Barriers to Treatment of Hepatitis B in an Urban Chinatown Community

GOALS:To evaluate the net effect of a concerted effort to treat hepatitis B virus (HBV) in a Chinese immigrant population, including barriers to initiating and continuing therapy and antiviral efficacy. BACKGROUND:Oral antiviral agents for HBV achieve high rates of viral suppression. However, there is limited information about the impact of attempts to treat HBV in high prevalence immigrant communities. METHODS:Sixty-nine patients were identified in an urban Chinatown Internal Medicine practice who had indications for treatment of HBV. A coordinated effort was made to provide antiviral therapy to these patients. Barriers to starting treatment and reasons for discontinuation were categorized on the basis of a systematic review of medical records. Suppression of HBV DNA to undetectable levels was considered a treatment response. RESULTS:Twenty-six percent (18/69) of patients did not start medication because of failure to follow-up or treatment refusal. Oral antiviral therapy was initiated in 74% (51/69) of cases and 38 of 39 patients who remained on treatment achieved viral suppression. Twelve patients discontinued medication because of social, economic, or other reasons. In total, 55% (38/69) of treatment candidates achieved undetectable HBV DNA levels on therapy. CONCLUSIONS:Although oral antiviral therapy was highly effective in achieving viral suppression in patients who were maintained on treatment, only 55% of treatment candidates reached this endpoint. Barriers to care kept nearly one half of patients from initiating or continuing therapy. A multidisciplinary approach including education and social and financial support is needed to maximize the benefit of available HBV treatment in this urban immigrant population.