Eliminating hepatitis B vaccination disparities for West African immigrants

Abstract

Background: Hepatitis B virus (HBV) infection is endemic in West Africa. There has been a significant increase in the Bronx West African (WA) community. To achieve HBV elimination, vaccination of non-immune individuals is important. Unfortunately, vaccine uptake in immigrant populations is at this time very limited.

Methods: An educational program was conducted by medical providers of WA origin in collaboration with local faith-based organizations, after which free HBV screening was offered. Non-immune individuals were initially recommended to contact their medical provider or referred to the Department of Health for vaccination. Beginning in 2021, the program offered vaccination. A questionnaire including reasons for vaccination in the program was offered.

Findings: Among the first500 individuals screened,34.6 % required vaccination. Among those screened before program vaccine availability, 72.2 % initiated the vaccination series,with38.2 % obtainingit at an outside setting and34 % returning when available through the program.Among patients screened after program vaccineavailability, 92.1 % initiated the series.Of those receiving vaccination in the program and completing the questionnaire,70.7 % had access to care but chose vaccination by the program because of the trust instilled by WA personnel.

Interpretation: Our findings demonstrate the effectiveness of integrating vaccination into an HBV screening program for an immigrant population. It emphasizes the importance of timeliness and cultural sensitivity.

Fig. 1.

Assessment of reason for vaccination through Starfish Program Individuals were assigned to “not integrated into the US healthcare system” if they did not have US insurance, PCP, or a chronic medical condition that was managed in the US. Individual who had evidence of integration in the US healthcare system were subdivided into “PCP did not discuss/recommend” or “trust” based on questionnaire response. PCP, Primary Care Physician; HBV, Hepatitis B virus; US, United States; SP, Starfish Program.

Fig. 2.

Sankey diagram of vaccination status for Cohorts A-C- SP, Starfish Program;