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HBV Gaps
Bridging the Gap: Addressing HBV Disparities in Immigrant Communities

Released: November 08, 2024

Expiration: November 07, 2025

Mindie H. Nguyen
Mindie H. Nguyen, MD, MAS, AGAF, FAASLD
Activity Information

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Key Takeaways
  • In the United States, significant gaps exist in hepatitis B virus screening, diagnosis, and treatment, with only about 19% of insured patients with chronic hepatitis B diagnosed and only 60%-70% receiving minimum recommended testing and treatment.
  • Disparities in care are notable among Asian communities and other immigrant groups, highlighting the need for culturally and linguistically tailored approaches to improve diagnosis and treatment rates.

For people with chronic hepatitis B (CHB), it is essential to recognize that approximately 80% of the hepatitis B virus (HBV) infection burden in the United States is found in people who emigrated from other countries. Attention must be directed towards communities from regions where HBV is endemic, including some Asian and African American immigrant communities. Additional regions, including several parts of South America and Eastern Europe, also have endemic HBV. Given the high prevalence of HBV, people who have emigrated from these areas should not be overlooked. 

Screening and Diagnosis
Significant gaps and barriers to HBV care exist at multiple levels. First, the challenges begin with screening and diagnosis. Recent data indicate that among individuals with private insurance in the United States, only about 19% of those with CHB have been diagnosed. Globally, the diagnosis rate among persons with CHB is estimated to be even lower, at around 10%. While the diagnosis rate among the insured US population is somewhat higher, it still falls significantly short of the World Health Organization’s diagnosis goal of 80% for viral elimination.  

Treatment
Among people who do receive a diagnosis, there are further gaps with disease evaluation and treatment rates. Data from the United States and other regions reveal that only about 70% of people with a CHB diagnosis have undergone the minimum recommended testing, including assessments of liver enzyme levels (eg, alanine aminotransferase) and HBV DNA. These data include individuals managed in both tertiary care liver centers and community settings with private insurance coverage. Among people who have received appropriate evaluations and meet treatment criteria for diagnosis of CHB, only about 60%-70% have initiated antiviral treatment.

Disparities Among Key Populations
Recent studies across nearly 30 centers from the United States, Europe, and the Asia-Pacific region show that non-Asian patients with CHB in Western countries and Asian patients from Asia have similar rates of evaluation and treatment initiation. Interestingly, Asian Americans residing in Western countries are about 50% less likely to receive adequate evaluation and treatment compared with Asians in Asia. This suggests potential barriers related to language and cultural approaches among Asian Americans living in Western countries.

Research has also highlighted similar disparities and barriers among African and other immigrant communities in the United States. 

Strategies for Improvement
Addressing these issues requires initial awareness and acknowledgment of these existing gaps and barriers across disease management stages, from diagnosis to treatment. Potential effective strategies should ensure language-sensitive and culturally sensitive care, because the large majority of people with CHB in the United States are immigrants. Evidence demonstrates that these patients face unique challenges compared with both non-Asian populations with CHB in the United States as well as Asian populations with CHB in Asia. 

Learn More
To learn more about overcoming barriers to HBV screening and care, join me and my colleagues Dr. Patricia Jones and patient advocate Jennifer Wild at our upcoming virtual workshop. We’ll discuss practical strategies to expand testing and care for HBV infection for priority populations in diverse settings through simplified pathways for screening and treatment.

Your Thoughts?
In your clinical practice, how frequently do you screen patients for HBV? Join the discussion by posting a comment below.