The 2021 Hep B United / TB Elimination Alliance Summit took place on November 2-3, 2021. This year’s theme was Centering Community to Advance Health Equity — inspired by the summit planning committee and the 2020 TB Summit design contest winner, Setie Asfaha of TB Free California. Scroll down to access resources from the summit.

Click Posters to jump to Poster Presentations

Click Exhibitors to jump to Exhibitor Booths

Join us on Thursday, January 20, 2022 at 1pm PT/4pm ET for the rescheduled “A Conversation with CDC Partners” webinar. Register here (https://bit.ly/AConversationwithCDCPartners).

Tuesday, November 2, 2021

Session Speakers Moderator Resources
Opening Dr. Chari Cohen

Jeff Caballero

Juliet K. Choi

Joe Lee Recording
Local Innovations and Hep B and TB Prevention Efforts Becky Nguyen  

Chien-Chi Huang

Jaime Carrillo

Catherine Freeland Recording

Becky Nguyen Slides

Chien-Chi Huang Slides

Jaime Carrillo Slides

Leveraging Data to Strengthen Hepatitis B and Tuberculosis Elimination Strategies Dr. Amit Chitnis 

Dr. Robert Wong

Dr. Fayette Truax Recording

Dr. Amit Chitnis  and Dr. Robert Wong Slides

Barriers to Screening and Testing in the Pacific Islander Community Kenson Alik

Melisa Laelan

Jaime Carrillo Recording

Melisa Laelan Recording

Kenson Alik Slides

Melisa Laelan Slides

Parallel Strategies for Screening, Testing, Treatment and Maintenance

Closing Remarks

Dr. Amy Tang

Dr. Y-Uyen Nguyen

Dr. Su Wang

Jen Lee

Joe Lee

Recording

Dr. Amy Tang Slides

Dr. Y-Uyen Nguyen

Wednesday, November 3, 2021

Session Speakers Moderator Resources
Opening Personal Stories  Joe Lee Recording

Sura’s Story

Mary’s Story

The Lived Experience: Overcoming Challenges to Treatment and Care Alice Chan 

Handaa Enkh Amgalan

Richard Smith 

Tenzin Kunor

Rhea Racho Recording
Impact of COVID-19 on Hep B and TB Services Dr. Eric Chak 

Dr. Janice Louie 

Pervaiz Tufail

Tracy Sun Recording

Dr. Eric Chak Recording

Dr. Janice Louie Recording

Pervaiz Tufail Recording

Dr. Eric Chak Slides 

Pervaiz Tufail Slides

Mobilizing Communities to Improve Hep B and TB Policies Dr. Andrea Caracostis 

Ryan Clary

Turner Bitton Recording

Ryan Clary Slides

Closing Remarks Dr. Ed Zuroweste Joe Lee Recording

Posters

TitleAuthorsAbstractPosterRecording
Resuming and Sustaining Screening Efforts in the Late PandemicMinhChau Pham
Diana Nguyen

