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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