Transcript Slide 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-toblood 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 1525% 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
Profile 2
Profile 3
Profile 4
Profile 5
HBsAg
Negative
Negative
Positive
Negative
Negative
Anti-HBc
Negative
Negative
Positive
Positive
Positive
Anti-HBs
Negative
Positive
Negative
Positive
Negative
This person
has acute or
chronic HBV
infection.
This person No infection
has been
Has been
exposed to exposed; but
HBV and has interpretation
cleared
unclear
blood of
infection; has
immunity
due to
previous
infection.
Specialist
referral for
further linkage
to care
Watch for
Watch for
reactivation if reactivation
patient
becomes
immune
suppressed
Hepatitis Profiles
Profile 1
Profile 4
Profile 2
Profile 5
Profile 3
9%
29%
Significance No infection No infection
No exposure No
No immunity exposure
Has
immunity
35%
22%
5%
Figure 1. Hepatitis Outcome Based on
Action
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.
Get
vaccinated
No
vaccination
needed;
immune
due to
previous
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
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).
Profile 1
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.
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
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
The project was supported by UCSD Skagg’s
vaccinations within this high-risk community and provide resources to
School of Pharmacy and Pharmaceutical
enable them to obtain the necessary immunizations.
Sciences. We would like to thank the Asian
• REDCap was a helpful program that allowed for user-friendly data
Pacific Health Foundation members and the
entry; however drawbacks include the lengthy process required to
student volunteers for their continued
gain access and the limitations in the program’s ability to manipulate
involvement in making our health fairs
data.
successful.
ACKNOWLEDGEMENTS
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/highrisk_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 AsianAmerican communities. J Natl Med Assoc. 2007;99(8):900–7.