School of Medicine, George Washington University, Washington, DC, USA.
Department of Medicine, Alameda Health System - Highland Hospital Campus, Oakland, CA, USA.
Endoscopy Unit, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
Endoscopy Unit, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA. email@example.com.
Safety-net hospitals are enriched in ethnic minorities and provide opportunities for high-impact hepatitis B virus (HBV) screening.
We aim to evaluate the impact of a pilot program integrating HBV screening into outpatient endoscopy among urban safety-net populations.
From July 2015 to May 2017, consecutive adults undergoing outpatient endoscopy were prospectively assessed for HBV screening eligibility using US Preventative Services Task Force guidelines. Rates of prior HBV screening were assessed, and those eligible but not screened were offered HBV testing. Multivariate logistic regression models evaluated predictors of test acceptance among eligible patients.
Among 1557 patients (47.1% male, 69.4% foreign born), 65.1% were eligible for HBV screening, among which 24.5% received prior screening. In our pilot screening program in the endoscopy unit, 91.4% (n = 855) of eligible patients accepted HBV testing. However, only 55.3% (n = 415) of those that accepted actually completed HBV testing. While there was a trend toward higher rates of test acceptance among African-Americans compared to non-Hispanic whites (OR 3.31, 95% CI 0.96-11.38, p = 0.06), no other sex-specific or race/ethnicity-specific disparities in HBV test acceptance were observed. Among those who completed HBV testing, we identified 10 new patients with chronic HBV (2.4% prevalence). Only 24.5% of eligible patients received prior HBV screening among our cohort.
Our pilot program integrating HBV screening into outpatient endoscopy successfully tested an additional 415 patients, improving overall HBV screening from 24.5 to 75.6%. Integrating HBV testing into non-traditional settings has potential to bridge the gap in HBV screening among safety-net systems.