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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.
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.
Kuehn BM. Connecting Refugees With Follow-up Care for Hepatitis B. JAMA. 2020;324(2):129. doi:10.1001/jama.2020.10632
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