Vietnamese American Cancer Foundation
Despite the COVID-19 pandemic, cancer remains the leading cause of death for Asian Americans and Pacific Islanders (AAPI), including the Vietnamese American (VA) community. In this specific AAPI subgroup, lung cancer and liver cancer are the top two cancers by mortality. Hepatitis B (HBV) and tuberculosis (TB) are pertinent infections that affect the VAs at disproportionate rates and put this community at increased risks of these two cancers, respectively. About one in 8 VAs is infected with HBV and as many as two-thirds of HBV infected VAs are unaware of their status. Regarding TB infections in Orange County, CA, case rate among Asians was more than nine times higher than the rate for Hispanics in 2020, with 47.5% of new cases are those who were born in Vietnam. Limited access to preventative services and other social determinants of health are contributing factors to these observed infection rates. COVID-19 pandemic has also proved to be a substantial barrier to care, enlarging the needs to resume and increase efforts to provide community education, screenings, and linkage to care. In response to the community’s needs, especially since COVID-19 vaccine became available to the public, VACF has safely hosted many community vaccination events in partnership with various community sites where HBV and TB outreach and education are conducted in accordance with on-site screenings. Community members are also provided with linguistically and culturally appropriate patient navigation which help improve their knowledge of HBV and TB, as well as ensure timely linkages to care. PosterRecording
Implementation of a Train-the-Trainer Pilot Program: Increasing Hepatitis B Awareness in San Diego during the COVID-19 PandemicKayla Giang
Binh Tran, PharmD
France Nguyen, PhD
David Lam
Winnie Gong
Rolando Arreola
Diana Le
Asian Pacific Health Foundation aims to educate providers and communities on hepatitis B to reduce health disparities, and improve testing and linkage to care to prevent HBV-related liver disease and cancer. In this year’s project, APHF’s approach is the Direct Outreach through Train-the-trainer strategy directed to the Asian community in San Diego. APHF will educate a group of “trainers” quarterly who will then educate and share information with their “trainees.” APHF will also conduct a seminar on Hepatitis B for health professionals. These educational activities aim to increase HBV screening, and develop strategies for reaching specific, hard-to-reach populations in San Diego.PosterRecording
Concept Testing Insights to Inform an Inclusive Latent Tuberculosis (TB) Infection Communications Campaign John Parmer, PhD
Leeanna Allen, MPH
Nick DeLuca, PhD

Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Communications, Education, and Behavioral Studies Branch
CDC’s Division of Tuberculosis Elimination (DTBE) is developing a communications campaign on latent TB infection (LTBI). The campaign seeks to raise awareness about LTBI, increase awareness of treatment for LTBI, and encourage providers to test and treat LTBI among populations at risk. We conducted focus groups with populations at risk for TB, and in-depth interviews with the health care providers who serve them, to test campaign concepts and educational materials. These activities provided insights into what key elements resonate most, and which concept works best to encourage LTBI testing and treatment. Poster
Hepatitis B Birth Dose Vaccine Decision-Making Over Time in a Cohort of Mothers with Multiple Children in the Military Health System, 2014-2017Jessica Fung Deerin, PhD, MPH,
Rebecca Clifton, PhD, Angelo Elmi, PhD,
Paul Lewis, MD, MPH,
Irene Kuo, PhD, MPH

The George Washington University, Milken Institute School of Public Health
Background: There is little known on how parental vaccination decisions change over time or over subsequent children and how this impacts vaccine uptake. This study assesses the impact of mothers’ decision to delay or refuse the hepatitis B (HepB) birth dose for firstborn children on vaccination decisions for subsequent children.

Methods: We conducted a longitudinal cohort analysis of mothers who had their first liveborn child and a subsequent liveborn child in the Military Health System (MHS) from January 1, 2014 through June 30, 2017 utilizing administrative claims data. We analyzed diagnosis codes for vaccine refusal and vaccination and current procedural terminology (CPT) codes to identify mother’s vaccination decisions. Logistic regression models were used to assess parental vaccination decision for the firstborn on parental vaccination decision for the subsequent child.

Results: Overall, 96% of mothers made the same vaccination decision for both children, with 94% of mothers accepting the HepB birth dose for both children. When mothers decided to delay the first HepB vaccine >3 days or refuse any HepB vaccine for the first 18 months for the firstborn child, there was a higher odds of the mother delaying (aOR=46.2 (95% CI: 27.1, 78.9)) or refusing (aOR=176.2 (95% CI: 68.0, 456.5)) the first HepB vaccine for the subsequent child compared to accepting the HepB birth dose.

