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Unmet Needs of Chronic Hepatitis B
Improving Patient and Community Education and chronic liver disease in these populations.
33,34
For instance, in the US,
Promotion of patient and community education is critical because the barriers recommendations for universal vaccination, school-entry laws, and the
to access to care are perhaps greatest at the grass-roots level. The effectiveness Vaccines for Children program of the Centers for Disease Control (CDC)
of community education concerning infection with CHB and the care needed have led to high rates of hepatitis B vaccination, particularly among
has been well demonstrated by a significant enhancement of hepatitis B
awareness and rates of HBV vaccination.
11
In the past few years, there have
Continued local medical education
been growing efforts by many foundations and local health-promotion
organizations in the US to improve public awareness of hepatitis B.
programs can provide unique
opportunities for communication
First, HBV education needs to focus on highly targeted groups and
communities. It is reported that as many as 80–98% of HBV-infected APIAs
between the primary care professions
are non-US-born.
11,31
The groups that tend not to receive screening are those
and specialists familiar with evaluation
whose socioeconomic status is low and/or those who have poor levels of
education, both of which factors have a deleterious effect on levels of
and treatment advances in CHB.
knowledge regarding CHB.
11
The types of approach to education
concerning CHB should be planned according to the culture, beliefs, Asian-American children.
35
Free or low-cost screening and vaccination
attitudes, and special needs in a community, as these factors may play an programs for adults should be implemented for all high-risk populations.
important role in perception of health. Many different methods have been Currently, US guidelines recommend testing and vaccination for other high-risk
used to deliver hepatitis B education, such as websites, printed materials, groups such as hemodialysis patients, healthcare workers, and intravenous
periodicals, video programs, public health fairs, group-based lectures, and drug users. The Advisory Committee on Immunization Practices (ACIP) has
free hepatitis B-screening campaigns.
32
The stigma of CHB crosses all social recommended vaccination for all adults seeking HBV protection without
and educational categories and may be one of the major factors limiting an acknowledgment of a specific risk factor and testing of immigrants from
individual’s choice to be screened. endemic areas.
36
Further changes to the guidelines should include
Asian-American immigrants and those with at least one immigrant parent as a
The content of HBV education should be designed in a culturally sensitive high-risk group eligible for universal testing and vaccination (see Table 1).
37
and linguistically appropriate manner for at-risk communities. As English
could be a common language barrier to education, several popular Other strategies may also improve vaccination rates. In a controlled trial,
languages in APIA communities have been used for printed education both community mobilization and a media campaign increased the rates
materials. As the educational status of many new APIA immigrants may be of vaccination among Vietnamese-American children and was cost-
lower than that of the indigenous population, the contents of the education effective.
38
One study in London, UK, found that in inner-city areas with
programs should be edited to be as simple as possible so that the main high prevalence of hepatitis B carriage, mobility, and diverse ethnicity, a
messages about CHB can be easily understood. In addition to the standard dedicated centralized immunization service was highly effective if
facts about CHB, education should also be aimed at clarifying the common adequate support services (translation and counseling) were available.
39
misperceptions of HBV-related disease that result from differences in
cultural background. Hand in hand with enhanced education programs Future Research
leading to greater screening for CHB infection, there needs to be access to Recently, a hepatitis B clinical research network has been established by the
appropriate treatment (e.g. HBV vaccine or antivirals). If the latter is lacking, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). We
one has to question the ethics of screening in the first place. hope that increased research funding will support not only basic and clinical
research to better delineate the pathogenesis and management of hepatitis B,
Health-promotion Strategies but also the adoption of a health services approach to assess unmet needs and
Screening and vaccinating high-risk adults for hepatitis B is cost-effective, to establish evidence-based steps to integrate resources so that we can
and will greatly reduce the long-term burden of HBV-associated liver cancer improve the outcomes of chronic infection with hepatitis B. ■
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http://www.who.int/mediacentre/factsheets/fs204/en/index.html 16. Strauss E, Arch Med Res, 2007;38(6):711–5. http://www.census.gov/main/www/cen2000.html (accessed
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US GASTROENTEROLOGY & HEPATOLOGY REVIEW 27
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