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News From the Centers for Disease Control and Prevention
July 14, 2020

Connecting Refugees With Follow-up Care for Hepatitis B

JAMA. 2020;324(2):129. doi:10.1001/jama.2020.10632

Improved efforts are needed to connect newly arrived refugees who test positive for hepatitis B virus (HBV) with medical care in the US, according to a CDC report.

Phanie/sciencesource.com

The CDC recommends HBV testing for refugees if they’re from countries where the prevalence was at least 2% or they’re in a high risk group. For those who test positive, the CDC recommends referral to a gastroenterologist or hepatologist. About 15% to 25% of untreated adults who were infected early in life develop liver cirrhosis or hepatocellular carcinoma, the authors wrote. Yet a review of laboratory tests and follow-up care from 2006 to 2018 at 3 refugee screening sites found low referral rates at 2 sites. Among patients who initially were linked with care, not many still received ongoing or optimal care.

At the Denver site, all patients with positive hepatitis B surface antigen test results were referred to a gastrointestinal specialist. Among 204 HBV-positive patients included in the review, less than one-third were successfully linked with care and only 24 were retained in care. In St Paul, Minnesota, the clinic provided follow-up primary and specialty care. Among 137 HBV-positive patients, 21% were retained in care. At a Philadelphia clinic, patients who tested positive were followed up by a primary care clinician or a gastrointestinal or infectious disease specialist. Among 53 refugees who tested positive, 53% were initially linked with care and only 11% were retained. Across the clinics, 79% to 89% of patients with hepatitis B did not receive optimal care.

Factors affecting follow-up care include insufficient HBV counseling, language barriers, transportation problems, and access to health insurance. Future efforts should examine ways to overcome these obstacles, the authors wrote.

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