Conclusion: Public health intervention should focus on experienced mothers who delayed or refused the first HepB vaccine for the firstborn child to improve HepB birth dose vaccine uptake.
Poster
Association Between Delay of First Hepatitis B Vaccine and Delayed Completion of Hepatitis B Vaccination in the Military Health System, 2014-2017Jessica Fung Deerin, PhD, MPH,
Rebecca Clifton, PhD, Angelo Elmi, PhD,
Paul Lewis, MD, MPH,
Irene Kuo, PhD, MPH

The George Washington University, Milken Institute School of Public Health
Background: The first dose of the hepatitis B (HepB) vaccine is recommended to be given within 24 hours of birth for all medically stable children. Parents may consider not receiving the birth dose and delaying the first dose. However, delay of the first HepB vaccine is associated with incomplete vaccination by the up-to-date time frame. Age-appropriate vaccination was defined as completing the series by 7 months and up-to-date vaccination was defined as completing the series by 19 months. There is little known on timeliness of completing the vaccination series at an age-appropriate time in a U.S. population. This study assesses the impact of delaying the first HepB vaccine on timeliness of completing the series.

Methods: We utilized survival analysis methods on administrative claims data from the Military Health System (MHS) among children who received the first dose of the HepB vaccination series and who were born from January 1, 2014 through June 30, 2017. We assessed HepB vaccination coverage rates by 7 months and 19 months. We compared Kaplan-Meier survival curves of children who received and delayed the birth dose. Multilevel Cox proportional hazards models were used to determine factors associated with delayed timeliness of completing the HepB vaccination series.

Results: Overall, 97% of children received the HepB birth dose, 57.9% of children completed the HepB vaccine series by 7 months and 69.1% of children completed the series by 19 months. Of the 92,744 children who received the birth dose, 58% completed the series by 7 months of age. Of the 2,409 children who delayed the first HepB vaccine >3 days of life, 43% completed the series by 7 months of age. Children who delayed the first HepB vaccine >3 days were 40% less likely to have timely completion of the HepB vaccination series compared to those who received the birth dose (aHR=0.60, 95% CI: 0.57, 0.63).

Conclusion: Delay of the first dose of the HepB vaccine was associated with delayed completion of the HepB vaccination series. Medical providers should continue to encourage parents to provide the first HepB vaccine by 24 hours of their child’s life.
Poster
Hepatitis B birth dose vaccination patterns in the Military Health System, 2014-2018Jessica Fung Deerin, PhD, MPH,
Rebecca Clifton, PhD, Angelo Elmi, PhD,
Paul Lewis, MD, MPH,
Irene Kuo, PhD, MPH

The George Washington University, Milken Institute School of Public Health
Background: Since 2005, the universal hepatitis B (HepB) birth dose has been recommended for all medically stable infants weighing >2,000 g at birth. The timing of the birth dose provides a critical safeguard and prevents infection among infants born to HBsAg-positive mothers not identified prenatally. We assess infant HepB vaccination in the U.S. Department of Defense’s Military Health System (MHS) to identify trends in vaccination coverage and sociodemographic factors associated with non-receipt of the birth dose, receiving the first HepB vaccine >3 days of life, and not receiving any HepB vaccine in the first 18 months of life utilizing parental refusal codes. To our knowledge, this is one of the first studies assessing trends in parental refusal of the HepB birth dose utilizing administrative claims parental refusal codes.

Methods: We conducted a retrospective cohort analysis of MHS live births from January 1, 2014 through December 31, 2018 utilizing administrative claims data. Data were included from 44 hospitals in 24 unique states, territories, or countries. We analyzed diagnosis codes for vaccine refusal and vaccination and current procedural terminology (CPT) codes to identify vaccination patterns. Generalized linear mixed effects models with a logit link were used to assess factors associated with vaccination patterns.

