Experience of a New York City
Community Health Center
Su Wang, MD, MPH
Assistant Director of Medical Affairs
Charles B. Wang Community Health Center
New York, NY swang1@cbwchc.org
Trust for America’s Health Congressional Briefing
October 14, 2010

Hepatitis B: Health Disparity in the US
 Asian Americans make up >50% of all Hepatitis B in US
 ~1 out of 10 Asian Americans has HBV
 Other countries of origin
 22% from Latin America
 13% from Africa
 7.5% from Europe
 1 of 4 with CHB may develop cirrhosis or liver cancer
 Potentially preventabl e now, with antiviral medication
 >$1 billion/year spent on HBV hospitalizations in US

Charles B. Wang Community Health Center
(CBWCHC)
• Federally Qualified Health Center established in 1971
• Located in Chinatown, Manhattan
& Flushing, Queens
• 98% served in language other than English
– Mandarin, Cantonese,
Fujianese, Korean, Vietnamese
• Comprehensive Care:
– Internal Medicine and specialties, Pediatrics, Women’s
Health, Mental Health, Dental,
Social Work

CBWCHC Patients, by Insurance Status
36,000 patients for 201,000 visits in 2008

High Prevalence of HBV in Our Community
CBWCHC Community
Screening
Community-based screening
Asian-American Hepatitis
B Program (AAHBP)
Hepatitis B family
(Household contacts of
HBV+ individuals)
Perinatal household contacts
B Free NYC
Partners
NYC DOHMH
Gilead, BMS, NYU
Years
CAMS, CAIPA, Oxford,
GSK, NYC DOHMH
NYC City Council, NYU,
NYC DOHMH, HHC
2000-2003
2004-2008
Robin Hood Foundation,
NYC DOHMH
2006-2008
2008current
2009current
Total
#
Screened
2100
3000
1200
170
700
6670
%
HBV+
11-
16%
24%
20%
25%
13%

Need to Increase HBV Screening
• 1/3 with chronic hepatitis B are unaware (not yet diagnosed)
– Need PCP education to increase screening
– Only 50% of Asian MDs report screening all their Asian patients 1
– Stigma issues persist
• Screening/Diagnosis  Prevention
– HBV is 50x more infectious than HIV
– Recommend condom use, partner and household contact vaccination
– Regular monitoring of disease  prevent progression
D Chu, ASF Lok, TT Tran, and others. Hepatitis B Virus (HBV) Screening Practices of Asian-American Primary Care
Physicians (PCPs) Who Treat Asian Adults Living in the United States. 13th International Symposium on Viral Hepatitis and Liver Disease (ISVHLD). Washington, DC. March 20-24, 2009. Abstract OP-61/330 (Oral).

Increase HBV Vaccination: Safe and Effective
• Part of childhood vaccination series since 1990s
• Many adults are not protected
– Need immunization strategy for adults
– In our community screenings, 30-40% needed vaccination
• Not covered by all insurance companies
• Vaccine gratis through DOH via Section 317 but doesn’t cover administration costs
 HBV can be prevented!

What are we trying to prevent?
• Chronic HBV (CBWCHC registry= 4500 patients)
– Lifelong disease
– Routine medical visits (every 3-12 months), blood tests, potential life-long antiviral medication ($)
– Potential of infecting others, stigma/shame, fear of telling partners and household members
• Cirrhosis/Liver Cancer
– Specialist visit, hospitalization, liver resection, transplant ($$)
– Days lost work, disability, high mortality
– Men more at risk of cancer and less likely to access health care, families lose primary wage-earner

Preventing Perinatal Transmission is Crucial
• 35-50% with HBV were infected by mothers around childbirth
• Birth dose of vaccine + immunoglobulin (HBIG) effective at preventing transmission from mother
– Decreases transmission from 90% to 5-15%
– Many gaps/misses in identification of HBV women and coordinating their care from PCP, OB, Hospital,
Pediatrician and DOH
– 1,000 babies/yr in US still get HBV from their mothers

FQHCs Reach the Communities at Risk
• Can reach the communities at risk
– Geographically located to reach vulnerable groups
– Provide linguistically and culturally effective care
• Offer sliding scale costs for uninsured; affordable services
(blood test, ultrasound, meds)
• Able to screen and provide important linkage to care
–
Follow up with medical personnel and other support services
 medical home
– Infrastructure to vaccinate

Hepatitis B: Frontline Gaps and Needs
• Funding
– Screening/vaccination- invest in prevention
– Support for medical services for HBV patients
• Routine bloodtests and ultrasounds
• Affordable medication- helps w compliance
– Invest in chronic care model of health care delivery
• Case Management, Patient navigators, Improved HIT
• Hep B Care Program- patient education/self tracking
• Education
– Public- increase screening, decrease stigma
– Providerequip PCP’s serving high risk groups to screen and monitor/treat HBV

Hepatitis B is a Winnable Battle....
We have the tools
Now is the time
Our patients thank you
Thanks to
Trust for America’s Health &
American Association for the Study of Liver Diseases for their collaborative report

Hepatitis B Registry Form

Case Management Database

Patient Hep B Care Tracker

HBV Outreach