Jessica P. Hwang, MD, MPH M.D. Anderson Cancer Center Department of General Internal Medicine September 15, 2006

1. Hepatitis B & C Screening in Houston A Collaboration between Academia and the API Community Jessica P. Hwang, MD, MPH M.D. Anderson Cancer Center Department of General Internal Medicine September 15, 2006

2. APIs in Texas • 2nd largest state of the USA • Population: 20,851,820 • Asian: 644,193 (3.1% of Texas) • Vietnamese: 143,352 (22.3% of Asian) • Indian: 142,689 (22.2% of Asian) • Chinese: 120,776 (18.8% of Asian) • Filipino: 75,226 (11.7% of Asian) • Korean: 54,300 (8.4% of Asian) • Cambodian: 8,225 (1.3% of Asian) U.S. Census Bureau, Census 2000 Summary File 1

3. APIs in Houston • Largest city in Texas • Fourth largest in the United States • Eighth largest API community • Population in Harris County and Fort Bend County: 3,755,030 • Asian in Harris County and Fort Bend County: 235,615 (6.3% of Houston) • Vietnamese: 63,785 (27.1% of Asian) • Indian: 53,751 (22.8% of Asian) • Chinese: 51,017 (21.7% of Asian) • Filipino: 23,831 (10.1% of Asian) • Korean: 10,881 (4.6% of Asian) • Cambodian: 2,536 (1.1% of Asian) U.S. Census Bureau, Census 2000 Summary File 1

4. Hepatitis B and C Screening Alief Health Fair

5. Alief Health Fair • Provides health screenings and information on health and education • Fourth annual fair, August 2006 • Over 100 agencies offering free services or information • Medically underserved, multilingual, multicultural area • 70% of the school children on the free or reduced lunch program • Attendance this year - 2,200 people

6. Alief Health Fair Sponsors of this program: • Government • U.S. Congressman Al Green • TX Senator Rodney Ellis • TX State RepresentativeHubert Vo • Houston City Council Members: M.J. Khan & Shelley Sekula-Gibbs, M.D. • Faith-based • Notre Dame Church • Wilcrest Baptist Church • Medical • West Houston Medical Center • Community Health Choice • Y-ME National • MD Anderson Cancer Center • Texas Liver Coalition • Hope Clinic

7. Alief Health Fair Hepatitis Screening • Saturday, August 5, 2006 • 9:00 am to 2:00 pm • Recruitment: word of mouth, articles in local newspaper, radio • Sponsors: Texas Liver Coalition HOPE Clinic University of Texas M.D. Anderson Cancer Center

8. Screening Partners: MDACC • NCI-designated comprehensive cancer center • 74,000 patient this year • <2% API patients • 75 API (10%) with hepatocellular carcinoma • 1992-2004 • Overall survival (7.4 months) • Survival with therapy (9.3 months) • Survival without therapy (3.9 months)

9. Screening Partners: MDACC HBV Qualitative Study • To describe the HBV burden in Houston and plan effective strategies to reduce that burden • To conduct focus groups with Houston Chinese, Korean, and Vietnamese communities • To describe HBV knowledge and attitudes

10. Screening Partners: Texas Liver Coalition • Founded in 1995 • Non-profit organization with the mission to educate, support and comfort people with liver disease and their families • Offers phone and Internet help lines • Educational programs and screening • Physician education about liver disease • Support groups throughout Texas

11. Screening Partners: Texas Liver Coalition • Advance Liver Therapies • John Vierling, MD • AASLD President • Funding from St. Luke’s Episcopal Charities • Hepatitis screening in the API community

12. Screening Partners: HOPE Clinic • HOPE Clinic – “Helping Other People through Encouragement” • The Hope clinic is now certified as a FQHC (Federally Qualified Health Center) look-alike • Open 4 days a week • Founded by Asian American Health Coalition • Located in Chinese Community Center • Executive Director • Medical Director • Nurse Manager

13. Collaboration • Texas Liver Coalition • Funding • Labs, phlebotomy • M.D. Anderson Cancer Center • Project coordination • Patient education during health fair • Contact patients (telephone, letters, reminders) • HOPE Clinic • Followup of positive patients

14. Screening Labs • Quest Laboratory • HBsAg, anti-HBs, anti-HBc • HCV • Panel costs $44/person

15. Screening Results • 118 Asian participants (N=205; 57.6%) • 65 Chinese (55.1%) • 39 Vietnamese (33.1%) • 14 Other Asians (11.8%) • HBsAg positive (n=12; 10.2% of total Asians) • HCV positive (n=7; 5.9% of total Asians) • Vietnamese (n=6; 15.4% of total Vietnamese)

16. Screening Results

17. Screening Results (Cont.)

18. Screening Results (Cont.)

19. Screening Results (Cont.)

20. Patients Follow-up • All positives contacted by MDACC • Letters mailed out by MDACC • All positives seen at HOPE clinic • HBsAg+: referral list • Anti-HBc+: one dose vaccine, repeat serologies in 6 weeks • Anti-HCV+: confirmatory test (PCR)

21. Future Directions • City of Houston HBV Surveillance • Options for uninsured patients • Physician education

22. Thank You! • Texas Liver Coalition: Heather Guerrero, John Vierling, Dave Erickson • HOPE Clinic: Karen Tso, Beverly Gor, Catherine Tsai • MDACC: Jing Peng, Peyton Moon, Maria Suarez • University of Houston: Jenny Yi