Results: HepB birth dose vaccination coverage increased from 79.6% in 2014 to 88.1% in 2018.
Poster
Implementing D.O.T.S. to Raise Awareness of LTBI and TB in the Vietnamese Community in San DiegoBinh N. Tran
Kayla Giang
Andre Hirakawa
Nhi Lang
Isabelle Yu
Tevykah Pouv
Jean Yung
Michelle Fang
France Nguyen
This project will pilot an educational program about LTBI/TB, D.O.T.S: Direct Outreach through Train-the-Trainers Strategy, targeting the San Diego Vietnamese community. In the US, about 20% of TB cases were among Californians. Despite an overall TB decline in California and the US, rates are increasing in San Diego. Asians made up 41% of reported TB cases in San Diego, and most TB cases (72%) in the county were reported among the foreign-born. Furthermore, California has the largest population of Vietnamese in the country (San Diego County has the third largest Vietnamese population), and 65% of Asians in this state are foreign-born. Vietnamese also have the lowest English proficiency compared to other Asian subgroups. Due to these factors, APHF will focus on the Vietnamese community in San Diego to maximize the impact of TB control efforts. Reaching out to Vietnamese to help educate them is crucial since Vietnam has one of the highest TB burdens in the world. Additionally, more than 80% of TB cases are people with untreated LTBI. In the train-the-trainer strategy, APHF will create LTBI/TB videos and accompanying handouts in English and Vietnamese to educate a group of “trainers” quarterly, who will then educate and share information with their “trainees.” APHF will also conduct an online seminar on LTBI/TB for health professionals. These educational activities aim to raise awareness about the link between LTBI and TB disease, address misperceptions, decrease stigma, and encourage and facilitate testing and treatment for LTBI and TB. PosterRecording
An Updated Tuberculosis Elimination Plan for California (2021-2025)Jennifer Flood*
Cathy Miller*
Araxi Polony*
the California TB Elimination Advisory Committee
Background: The California Tuberculosis Elimination Advisory Committee (CTEAC), together with the California Tuberculosis Control Branch (TBCB), created an updated tuberculosis (TB) elimination plan (TBEP) for California (2021-2025). While the state has made great strides in controlling TB, disparities among populations have increased, especially among Asian and Pacific Islander populations. The new Plan includes intensified efforts to promote TB-related health equity and an increased focus on outreach to high risk communities.

Methodology: In 2020, the CTEAC membership and other stakeholders met to update the 2016-2020 TB Elimination Plan. Progress made during 2016-2020 was reviewed and attendees participated in a comprehensive review of the barriers to elimination and proposed new action steps. TBCB updated these and circulated them to CTEAC members for review.

Results: The TBEP is composed of five overarching recommendations which address strategies for: 1) finding/engaging high risk individuals/their providers; 2) testing and treatment of latent TB infection (LTBI); 3) LTBI surveillance; 4) resources for TB elimination; and 5) establishing a cohesive LTBI network and research agenda in California. Barriers and potential solutions are presented in the Plan. A new target for 2025 was established to reduce TB disparities among non-U.S.-born Californians by 25%.

Discussion: The California TBEP outlines actions that can be taken to shorten the time to reach TB elimination. It presents new bold TB elimination targets, including those that address TB disparities among the California population.
Poster
The care cascade for latent tuberculosis infection in children at a
federally qualified health center in Northern California
Burrough W1, Hsieh C1,2, Mochizuki T3, Tamerat M1, Noor Z1, Lewis G1, Asfaha S3, Katrak S3, Chitnis A4, Jaganath D1,2,5

1.Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, USA
2.Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, USA
3.Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA
4.Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, USA
5.Center for Tuberculosis, University of California, San Francisco, San Francisco, USA
Background: It is critical to screen, diagnose and treat children with latent tuberculosis infection (LTBI), as they are at risk of severe tuberculosis (TB) disease and reservoir for future TB transmission. We analyzed six years of well-child visits to characterize the pediatric LTBI care cascade.

Design/Methods: We extracted electronic medical record (EMR) data for well-child visits in children 1-18 years old between 2014 and 2020 at a pediatric federally qualified health center in Oakland, California. Per American Academy of Pediatrics (AAP) guidelines, children should be screened annually for TB risk factors at well-child visits. This clinic uses an EMR note template to prompt providers to complete this screen. Of those with TB risk factors, we determined the proportion with subsequent testing, imaging, and treatment initiation.

