Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Hepatology International
Published in: Hepatology International 4/2014

Open Access 01-10-2014 | Review Article

Community-based hepatitis B screening: what works?

Authors: Monica C. Robotin, Jacob George

Published in: Hepatology International | Issue 4/2014

Login to get access

Abstract

Introduction

Chronic hepatitis B (CHB) affects over 350 million people worldwide and can lead to life-threatening complications, including liver failure and hepatocellular cancer (HCC). Modern antiviral therapies could stem the rising tide of hepatitis B-related HCC, provided that individuals and populations at risk can be reliably identified through hepatitis B screening and appropriately linked to care. Opportunistic disease screening cannot deliver population-level outcomes, given the large number of undiagnosed people, but they may be achievable through well-organized and targeted community-based screening interventions.

Material and methods

This review summarizes the experience with community-based CHB screening programs published in the English-language literature over the last 30 years.

Results

They include experiences from Taiwan, the USA, The Netherlands, New Zealand, and Australia. Despite great variability in program setting and design, successful programs shared common features, including effective community engagement incorporating the target population’s cultural values and the ability to provide low-cost or free access to care, including antiviral treatment.

Conclusion

While many questions still remain about the best funding mechanisms to ensure program sustainability and what the most effective strategies are to ensure program reach, linkage to care, and access to treatment, the evidence suggests scope for cautious optimism. A number of successful, large-scale initiatives in the USA, Asia–Pacific, and Europe demonstrated the feasibility of community-based interventions in effectively screening large numbers of people with CHB. By providing an effective mechanism for community outreach, scaling up these interventions could deliver population-level outcomes in liver cancer prevention relevant for many countries with a large burden of disease.
Literature
1.
Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol. 2004;38(10 Suppl 3):S158–S168PubMedCrossRef
2.
San Francisco Department of Public Health. Chronic Viral Hepatitis Registry Project. Chronic Hepatitis B Surveillance Report 2007–2008. San Francisco Department of Public Health, 2009:12
3.
World Health Organization (WHO). Immunization Surveillance, Assessment and Monitoring. Geneva: WHO; 2014.
4.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–2128PubMedCrossRef
5.
El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 2012;142(6):1264 e1–1273 e1
6.
Haworth EA, Soni Raleigh V, Balarajan R. Cirrhosis and primary liver cancer amongst first generation migrants in England and Wales. Ethn Health. 1999;4(1–2):93–99PubMedCrossRef
7.
Visser O, van Leeuwen FE. Cancer risk in first generation migrants in North-Holland/Flevoland, The Netherlands, 1995–2004. Eur J Cancer. 2007;43(5):901–908PubMedCrossRef
8.
Supramaniam R, O’Connell DL, Tracey E, Sitas F. Cancer Incidence in New South Wales Migrants 1991–2001. Sydney: The Cancer Council NSW; 2006
9.
McDermott S, Desmeules M, Lewis R, Gold J, Payne J, Lafrance B, et al. Cancer incidence among Canadian immigrants, 1980–1998: results from a national cohort study. J Immigr Minor Health. 2011;13(1):15–26PubMedCrossRef
10.
McBride G. Hepatitis B virus-induced liver cancer in Asian Americans: a preventable disease. J Natl Cancer Inst. 2008;100(8):528–529PubMedCrossRef
