African Immigrants At Increased Risk for Hepatitis B
Ed. note: April is Minority Health Month, bringing a national focus on advancing health equity and ending health disparities. During April we will be sharing several blog posts about responding to viral hepatitis disparities among minority communities.
Up to 1.4 million people in the U.S. are chronically infected with the hepatitis B virus (HBV). One of the populations disproportionately affected by this infectious disease is the African immigrant community, which has infection rates of approximately 10 percent 1,2. In the past, the African immigrant community has not been a focus for national healthcare efforts due to their small numbers. But over the last 20 years this population has more than doubled in size to over 1.6 million. This growth, along with advances in our understanding of HBV and the available tools to address it make this a critical time to raise awareness among providers of healthcare and social services and African immigrant communities about the risk for chronic hepatitis B, its potential consequences, and opportunities for prevention, diagnosis, and treatment.
Chronic hepatitis B is a serious illness that can lead to cirrhosis, liver failure, and liver cancer if it’s not identified early and managed. Without appropriate medical care, up to 25% of people infected with chronic hepatitis B will die from liver-related causes, including liver cancer 3. Chronic HBV infection is a major cause of liver cancer and a common reason for liver transplantation worldwide. Most people are not aware they are infected due to the “silent” nature of the virus with few or no symptoms. People can be infected and have no symptoms for 20 or 30 years. The good news is that there is a simple blood test to screen for HBV, a safe and effective vaccine to prevent the spread of infection, and 7 FDA-approved HBV treatments for those that need them. Early diagnosis and access to care are essential for improved health outcomes. In 2014, the U.S. Preventive Services Task Force (USPSTF) issued updated hepatitis B screening recommendations, indicating that people at high risk, including those born in Africa, should be screened for HBV regardless of symptoms. To assess your risk, take the CDC’s Hepatitis Risk Assessment.
The keys to addressing the high burden of chronic HBV infection among African immigrants are to improve awareness and access to hepatitis B information, screening, vaccination, and follow-up care. The Coalition Against Hepatitis for People of African Origin (CHIPO), a national coalition, seeks to do just that. CHIPO, which means “gift” in the Shona language (common in several sub-Saharan countries), works to promote hepatitis B education and prevention among African immigrants and the healthcare providers and organizations that serve these communities. CHIPO members do this through raising awareness, developing local and national partnerships, and advocating for increased screening and improved linkage to care services. We currently have over 30 coalition partners around the U.S., each dedicated to addressing viral hepatitis in African communities.
Reaching African immigrants for HBV screening, education, or treatment can be challenging. The group is highly diverse with many different ethnicities and languages from countries all over the continent. The most common countries of origin for African immigrants in the U.S. are Nigeria, Ethiopia, Egypt, Ghana and Kenya. In the U.S., African-born residents tend to live in large cities within communities of ethnic origin. Regular and preventive healthcare is atypical often due to lack of health insurance, financial constraints, and traditional beliefs or customs. But it is important to increase the number of African immigrants who get tested for hepatitis B, vaccinate those who need it to prevent new infections, and connect those who test positive to care and treatment to prevent disease progression or transmission. Often, HBV screening and vaccination is available at low or no cost at local health centers. For help finding a health center, visit the Health Resources and Services Administration’s health center locator.
CHIPO is pleased to join with other stakeholders from around the country in the heightened national response to viral hepatitis spurred by the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis. The Action Plan’s calls to educate communities and providers as well as work to reduce viral hepatitis-related health disparities are part of CHIPO’s mission.
For more information follow CHIPO on social media at Facebook.com/CHIPOCoalition or @CHIPO_HBV.
- Adair R, Nwaneri O. (1999). Communicable disease in African immigrants in Minneapolis. Arch Intern Med, 11;159(1):83-5.
- Ugwu C, Varkey P, Bagniewski S, Lesnick T. (2008). Sero-epidemiology of hepatitis B among new refugees to Minnesota. Immigr Minor Health, 10(5):469-74.
- Lok, A. S., & McMahon, B. J. (2001). Chronic hepatitis B. Hepatology, 34(6), 1225-1241. doi: S027091390141617X [pii] 10.1053/jhep.2001.29401