BACKGROUND

1. Targeting Populations at Risk for Hepatitis B using the REDCap Program XN Phan, BS1, BN Tran, PharmD, MS, MBA2, J Fontanesi, Ph.D.3, RG Gish, MD4 1Skaggs School of Pharmacy, UCSD, La Jolla, CA; 2Asian Pacific Health Foundation, San Diego, CA; 3Center for Management Science in Health, UCSD, San Diego, CA; 4Robert G. Gish Consultants LLC, La Jolla; CA RESULTS BACKGROUND • Hepatitis B is a viral and contagious liver disease that affects over 1.25 million people in the United States. Over fifty times more infectious than the HIV virus, Hepatitis B can be transmitted via blood-to-blood contact, unprotected sex, the sharing of needles or through vertical transmission.1 • Chronic Hepatitis B (CHB) is a silent disease in which people can live with for several decades without experiencing symptoms. Approximately 15-25% of chronic patients develop serious hepatic problems that include cirrhosis and hepatocellular carcinoma.2 • Asian and Pacific Islanders (APIs) are particularly at risk because they account for more than 50% of people in the United States living with chronic Hepatitis B.3 According to the CDC, the incidence of Hepatitis B-related liver cancer is highest among APIs with a death rate that is 7 times greater than among whites. • In 2010, the Institute of Medicine released a report stating the major factors delaying efforts to prevent and control this disease include the lack of awareness among high risk populations as well as insufficient knowledge of the extent of this problem among the general public and policymakers.4 Recent studies have also identified that those of Southeast Asian decent were subject to a higher probability of Hepatitis B infection and first generation Asians were also at higher risk.5 Figure 1. Hepatitis Outcome Based on Profiles The majority of individuals screened (35%) have immunity due to previous exposure to Hepatitis B. There is still a large percentage (29%) who are not protected against HBV and require vaccination. Table 1. Hepatitis B Profiles (Adapted from the Hepatitis B Free San Diego Protocol) The REDCap program was utilized for data entry. The system allowed for the categorization of individuals based on the results of their Hepatitis serology. All patients were mailed their test results with an explanation of the results and the action needed to be taken. Individuals who were HBsAg positive were also contacted via telephone and provided further linkage to care. OBJECTIVES • To expand on current knowledge and analyze how factors such as language, geography, proximity to health care facilities, income, insurance, and access to a health care provider affect the responses to Hepatitis B screening • To increase awareness of Hepatitis B among at risk populations in the San Diego community • Screening Population Demographics • Average age of individuals screened was 54 • 476 individuals had immunity • English was not the primary language for 89% of individuals screened (n=743) • 21% reported every being vaccinated (n=179) • Females (n=510), Males (n=322), Missing (n=2) • The 40 persons (4.8%) who tested HBsAg positive were foreign born METHODS Patient Information and Data Analysis • Through the Hepatitis Free San Diego initiative, health fairs throughout the San Diego community were held targeting the API community. • Prior to being screened, participants completed a registration survey to provide information about their socio-demographics, access to healthcare, personal medical background and family medical background. • Socio-demographics include information about the participant’s country of origin, gender, race, native language, marital status, and annual household income. • Venipuncture tests for HBsAg, anti-HBs, anti-HBc were performed onsite. • Data were collected and managed using the Research Electronic Data Capture (REDCap) tools hosted at UCSD. • REDCap is a secure, web-based application designed to support data capture for research studies. It provides functionality and features that enable researchers to rapidly develop databases or online surveys. • The prevalence of active Hepatitis B infection as well as immunity status was determined among the individuals and further dissected based on immigration, income, language, and access to health insurance. Statistical Analysis • Prevalence of Hepatitis B infection and immunity status for the screening population as well as within each demographic category was estimated using 95% Confidence Interval (CI). Figure 2. Demographics of Individuals Lacking Immunity These individuals were defined as those who tested negative for Anti-HBs (n=358). About 46% do not have health insurance and 38% did not have access to a health care provider. Additionally, 250 of these individuals (70%) had an annual household income less than $25,000. CONCLUSIONS • Although active Hepatitis B infection is declining, there is a large number of people within the Asian and Pacific Islander community who do not have immunity. • Many of these individuals also reported they did not have health insurance or a primary care provider. • The majority of individuals were foreign born and did not speak English as their primary language. • Efforts should be made to increase awareness of the importance of vaccinations within this high-risk community and provide resources to enable them to obtain the necessary immunizations. • REDCap was a helpful program that allowed for user-friendly data entry; however drawbacks include the lengthy process required to gain access and the limitations in the program’s ability to manipulate data. ACKNOWLEDGEMENTS The project was supported by UCSD Skagg’s School of Pharmacy and Pharmaceutical Sciences. We would like to thank the Asian Pacific Health Foundation members and the student volunteers for their continued involvement in making our health fairs successful. REFERENCES 1. D Lee WM. Hepatitis B virus infection. N Engl J Med. 1997;337(24):1733–1745. 2. The Hepatitis B Foundation. Diagnosis and Management: High Risk Groups. 
 http://www.hepb.org/professionals/high-risk_groups.htm. Accessed 2013 March 27. 3. Center for Disease Control and Prevention. Patient Education Resources: Hepatitis B Fact Sheet. 
 http://www.cdc.gov/hepatitis/HBV/PDFs/HepBGeneralFactSheet.pdf. Accessed 2013 March 27. 4. Institute of Medicine Washington, DC: The National Academies Press; 2010. Hepatitis and liver 
 cancer: a national strategy for prevention and control of hepatitis B and C. http://www.iom.edu/Reports/2010/ Hepatitis-and-Liver-Cancer-A-National-Strategy-for-Prevention- and-Control-of-Hepatitis-B-and-C.aspx. Accessed 2013 March 27. 5. Hsu CE, Liu LC, Juon H, et al. Reducing liver cancer disparities: A community-based hepatitis B prevention program for Asian- American communities. J Natl Med Assoc. 2007;99(8):900–7.