The Hepatitis B Initiative--Boston, MA

Evelyn Lilly--Executive Director

Christie Hershey, Ph.D.--Director

Hepatitis B Initiative (HBI)

• HBI is a student-run organization that aims to mobilize students to help communities prevent hepatitis B and its consequences among at-risk groups, particularly Asian Americans and Pacific Islanders (AAPIs).

• Founded in 1997 By Leslie Hsu (HSPH) & Michael Tran (HMS)

• Non-profit student-run organization-Medical, public health, graduate, & undergraduate students-Many Boston-area universities

HBI Activities• HBI accomplishes its mission by:

– (1) developing culturally and linguistically appropriate outreach materials on hepatitis B

– (2) collaborating with existing community resources to launch educational campaigns, and

– (3) providing free screenings and vaccinations.

Hepatitis B Initiative (HBI)

• Funding(1) Asian Health Initiative--Tufts New England Medical

Center(2) Centers for Medicare and Medicaid Services (CMS)(3) Local Mini-grants

• Donations-Blood Tests: Quest, South Cove/BIDMC, Dorchester House

-Vaccines: Massachusetts Immunization Program, Merck, South Cove, Dorchester House

Hepatitis B: Epidemiology

Centers for Disease Control (CDC)

Chronic Hepatitis B(By Ethnicity, Boston)

Per

100

,000

Po

pu

lati

on

Taken from the Boston Public Health Commission, Communicable Disease Control Division, 2004

4825

65

575

0

100

200

300

400

500

600

700

Asian Black Latino Caucasian

Chronic Hepatitis B(By Neighborhood, Boston)

Per

100

,000

Po

pu

lati

on

Taken from the Boston Public Health Commission, Communicable Disease Control Division, 2004

50

468

57 5744

72

121

57

95 91

123

27

7778

39 35

0

50

100

150

200

250

300

350

400

450

500

n<5 n<5

Highest incidence of chronic hepatitis B: Chinatown & Dorchester, MA

HBI Target Population

•Initially targeted the adolescent population to “catch-up”

•Now target the adult population, particularly recent immigrantsMain groups: -Chinese -VietnameseAdditional group: -Korean

Hepatitis B Clinics

South Cove Community

Health Center

in Chinatown, MA

The Sharewood

Project in Malden, MA

Dorchester House

Multi-service Center

in Dorchester, MA

•Work with 3 established clinics/free care sites to provide free screenings and vaccinations

•Clinic sessions 2-4 times per month at each site

Hepatitis B Clinics continued

•HBI registers and tracks all patients

•Volunteers provide hepatitis B education & counsel patients on screening results

•Volunteers speak Mandarin, Cantonese, and Vietnamese, among other languages

•At the Sharewood clinic, medical students can draw blood and give vaccines

•Refer infected patients for follow-up care

Outreach:(1) Material Development

• Language brochures

English

Chinese

Vietnamese

Korean

Japanese

Outreach:(1) Material Development

• Bilingual advertisements

Outreach:(2) Venues

• Presentations– YMCA– E.S.L. classes

• Vietnamese-American Civic Association

• Harvard’s Phillips Brooks House Association Chinatown Committee

Outreach:(2) Venues

• Faith-based– Churches – Temples

Outreach:(2) Venues

• Tabling– Community festivals

– Health fairs

– Restaurants

– Ethnic Asian markets

Outreach:(2) Venues

• Advertisements– Radio– Newspaper– Local TV channels– Organization website

www.hepbinitiative.org

• Postering– Near clinic sites

HBI Patients over the Years

0

20

40

60

80

100

120

140

160

180

1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

# P

ati

en

ts

Outreach:(3) Evaluation

• Clinic numbers

Screened Vaccinated

Sharewood 760 187

South Cove 597 146

*Dorchester 47 *7

**

* Not complete year

Outreach:(3) Evaluation

• Clinic forms include outreach question

Outreach:(3) Evaluation

• Referral forms from physician outreach packets

Outreach:(3) Evaluation

• Educational surveys at outreach events

Dragon Boat Festival: 116 surveys completed

(62 in English and 54 in Chinese)

Ethnicity

Other16.1%

Caucasian23.2%

Chinese69.6%

South Asian4.3%

Hispanic4.3%

Age Groups

26-3948%

40-4920%

19-2510%

50-6411%

65+4%

<183%

unanswered

Example of Educational Survey Analysis continued

Q8: Though it rarely happens, the hepatitis B vaccine can cause people to get infected with hepatitis B. [Correct answer: False]

False 48.4%

True 53.5%

Unanswered 15.1%

Q1: I can tell if people are infected with hepatitis B because they always look sick. [Correct answer: False]

Unanswered 9.8% True 15.1%

False 92.8%

Challenges & Lessons Learned

•Student turnover/continuity problem

Solutions-Advisors (physician, fiscal agent, community member, founder)-Encourage multi-year directors-Archival of information (director handbook with lessons learned,

CDs of materials, positional e-mail accounts)-Coordinator (apprentice) system

•Completion of 3-vaccine series

Problem/Solutions-Some patients leave the country before 3rd shot-At least give patient 2nd shot-Give patients documentation of first 2 shots-Improve reminder calls/mailings

Challenges & Lessons Learned

•Limited time for effective surveys-Pro: work with community organizations, which target the same

population we do and already have their trust-Con: we are only given a limited amount of time as one part of

their classes/eventsSolutions-Attempt pre & post surveys whenever possible-Target the survey to the specific event

-Use to educate vs. collect information

•Captive audiences are key-E.g. ESL class vs. large Chinatown festival-Do not require promotional items to attract people

Future Directions & Improvement

•Better survey design & implementation-more statistically useful

•Hire an administrative assistant

•Expand services-new clinic/outreach targeting Vietnamese population

•Find new, untapped outreach venues

•Expand target population-Korean, Japanese and Indian outreach

Thank you!

The Boston Hepatitis B Initiative Board of Directors

with our 2006 Jade Forum speakers