11.
Liaw Y-F, Sung JJY, Chow WC, Farrell G, Lee C-Z, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351(15):1521–1531PubMedCrossRef
12.
Chang TT, Gish RG, de Man R, Gadano A, Sollano J, Chao YC, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med. 2006;354(10):1001–1010PubMedCrossRef
13.
Chang TT, Liaw YF, Wu SS, Schiff E, Han KH, Lai CL, et al. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology. 2010;52(3):886–893PubMedCrossRef
14.
Papatheodoridis GV, Lampertico P, Manolakopoulos S, Lok A. Incidence of hepatocellular carcinoma in chronic hepatitis B patients receiving nucleos(t)ide therapy: a systematic review. J Hepatol. 2010;53(2):348–356PubMedCrossRef
15.
Hutton DW, Tan D, So SK, Brandeau ML. Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B. Ann Intern Med. 2007;147(7):460–469PubMedCrossRef
16.
Wong WW, Woo G, Jenny Heathcote E, Krahn M. Cost effectiveness of screening immigrants for hepatitis B. Liver Int. 2011;31(8):1179–1190
17.
Robotin MC, Kansil M, Howard K, George J, Tipper S, Dore GJ, et al. Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening. J Hepatol. 2009;50(5):990–998PubMedCrossRef
18.
Veldhuijzen IK, Toy M, Hahne SJ, De Wit GA, Schalm SW, de Man RA, et al. Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology. 2010;138(2):522–530PubMedCrossRef
19.
IOM (Institute of Medicine). Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington DC: Institute of Medicine; 2010
20.
Cowie B, Kelly H. Outcomes of a complex dynamic mathematical model of hepatitis B virus in Australia. Hepatol Int. 2010;27:59
21.
Hatzakis A, Wait S, Bruix J, Buti M, Carballo M, Cavaleri M, et al. The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference. J Viral Hepat. 2011;18(Suppl 1):1–16PubMedCrossRef
22.
Ganem D, Prince AM. Hepatitis B virus infection—natural history and clinical consequences. N Engl J Med. 2004;350(11):1118–1129PubMedCrossRef
23.
24.
Hu KQ, Pan CQ, Goodwin D. Barriers to screening for hepatitis B virus infection in Asian Americans. Dig Dis Sci. 2011;56(11):3163–3171PubMedCrossRef
25.
Rein DB, Lesesne SB, Leese PJ, Weinbaum CM. Community-based hepatitis B screening programs in the United States in 2008. J Viral Hepat. 2010;17(1):28–33PubMedCrossRef
26.
Whitehead T. Community based interventions, definitions and types. The Cultural Ecology of Health and Change (CEHC). University of Maryland; 2002
27.
Rein DB, Lesesne SB, Smith BD, Weinbaum CM. Models of community-based hepatitis B surface antigen screening programs in the U.S. and their estimated outcomes and costs. Public Health Rep. 2011;126(4):560–567PubMedPubMedCentral
28.
Milne A, Allwood GK, Moyes CD, Pearce NE, Lucas CR. Prevalence of hepatitis B infections in a multiracial New Zealand community. N Z Med J. 1985;98(782):529–532PubMed
29.
Chen CH, Yang PM, Huang GT, Lee HS, Sung JL, Sheu JC. Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants. J Formos Med Assoc. 2007;106(2):148–155PubMedCrossRef
30.
Lee H, Hontz I, Warner A, Park SJ. Hepatitis B infection among Asian American Pacific Islanders in the Rocky Mountain area. Appl Nurs Res. 2005;18(1):2–6PubMedCrossRef
31.
32.
Chao S, So S. The Jade Ribbon Campaign: a systematic, evidence-based public awareness campaign to improve Asian and Pacific Islander health. J Commun Healthc. 2011;4(1):46–55CrossRef
33.
Xu JJ, Tien C, Chang M, Rhee J, Tien A, Bae HS, et al. Demographic and serological characteristics of Asian Americans with hepatitis B infection diagnosed at community screenings. J Viral Hepat. 2013;20(8):575–581PubMedCrossRef
34.
Pollack H, Wang S, Wyatt L, Peng CH, Wan K, Trinh-Shevrin C, et al. A comprehensive screening and treatment model for reducing disparities in hepatitis B. Health Aff (Millwood) 2011;30(10):1974–1983
