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A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital

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Abstract

Background

Safety-net hospitals are enriched in ethnic minorities and provide opportunities for high-impact hepatitis B virus (HBV) screening.

Aim

We aim to evaluate the impact of a pilot program integrating HBV screening into outpatient endoscopy among urban safety-net populations.

Methods

From July 2015 to May 2017, consecutive adults undergoing outpatient endoscopy were prospectively assessed for HBV screening eligibility using US Preventative Services Task Force guidelines. Rates of prior HBV screening were assessed, and those eligible but not screened were offered HBV testing. Multivariate logistic regression models evaluated predictors of test acceptance among eligible patients.

Results

Among 1557 patients (47.1% male, 69.4% foreign born), 65.1% were eligible for HBV screening, among which 24.5% received prior screening. In our pilot screening program in the endoscopy unit, 91.4% (n = 855) of eligible patients accepted HBV testing. However, only 55.3% (n = 415) of those that accepted actually completed HBV testing. While there was a trend toward higher rates of test acceptance among African-Americans compared to non-Hispanic whites (OR 3.31, 95% CI 0.96–11.38, p = 0.06), no other sex-specific or race/ethnicity-specific disparities in HBV test acceptance were observed. Among those who completed HBV testing, we identified 10 new patients with chronic HBV (2.4% prevalence). Only 24.5% of eligible patients received prior HBV screening among our cohort.

Conclusions

Our pilot program integrating HBV screening into outpatient endoscopy successfully tested an additional 415 patients, improving overall HBV screening from 24.5 to 75.6%. Integrating HBV testing into non-traditional settings has potential to bridge the gap in HBV screening among safety-net systems.

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Abbreviations

HBsAg:

HBV surface antigen

Anti-HbsAg:

HBV surface antibody

HBcAb:

HBV core antibody total

HBV:

Hepatitis B virus

USPSTF:

United States Preventative Services Task Force

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Acknowledgments

This study was supported by a FOCUS grant from Gilead Sciences. Robert Wong is supported by an AASLD Foundation Clinical and Translational Research Award in Liver Diseases.

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Authors and Affiliations

  1. School of Medicine, George Washington University, Washington, DC, USA

    Brendan Campbell

  2. Department of Medicine, Alameda Health System – Highland Hospital Campus, Oakland, CA, USA

    Aristeo Lopez

  3. Endoscopy Unit, Division of Gastroenterology and Hepatology, Alameda Health System – Highland Hospital Campus, 1411 East 31st Street, Highland Hospital – Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA

    Benny Liu, Taft Bhuket & Robert J. Wong

Authors
  1. Brendan Campbell
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  2. Aristeo Lopez
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  3. Benny Liu
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  4. Taft Bhuket
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  5. Robert J. Wong
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Corresponding author

Correspondence to Robert J. Wong.

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Conflict of interest

Robert Wong has served as a consultant and member of the advisory board and speaker’s bureau for Gilead Sciences. Robert Wong reports receiving research grants from Gilead Sciences. All other authors declare that there is no conflict of interest.

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Campbell, B., Lopez, A., Liu, B. et al. A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital. Dig Dis Sci 63, 242–247 (2018). https://doi.org/10.1007/s10620-017-4870-x

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  • DOI: https://doi.org/10.1007/s10620-017-4870-x

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