San Francisco Hep B Free

Issue Background

Asian-American and Pacific Islander (AAPI) adults face persistent disparities in diagnosis, treatment, and prevention of hepatitis B when compared to other ethnic groups. Though AAPI adults account for approximately five percent of the United States’ population, they represent nearly 50 percent of the American adults living with hepatitis B.i The real number of AAPI adults living with hepatitis B is likely to be significantly higher than that, with up to two-thirds of the nearly 9 percent of AAPI adults with hepatitis B unaware that they are infected.ii When left untreated, hepatitis B can lead to serious liver problems including cirrhosis and liver cancer in up to 25 percent of people infected with the disease.iii Because hepatitis B is asymptomatic, it remains a particularly difficult disease for clinicians to appropriately detect and treat since many people who are infected do not seek medical treatment in time to prevent progression and spread of the disease.iv

Accordingly, efforts to minimize the rate of hepatitis B infection have centered on improving screening and awareness among high-risk populations, including AAPI adults. A safe and effective vaccine is available for the disease, and the U.S. Preventive Services Task Force currently includes AAPI adults in its target populations most likely to benefit from vaccination programs.v

About San Francisco Hep B Free

San Francisco Hep B Free (Hep B Free), founded in 2007, is a citywide program partnership between AsianWeek Foundation, the Asian Liver Center at Stanford University, and the San Francisco Department of Public Health. The partnership’s goal is to eliminate hepatitis B in San Francisco, California, through a three-pronged strategy: creating awareness among the public and health care providers about the importance of testing and vaccinating the AAPI community for hepatitis B, working with the primary care medical community to promote routine hepatitis B testing and vaccination among AAPI adults, and ensuring that chronically infected individuals have access to treatment for the disease once infected. Hep B Free is currently the country’s largest, most intensive health care campaign aimed at AAPI adults. 

Overview of Activities

Hep B Free is dedicated to eliminating the virus in the city by educating the city’s providers about prevention and treatment of the disease and increasing the awareness of hepatitis B and its effects among the AAPI community.

To educate providers about the importance of screening for and treating hepatitis B, in 2009, Hep B Free distributed the Hep B Free Clinician Honor Roll, which was a physician pledge to screen at-risk patients. Hep B Free also hosts hepatitis B educational sessions for physicians and providers at local medical centers, provides continuing medical education, targets physicians with mailed materials, and ensures that every hospital in San Francisco discusses hepatitis B during grand rounds at least once a year.vi The campaign also developed a screening algorithm that educates physicians on the proper process, care, and steps to diagnose a patient with hepatitis B.vii

To educate the AAPI community about hepatitis B and destigmatize the issue, Hep B Free launched a three-phase social marketing campaign, based on the successes of other campaigns targeting specific populations. The "B Sure. B Tested. B Free." phase featured San Francisco Mayor Gavin Newson, an advocate for the campaign, and Fiona Ma, an Asian-American supervisor who was willing to talk about her own experience with hepatitis B.  The “B a Hero” campaign emphasized that getting tested or sharing information about hepatitis B is a heroic act. The third phase featured AAPI individuals from the community, and the bold message "Which One Deserves to Die?" Hep B Free also opened free testing sites throughout the city, including at the AAPI Wellness Center, Chinatown Public Health Center, Chinese Hospital, North East Medical Services, and Adult Immunization & Travel Clinic and hosted community events and fairs to raise awareness and screen for hepatitis B.

The campaign recently launched a Business Initiative Honor Roll targeted at businesses in the city that frequently employ and serve the AAPI community. When business owners sign onto the Honor Roll, they commit to educating employees and customers about the disease and its role as a significant health issue in this community.

Results

Hep B Free’s efforts led to a heightened sensitivity and awareness of the disease and its prevalence among members of the AAPI community and physicians across San Francisco. The campaign’s focus on educating local providers contributed to increased awareness of the virus as well as routine screening and vaccination of AAPI patients.  It helped to make screening and vaccination a priority among AAPI patients, assisting in the treatment of the disease and lowering its prevalence among the city’s AAPI population.

