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Abstract Details
Evaluation of a Program to Improve Linkage to and Retention in Care Among Refugees With Hepatitis B Virus Infection - Three U.S. Cities, 2006-2018
MMWR Morb Mortal Wkly Rep. 2020 May 29;69(21):647-650doi: 10.15585/mmwr.mm6921a2.
Janine Young, Colleen Payton, Patricia Walker, Daniel White, Megan Brandeland, Gayathri S Kumar, Emily S Jentes, Ann Settgast, Malini DeSilva
Free PMC article
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Abstract
An estimated 257 million persons worldwide have chronic hepatitis B virus (HBV) infection (1). CDC recommends HBV testing for persons from countries with intermediate to high HBV prevalence (≥2%), including newly arriving refugees (2). Complications of chronic HBV infection include liver cirrhosis and hepatocellular carcinoma, which develop in 15%-25% of untreated adults infected in infancy or childhood (3). HBV-infected patients require regular monitoring for both infection and sequelae. Several studies have evaluated initial linkage to HBV care for both refugee and nonrefugee immigrant populations (4-9), but none contained standardized definitions for either linkage to or long-term retention in care for chronic HBV-infected refugees. To assess chronic HBV care, three urban sites that perform refugee domestic medical examinations and provide primary care collaborated in a quality improvement evaluation. Sites performed chart reviews and prospective outreach to refugees with positive test results for presumed HBV infection during domestic medical examinations. Linkage to care (29%-53%), retention in care (11%-21%), and outreach efforts (22%-71% could not be located) demonstrated poor access to initial and ongoing HBV care. Retrospective outreach was low-yield. Interventions that focus on prospective outreach and addressing issues related to access to care might improve linkage to and retention in care.