Results: We assessed 14,794 encounters with 48% of children under 5 years old. Screening was completed in 99% (14,575/14,794) of visits. However, of 715 children with risk factors, only 162 (23%) had documented testing ordered (83% with an interferon-gamma release assay). 89% (144/162) of ordered tests were completed, of these 3.5% (5/144) were positive. Of the five, 2 were previously treated. The remaining had negative chest radiographs and were started on 4 months of daily rifampin.
Conclusion: While EMR note templates promoted high rates of TB risk factor screening in children, there was a gap in ordering a diagnostic test. Further work is needed to explore barriers to testing in order to improve LTBI care for children.
Poster
Improving Hepatitis Education for South Asian Persons through Hep Free NYC’s South Asian Hepatitis InitiativeSarah Ahmed, MPH, CHES

NYC Department of Health and Mental Hygiene
Background: In New York City (NYC), over 332,000 persons are living with Hepatitis B (HBV) or Hepatitis C (HCV) viral infections. NYC has a large and diverse South Asian-born and diaspora population. According to the World Health Organization, HBV and HCV account for 420,000 deaths annually in the South East Asia Region. South Asian immigrants face many barriers to care including: limited English language proficiency, difficulty navigating the complex health care system, and ineligibility for health insurance.

Methods: The South Asian Hepatitis Initiative (SAHI) convened through Hep Free NYC and established goals and work plan. The work plan included translating existing materials, developing educational materials, developing a South Asian-focused viral hepatitis 101 presentation and hosting quarterly meetings.

Results: The SAHI goals are: to raise awareness; provide screening, immunization and referral services, build community and provider partnerships; and to identify and reduce cultural and language barriers to immunization screening and treatment about HBV, HCV, and liver disease among South Asian-born and diaspora populations. SAHI developed two post cards, one pocket card and a one-hour presentation accounting for cultural competency and health literacy. The NYC Health Department translated the HBV and HCV Booklets into Bengali, Urdu and Hindi. The materials have been distributed through social media and the Hep Free NYC website. SAHI has hosted three meetings in 2021, connecting 3 organizations to Hep B screening resources.

Conclusion: SAHI intends to support HBV and HCV awareness and access to testing and care in the community. Identification of low cost clinical care resources, and culturally and linguistically competent clinicians are critical for raising awareness and providing testing. Additional resources to support HBV and HCV health education, testing and care in the South Asian-born and diaspora community are needed.
Poster
Fighting HBV with a Community-Based Multiprong Approach Richard So, Executive Director

SF Hep B Free - Bay Area
Hepatitis B and the liver cancer it causes is still a major health crisis and health disparity in the United States, particularly among Asian immigrant and Asian American communities. Despite the existence of and affordable effective vaccine and affordable, effective treatment, lack of awareness and testing leads to significant preventable morbidity and mortality. Furthermore, lack of funding towards this issue prevents health systems and communities from making large and sustainable strides to eliminate the burden of hepatitis B caused disease. Our project used a community-based, multipronged approach to increase awareness and education around hepatitis B and the liver cancer it causes and give the community the tools to be educated, tested and vaccinated. Our approach targets high risk, untapped communities and critically involved a wide variety of local stakeholders across healthcare, business, advocacy groups, elected officials and ethnic media. After creating this group of knowledgeable, vested stakeholders, we agreed upon various strategies to achieve our goal which included public awareness, physician awareness, increased vaccination and the creation of a hepatitis B data baseline. At the core of the program was working with Asian-centric businesses in Northern San Mateo County to educate, screen and vaccinate employees and owners. Initial business education was successful before the pandemic hit and the program had to be halted. We intend to reinitiate the program when conditions are right for in-person learning, screening and vaccination. Poster
Improving hepatitis B and C care by increasing NYC Health Department screening and patient navigation
services collaboration
Liz Tang
Angelica Bocour
Tarek Mikati
Yanting Kelly Huang
Jackilyn Rivera Adeeba Khan
Farma Pene
Alexis Brenes
Anna Huang
Pei-Chi Chung

