SCREENING

Hepatitis B

shutterstock_311969051There is a marked disparity between Asian Americans and White Americans in the prevalence of chronic hepatitis B and its complications. For instance, approximately 5-10 % of all Asian Americans have HBV infection compared with 0.1% of White Americans. In the United States, an estimated two million Americans are chronically infected with HBV, with up to 40,000 new infections each year. Nearly 1.4 million out of 2 million chronically infected people are unaware they have the virus. Other studies have also shown that less than 25% of Asian American HBV carriers have been diagnosed, suggesting a large population (undiagnosed) serve as reservoirs for transmission. 

The fact that the majority of the HBV carriers are not aware of their infection clearly demonstrates that there are barriers to screening in the US. The barriers to screening in Asian Americans are multi-factorial. Patient-related obstacles are mostly consisted of lack of awareness about the disease, language and culture barriers, and Insurance issues. Additionally, providers and healthcare system currently available in the US lack the understanding of the significance of chronic hepatitis B. To be specific, there is a lack of public health systems to meet the needs of multicultural populations. There is also a poor communication between providers and patients of different racial, ethnic, or cultural backgrounds. Last but not least, there is a significant lack of cross-cultural training in health professional. As a result, there is a serious lack of adequate health access models available for minority populations. 

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Hepatitis C

shutterstock_326872229Hepatitis C virus (HCV) is a major cause of chronic liver diseases, including cirrhosis and liver cancer. Globally, 130-170 million people(2%–3% of the world’s population) are living with HCV infection, and each year, >350 000 die of cirrhosis and liver cancer. The epidemiology and burden of HCV infection varies throughout the world, with country-specific prevalence ranging from <1% to >10%. 

In the United States, 3.2 million people, with estimates as high as 7 million, have chronic HCV. Despite the availability of accurate screening test and effective interventions for HCV infection, there is a significant lack of screening. A majority of those infected are not aware of the fact that they are HCV carriers.

Both CDC and USPSTF recommend one time screening in all adults in the United States born between 1945 and 1965 (Baby Boomers). Other indications for screening are injection or intranasal drug use, history of blood transfusion before 1992, long-term hemodialysis, being born to HCV-infected mother, and others. Routinizing screening in primary care and other clinical settings are crucial to discover HCV carriers.