, Erman A, Hassan M, Feld JJ, Pullenayegum E, Wong WWL, Sander B. Characterising the effectiveness of social determinants of health-focused hepatitis B interventions: a systematic review. THE LANCET. INFECTIOUS DISEASES 2024; 24:e366-e385. [PMID: 38184004 DOI: 10.1016/s1473-3099(23)00590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 01/08/2024]
Abstract
Social determinants of health are important in designing effective interventions for hepatitis B virus (HBV) infection. This systematic review characterises equity-oriented, social determinants of health-focused HBV interventions, and describes their effectiveness in terms of the prevention, care, or treatment of HBV in high-income countries. We searched electronic databases for central concepts of 'HBV', 'equity', 'social determinants of health', 'intervention', and 'Organization for Economic Co-operation and Development (OECD) countries'. Screening and data abstraction were conducted independently by two reviewers. Data were abstracted from 66 studies; articles with a comparative study design (n=36) were included in the narrative synthesis, highlighting social determinants of health domains of interventions, HBV-relevant health outcomes, and extra-health social determinants of health effects (ie, those effects that extend beyond health outcomes). Synthesis aligned with six emergent themes corresponding to HBV prevention and care: knowledge and education, diagnosis and screening, immunisation, care initiation, engagement with clinical care and treatment, and upstream prevention. Studies presented a heterogeneous array of HBV-relevant health outcomes. Most interventions were tailored for social determinants of health domains of race, ethnicity, culture, and language; drug use; and socioeconomic status. Across the themes, at least two-thirds of interventions showed comparative effectiveness for addressing HBV. Extra-health social determinants of health outcomes were observed for two studies. Considerable diversity in population-level approaches was observed regarding intervention goals and effectiveness; most interventions were effective at enhancing the prevention, care, or treatment of HBV.
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Affiliation(s)
- Kikanwa Anyiwe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
| | - Aysegul Erman
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Marian Hassan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada; London School of Hygiene & Tropical Medicine, London, UK
| | - Jordan J Feld
- Sandra Rotman Centre for Global Health, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; ICES, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
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Tang LY, Pene F, Cherfas L, Schwartz J, Baquero MC. Facilitators and barriers to accessing hepatitis B care in the postpartum period among foreign-born New Yorkers: a qualitative analysis of case notes. BMC Public Health 2024; 24:116. [PMID: 38191335 PMCID: PMC10775572 DOI: 10.1186/s12889-023-16971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Approximately 241,000 people are living with hepatitis B in New York City. Among those living with hepatitis B, pregnant people are particularly at risk for elevated viral load due to changes in immune response and require prompt linkage to health care. The New York City Department of Health and Mental Hygiene's Viral Hepatitis Program implemented a telephone-based patient navigation intervention for people living with hepatitis B in the postpartum period to connect them with hepatitis B care. METHODS During the intervention, patient navigators called participants to inquire about their past experience with receiving care, available supports, and barriers to care, and worked with them to develop a plan with participants for linkage to hepatitis B care. The information collected during initial assessments and follow-up interactions were recorded as case notes. In this qualitative study, researchers conducted a thematic analysis of 102 sets of case notes to examine facilitators and barriers to accessing hepatitis B care among the intervention participants, all of whom were foreign-born and interested in receiving hepatitis B patient navigation services. RESULTS The qualitative analysis illustrated the various ways in which patient navigators supported access to hepatitis B care. Findings suggest that receiving care through a preferred provider was a central factor in accessing care, even in the presence of significant barriers such as loss of health insurance and lack of childcare during appointments. Expectations among family members about hepatitis B screening, vaccination and routine clinical follow up were also identified as a facilitator that contributed to participants' own care. CONCLUSIONS This study suggests that while there are numerous barriers at the personal and systemic levels, this patient navigation intervention along with the identified facilitators supported people in accessing hepatitis B care. Other patient navigation initiatives can incorporate the lessons from this analysis to support people in connecting to a preferred provider.
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Affiliation(s)
- Liz Y Tang
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
| | - Farma Pene
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - Lina Cherfas
- A Good Question, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - Jessie Schwartz
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - María C Baquero
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
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Win A, King S, Wu G, Kwon S. Hepatitis B virus screening in Asian immigrants: Community-based campaign to increase screening and linkage to care: A cross-sectional study. Health Sci Rep 2023; 6:e773. [PMID: 36875931 PMCID: PMC9983072 DOI: 10.1002/hsr2.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Aims Despite established screening guidelines, many Asian immigrants remain unscreened. Furthermore, those with chronic hepatitis B (CHB) are not linked to care citing multiple barriers. The objective of this study was to determine the role of our community-based hepatitis B virus (HBV) campaign on HBV screening and the success of linkage to care (LTC) efforts. Methods Asian immigrants from the New Jersey and New York metropolitan areas were screened for HBV from 2009 to 2019. We started to collect LTC data starting in 2015, and those found to be positive were followed up. In 2017, because of low LTC rates, nurse navigators were hired to aid in the LTC process. Those excluded from the LTC process included those who were already linked to care, declined, and/or had moved or passed away. Results Total of 13,566 participants were screened from 2009 to 2019, of which, the results for 13,466 were available. Of these, 372 (2.7%) were found to have positive HBV status. Approximately 49.3% were female and 50.1% were male, and the rest were of unknown gender. A total of 1191 (10.0%) participants were found to be HBV negative but required vaccination. When we started to track LTC, we found 195 participants that were eligible for LTC between 2015 and 2017 after the exclusion criteria were applied. It was found that only 33.8% were successfully linked to care in that time period. After hiring nurse navigators, we saw LTC rates increase to 85.7% in 2018 and to 89.7% in 2019. Conclusion HBV community screening initiatives are imperative to increase screening rates in the Asian immigrant population. We were also able to demonstrate that nurse navigators can successfully help increase LTC rates. Our HBV community screening model can address issues with barriers to care including lack of access in comparable populations.