The campaign’s most recent data show that since the program’s inception, it reached more than 1,100 health care providers through more than 60 educational events and reached more than 200,000 members of the general public through broader community events.viii This outreach resulted in more than 20,000 AAPI adults screened and vaccinated against hepatitis B.ix Of the 3,315 AAPI clients tested at Hep B Free standalone screening sites, 6.5 percent were found to be chronically infected and referred to followup care.x By 2014, 1,228 physicians and clinicians—more than 90 percent of primary care physicians in San Francisco—signed the Hep B Free Clinician Honor Roll,xi which directly led to the screening of more than 10,000 San Francisco residents for the disease. Hep B Free’s effort to collaborate with businesses through its Business Initiative Honor Roll has also seen success. As of 2016, the campaign had reached out to all businesses in San Francisco’s Chinatown and Japantown, and more than 100 businesses have signed onto the Honor Roll throughout the city.xii

After Hep B Free’s initial successes in increasing awareness, screening, and vaccination, the model was replicated in multiple cities across the United States, including Honolulu, Las Vegas, and New York City.  The model has even been replicated internationally, in Papua New Guinea, North Korea, Australia, Myanmar, and Timor-Leste.

Alignment to the National Quality Strategy (NQS)

Hep B Free promotes person- and family-centered care, prevention and treatment of leading causes of morbidity and mortality, and making quality care more affordable through the levers of certification, accreditation, and regulation; and innovation and diffusion.

Hep B Free promotes:

  • Person- and family-centered care.
  • Prevention and treatment of leading causes of morbidity and mortality.
  • Making quality care more affordable through the levers of certification, accreditation, and regulation; and innovation and diffusion.

Contact

For more information about Hep B Free, contact Acardi Kolchak, the Executive Director of San Francisco Hep B Free at arcadi.kolchak@sfhepbfree.org.


i. https://www.cdc.gov/hepatitis/populations/api.htm.
ii. https://www.cdc.gov/features/aapihepatitisb/.
iii. https://www.cdc.gov/features/aapihepatitisb/.
iv. http://www.hepb.org/what-is-hepatitis-b/what-is-hepb/.
v. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-b-virus-infection-screening-2014.
vi. Domingo, J. R., Yoo, G. J., Henne, J., Shiau, R., & Sanchez, M. A. (2016). HBV Testing and Vaccinations among Asian and Pacific Islander Patients: Understanding the Impact of the San Francisco Hepatitis B Free Campaign on Physician Awareness.
vii. Domingo, J. R., Yoo, G. J., Henne, J., Shiau, R., & Sanchez, M. A. (2016). HBV Testing and Vaccinations among Asian and Pacific Islander Patients: Understanding the Impact of the San Francisco Hepatitis B Free Campaign on Physician Awareness.
viii. Maglalang, D. D., Mortera, S. H., Yoo, G. J., Henne, J., Shiau, R., & Sanchez, M. A. (2015). Changing Attitudes towards Hepatitis B among Asian Americans: From Saving Face to Getting Serious. prevention, 13(3):34-45.
ix. San Francisco Hep B Free: a grassroots community coalition to prevent hepatitis B and liver cancer. (Journal of Community Health, Aug. 2011).
x. San Francisco Hep B Free: a grassroots community coalition to prevent hepatitis B and liver cancer. (Journal of Community Health, Aug. 2011).
xi. San Francisco Hep B Free. (2014). San Francisco Hep B Free: 2014 Year in review. San Francisco, CA: Genevieve Jopanda.
xii. https://www.sfhepbfree.org/our-business-partners.

Page last reviewed July 2017
Page originally created July 2017
Internet Citation: San Francisco Hep B Free. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/workingforquality/priorities-in-action/sanfrancisco-hepbfree.html