35.
Trinh-Shevrin C, Pollack HJ, Tsang T, Park J, Ramos MR, Islam N, et al. The Asian American hepatitis B program: building a coalition to address hepatitis B health disparities. Prog Community Health Partnersh 2011;5(3):261–271
36.
Juon HS, Strong C, Oh TH, Castillo T, Tsai G, Oh LD. Public health model for prevention of liver cancer among Asian Americans. J Community Health 2008;33(4):199–205
37.
Perumalswami PV, Factor SH, Kapelusznik L, Friedman SL, Pan CQ, Chang C, et al. Hepatitis Outreach Network: a practical strategy for hepatitis screening with linkage to care in foreign-born communities. J Hepatol. 2013;58(5):890–897PubMedCrossRef
38.
Chang ET, Sue E, Zola J, So SK. 3 For Life: a model pilot program to prevent hepatitis B virus infection and liver cancer in Asian and Pacific Islander Americans. Am J Health Promot. 2009;23(3):176–181
39.
Ma GX, Gao W, Tan Y, Chae WG, Rhee J. A community-based participatory approach to a hepatitis B intervention for Korean Americans. Prog Community Health Partnersh. 2012;6(1):7–16PubMedCrossRef
40.
Hsu CE, Liu LC, Juon HS, Chiu YW, Bawa J, Tillman U, et al. Reducing liver cancer disparities: a community-based hepatitis-B prevention program for Asian-American communities. J Natl Med Assoc. 2007;99(8):900–907
41.
Lee J, Lok AS, Chen J. Hepatitis B prevalence among Asian Americans in Michigan: an assessment to guide future education and intervention strategies. J Community Health. 2010;35(5):534–542PubMedCrossRef
42.
Hsu L, DeJong W, Hsia R, Chang M, Ryou M, Yeh E. Student leadership in public health advocacy: lessons learned from the Hepatitis B Initiative. Am J Public Health. 2003;93(8):1250–1252PubMedCrossRefPubMedCentral
43.
Hwang JP, Mohseni M, Gor BJ, Wen S, Guerrero H, Vierling JM. Hepatitis B and hepatitis C prevalence and treatment referral among Asian Americans undergoing community-based hepatitis screening. Am J Public Health. 2010;100(Suppl 1):S118–S124PubMedCrossRefPubMedCentral
44.
Woo C, Hill M, de Medina M, Schiff E. Screening for hepatitis B virus and hepatitis C virus at a community fair: a single-center experience. Gastroenterol Hepatol. 2013;9(5):293–299
45.
Marineau M, Tice AD, Taylor-Garcia D, Akinaka KT, Lusk H, Ona F. Culturally sensitive strategies designed to target the silent epidemic of hepatitis B in a Filipino community. Hawaii Med J. 2007;66(6):154–156PubMed
46.
Herman A, Bullen C, Finau S, Ofanoa M. Mobilising Pacific people for health: insights from a hepatitis B screening programme in Auckland, New Zealand. Pac Health Dialog. 2006;13(2):9–15
47.
Robinson T, Bullen C, Humphries W, Hornell J, Moyes C. The New Zealand Hepatitis B Screening Programme: screening coverage and prevalence of chronic hepatitis B infection. N Z Med J. 2005;118(1211):U1345PubMed
48.
Kallman JB, Tran S, Arsalla A, Haddad D, Stepanova M, Fang Y, et al. Vietnamese community screening for hepatitis B virus and hepatitis C virus. J Viral Hepat. 2011;18(1):70–76.PubMedCrossRef
49.
Veldhuijzen IK, Wolter R, Rijckborst V, Mostert M, Voeten HA, Cheung Y, et al. Identification and treatment of chronic hepatitis B in Chinese migrants: results of a project offering on-site testing in Rotterdam, the Netherlands. J Hepatol. 2012;57(6):1171–1176PubMedCrossRef
50.
Richter C, Beest GT, Sancak I, Aydinly R, Bulbul K, Laetemia-Tomata F, et al. Hepatitis B prevalence in the Turkish population of Arnhem: implications for national screening policy? Epidemiol Infect. 2012;140(4):724–730PubMedCrossRef
51.
van der Veen YJ, van Empelen P, de Zwart O, Visser H, Mackenbach JP, Richardus J. Cultural tailoring to promote hepatitis B screening in Turkish Dutch: a randomized control study. Health Promot Int. 2013;52:8950–8961