NYC Department of Health and Mental Hygiene
Background: About 241,000 people are living with chronic hepatitis B (HBV) and 91,000 with chronic hepatitis C (HCV) in New York City (NYC). NYC Sexual Health Clinics (SHC) offered HBV and HCV screening to patients accessing HIV prevention services since SHC’s PrEP/PEP program started. A 2016-2017 analysis showed that HBV and HCV prevalence was low (<1%). Since March 2021, hepatitis screening was expanded to all patients and the Viral Hepatitis Program (VHP) offered multi-lingual navigation services.

Objective/Purpose: NYC Health Department SHC and VHP collaborate to improve engagement in HBV and HCV care through increasing screening and multi-lingual navigation services.

Methods: Since March 2021, people who tested positive for HBV and/or HCV and accepted VHP navigation at SHC were referred to the VHP Telephone Navigation Program for linkage to hepatitis care and supportive services. Referrals to VHP were provided by phone and ≥3 outreach attempts via phone and/or text message were made. Test history and linkage to care outcomes were entered into the hepatitis
surveillance system.

Results: From March-September 2021, VHP received 36 HBV, 10 HCV, and 1 HBV/HCV referrals. Thirty (83%) people with HBV received navigation services and 14 (47%) were linked to care. Eight (80%) people with HCV received navigation services and 4 (50%) had a subsequent negative RNA test result. Overall, 11 (23%) people referred to VHP were uninsured, and 9 (19%) were non-English-speaking.

Conclusion/Discussion: More HBV/HCV cases were identified and connected to HBV/HCV care in six months in 2021 than during 2016-2017. This collaboration helped people get hepatitis care through multi-lingual navigation services.
PosterRecording

Exhibitors

NameRepresentativeHandouts/ResourcesVideo
Asian Services In Action, IncTamoor Rashid, Community Health Promotions Coordinator & Quality Data AnalystAHIMSA - ASIA

ICHC General Information

Fact Sheet - ASIA

ICHC - ASIA

Sustainability Services - ASIA
Recording
CDC Division of TB Elimination (DTBE)Allison Maiuri, Team Lead for Education, Training, and Behavioral Studies

Carissa Sera-Josef, Public Health Advisor
DTBE Resources
Curry International Tuberculosis Center (CITC), University of California San Francisco (UCSF)Kelly Musoke, Deputy DirectorCITC Update

Warmline Brochure
Recording
Global Tuberculosis InstituteAnita Khilall, Program Director, Education & Training
Heartland National TB CenterDelphina Sanchez, Director of EducationHNTC_Presentation HandoutsRecording
Hepatitis B FoundationYasmin Ibrahim, Public Health ManagerAbout HBF

Hep B United 2-Pager

Hepatitis B Fast Facts

Hepatitis B: What You Need to Know

Living with Chronic Hepatitis B and D (Fact Sheet for Patients)

Hepatitis Delta Fact Sheet for Providers

Know Hepatitis B Campaign Resource Flyer

Hepatitis B Flipchart for African Community Health Education

2020 HBU Capacity Building Program Report

Hepatitis B Community-Based Screening Guide

Infographic: State of Viral Hepatitis During the COVID-19 Pandemic

Health Insurance Costs Impacting Shoppers Living with Hepatitis B
Recording
Coalition against Hepatitis in People of African Origin
(CHIPO) – NYC Committee
Farma Pene, Community Projects Coordinator, Viral Hepatitis ProgramAbout CHIPO-NYC

Pocket Card_English

Pocket Card_French
Rutgers Global Tuberculosis Institute (GTBI) Rosie GarciaConsultation Handout

GTBI Core Courses and Educational Services

GTBI - Product Highlights
The Global TB Institute’s Overview
TB Elimination AllianceJoe Lee, Director of Strategic Initiatives and PartnershipsResources