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Affiliation(s)
- Aziza Win
- Ross University School of Medicine Miramar Florida USA
| | - Scott King
- Department of Computer Science University of British Columbia Vancouver British Columbia Canada
| | - Gregory Wu
- Department of Surgery Holy Name Medical Center Teaneck New Jersey USA
| | - Steve Kwon
- Department of Surgery Holy Name Medical Center Teaneck New Jersey USA.,Department of Surgery Columbia University Medical Center New York City New York USA
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Jang Y, Ahn SH, Lee K, Kwon OY, Kim JH. Development and Pilot Testing of a Smartphone-Based Self-Care Program for Patients with Chronic Hepatitis B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111139. [PMID: 34769658 PMCID: PMC8582966 DOI: 10.3390/ijerph182111139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
The purpose of this study is to develop a smartphone-based self-care program (Hep B Care®) for patients with the chronic hepatitis B virus (HBV). To pilot test the feasibility of Hep B Care®, 63 participants with chronic HBV were recruited from an outpatient clinic at S hospital, Seoul, South Korea (experimental group [EG]: n = 30, control group [CG]: n = 33) between February and July 2016. Hep B Care® was developed based on the theory of self-care whilst having a chronic illness. During the 12-week intervention period, the application: (1) provided information about the disease, medication, nutrition, and exercise; (2) encouraged taking medication and exercise using alarms; and (3) enabled the exchange of messages between healthcare providers and patients. Salivary cortisol, fatigue, depression, anxiety, knowledge of the HBV, quality of life, and medication adherence were all measured as outcomes. Cortisol levels were significantly increased, knowledge of the HBV was improved, and the mean anxiety score was significantly decreased in the EG. Thus, Hep B Care ® partially improved health outcomes in the EG. We recommend that large trials be conducted among patients with the HBV. The smartphone-based self-care program for providing education and coaching is effective for improving knowledge and reducing anxiety among patients with the HBV.
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Affiliation(s)
- Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1, Seodaemun-gu, Seoul 03722, Korea;
| | - Sang Hoon Ahn
- College of Medicine, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University, 50-1, Seodaemun-gu, Seoul 03722, Korea;
| | - Kyunghwa Lee
- College of Nursing, Konyang University, Daejeon 35365, Korea;
| | - Oh Young Kwon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Seodaemun-gu, Seoul 03722, Korea;
| | - Jeong Hyun Kim
- College of Nursing, Ansan University, Ansan 15328, Korea
- Correspondence:
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Hyun CS, Ko O, Lee S, McMenamin J. Long term outcome of a community-based hepatitis B awareness campaign: eight-year follow-up on linkage to care (LTC) in HBV infected individuals. BMC Infect Dis 2019; 19:638. [PMID: 31319805 PMCID: PMC6637477 DOI: 10.1186/s12879-019-4283-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/11/2019] [Indexed: 01/05/2023] Open
Abstract
Background Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality. High HBV prevalence in immigrants and ethnic minorities and numerous barriers to healthcare access are associated with serious health disparities in the United States. Reportedly, self-awareness of HBV infection is low, suggesting a greater need for effective screening and education. Further, low levels of linkage to care (LTC) (completion of a first doctor’s visit after the diagnosis of chronic HBV infection) may be responsible for the lack of engagement over the continuum of care and for needed services. Methods Demographics and survey data were obtained from 97 Korean American adults chronically infected with HBV, initially identified through a series of community screening events in northern New Jersey between Dec. 2009 and June 2015. Eight year follow-up on these HBV-infected individuals was obtained to determine their access to care, and thus the efficacy of a campaign to improve LTC. The participants’ self-awareness of HBV infection and other factors for LTC were also evaluated. Results Of a total of 97 HBV-infected participants (age range 30 to 79), 74 were aware of their infections at screening. The remaining 23 had been unaware of their infections until screening. Eight years after the campaign, some 66 of these 97 individuals accessed care (LTC rate 68%). Health insurance status, presence or absence of symptoms and level of knowledge of CHB were among the most significant factors in LTC. Conclusion A community-based hepatitis B screening and education campaign can be instrumental in prompting HBV infected individuals to access care, as demonstrated in the cumulative increase in LTC in our cohort. Despite many years of awareness of HBV infection, many are not accessing care owing to a lack of health insurance, suggesting a pressing need for advocacy and health education to improve access to affordable coverage in the Asian American population. Community efforts and strategies similar to the ones employed in the current study may serve as a model to improve the engagement of HBV-infected individuals in high risk immigrant populations.
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Affiliation(s)
- Chul S Hyun
- Center for Viral Hepatitis, 35 Van Nostrand Avenue, Englewood, NJ, 07631, USA.
| | - Okhyun Ko
- KCS Public Health and Research Center, 2 W. 32nd St. Suite 604, New York, NY, 10001, USA
| | - Seulgi Lee
- Asian Health Services, Holy Name Medical Center, 718, Teaneck, NJ, 07666, USA
| | - Joseph McMenamin
- McMenamin Law Offices, PPLC, 10617 Falconbridge Drive, Richmond, VA, 23238, USA
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