52.
Zuure FR, Bouman J, Martens M, Vanhommerig JW, Urbanus AT, Davidovich U, et al. Screening for hepatitis B and C in first-generation Egyptian migrants living in the Netherlands. Liver Int. 2013;33(5):727–738PubMedCrossRef
53.
Robotin M, Porwal M, Kansil M, Penman A, George J. Community-based prevention of hepatitis-B-related liver cancer: Australian insights. Bull World Health Organ. 2014;92(5):374–379PubMedCrossRefPubMedCentral
54.
Tipper S, Penman AG. The NSW HBV and liver cancer pilot program: an update on the ‘B Positive’ Project. Cancer Forum. 2009;33(2):129–133
55.
Gish RG, Cooper SL. Hepatitis B in the Greater San Francisco Bay Area: an integrated programme to respond to a diverse local epidemic. J Viral Hepat. 2010;17(1):28–33CrossRef
56.
Sheu LC, Toy BC, Kwahk E, Yu A, Adler J, Lai CJ. A model for interprofessional health disparities education: student-led curriculum on chronic hepatitis B infection. J General Intern Med. 2010;25(2):140–145CrossRef
57.
Lin SY, Chang ET, So SK. Why we should routinely screen Asian American adults for hepatitis B: a cross-sectional study of Asians in California. Hepatology. 2007;46(4):1034–1040
58.
Chronic Hepatitis B Surveillance Report 2007–2008, San Francisco. Chronic viral hepatitis Registry project San Francisco: Communicable Disease Control and Prevention Section, San Francisco 2009
59.
van der Veen YJ, de Zwart O, Mackenbach J, Richardus JH. Cultural tailoring for the promotion of hepatitis B screening in Turkish Dutch: a protocol for a randomized controlled trial. BMC Public Health. 2010;10:674PubMedCrossRefPubMedCentral
60.
Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56(2):422–433
61.
Mostert MC, Richardus JH, de Man RA. Referral of chronic hepatitis B patients from primary to specialist care: making a simple guideline work. J Hepatol. 2004;41(6):1026–1030PubMedCrossRef
62.
Chao SD, Chang ET, Le PV, Prapong W, Kiernan M, So SK. The Jade Ribbon Campaign: a model program for community outreach and education to prevent liver cancer in Asian Americans. J Immigr Minor Health. 2009;11(4):281–290PubMedCrossRef
63.
Chen CJ, Kendall J, Shyu YI. Grabbing the rice straw: health information seeking in Chinese immigrants in the United States. Clin Nurs Res. 2010;19(4):335–353PubMedCrossRef
Metadata
Title
Community-based hepatitis B screening: what works?
Authors
Monica C. Robotin
Jacob George
Publication date
01-10-2014
Publisher
Springer India
Published in
Hepatology International / Issue 4/2014
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI
https://doi.org/10.1007/s12072-014-9562-4

Other articles of this Issue 4/2014

Hepatology International 4/2014 Go to the issue

Original Article

The natural history of HCV-related cirrhosis and its temporal progression across the different clinical stages

Review Article

Diagnostic role of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: a systematic review and meta-analysis

Guidelines

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Original Article

Real-life practice of antiviral therapy and disease patterns of patients with chronic hepatitis B: a single-center retrospective observation study

Erratum

Erratum to: Yttrium-90 radioembolization for hepatocellular carcinoma in hepatitis B: commentary on a 103-patient Asian cohort

Original Article

Extended treatment with pegylated interferon alfa/ribavirin in patients with genotype 2/3 chronic hepatitis C who do not achieve a rapid virological response: final analysis of the randomised N-CORE trial
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits