SF Hep B Free: Preventing Liver Cancer through Sustainable Testing and Vaccination

Background: San Francisco has the highest rate of liver cancer in the country. Hepatitis is responsible for 80% of all liver cancer cases. As many as 1 in 10 Asian Americans have chronic hepatitis B (CHB), compared to 1 in 1000 in the general population. Without treatment or monitoring, 1 in 4 infected persons will die from liver cancer. There are no symptoms. A simple blood test can detect chronic infection; a safe and effective vaccine can prevent infection.

Setting: City of San Francisco

Population: Adults born in countries with endemic rates of CHB infection

Project Description: The goal of SF Hep B Free is to make hepatitis B screening & vaccination standard of care in all primary care practices. The largest API-targeted campaign in the country, it utilizes decentralized collaboration between government, the healthcare sector, nonprofit organizations and for profit businesses. High-profile partnerships, in-kind donations and non-stop media buzz give the grassroots movement visibility. Direct outreach to all primary care providers through multiple venues creates a sustainable infrastructure for screening & vaccination. Besides the normal routes of Grand Rounds, CME’s, and staff in-services, a new approach has been launched via a Clinician Honor Roll seeking a pledge to adhere to the CDC hepatitis guidelines of 2008. Multiple approaches are used to motivate people to go to their own clinician and ask about testing and vaccination.

Results/Lessons Learned:Limited resources can be greatly leveraged when diverse sectors collaborate effectively toward a common goal. Continued public awareness efforts break down barriers to discussing health issues within the Asian community. Physicians take notice when patients continue to bring up a particular health issue, such as their hepatitis B status. Several local healthcare institutions have initiated internal audits to determine the adequacy of their own screening, vaccination, and follow-up protocols.