ABSTRACT
OBJECTIVE: To test an intervention to increase screening for hepatitis B (HBV) in at-risk immigrants in the primary care setting. PATIENTS AND METHODS: From a Mayo Clinic primary care panel, we identified approximately 19,000 immigrant patients from 9 high-risk countries/ethnic groups with intermediate or high prevalences of chronic HBV. Eligible patients with no record of prior HBV testing scheduled for primary care visits within the study period spanning October 1, 2017, through October 31, 2018, were identified. During the intervention period, the primary health care professional was notified by email 1 week prior to each primary care visit and encouraged to discuss screening for HBV infection and order screening tests at the appointment. We assessed rates of HBV screening during control and intervention periods. RESULTS: We identified 597 patients in the control period and 212 patients in the intervention period who had not been screened previously for HBV. During the intervention period, 31.4% (58) of the 185 eligible patients were screened for HBV vs 7.2% (43) of the 597 eligible patients in the control period. Thus, the intervention resulted in a 4.3-fold increase in screening (P<.00001). Of the 101 patients screened in the at-risk population, 22 (21.8%) screened positive for prior exposure to HBV (hepatitis B core antibody-positive) and 6 (5.9%) for chronic HBV infection (hepatitis B surface antigen-positive). CONCLUSION: Notifying primary care physicians of the high-risk status of immigrant patients substantially increased screening for HBV. Identifying patients with HBV is important for monitoring disease prevalence, preventing transmission, and initiating treatment and cancer surveillance, allowing earlier recognition and prevention of chronic hepatitis, disease reactivation, cirrhosis, and hepatocellular carcinoma.
ABSTRACT
Soil transmitted helminths (STHs) affect more than one billion of the world's population and are very prevalent in regions with high poverty rates and poor sanitation. Efforts to achieve Millennium Development Goals, such as combating diseases and increasing the number of people with access to safe drinking water and proper sanitation facilities, will directly help in eliminating STHs. The Plains regions of Bangladesh has one of the highest prevalence rates of STHs, and the efforts made by the World Health Organization might not be enough to eradicate these diseases in this region before the 2015 goal. This survey was conducted in the Manikganj district of Central Bangladesh to evaluate local awareness about the transmission and prevention of STHs. The results from this survey show that although a large percentage of the respondents were knowledgeable about the spread and impact of intestinal worms, the majority of individuals still do not take the necessary steps to prevent infection. Our findings demonstrate the complexity of controlling and eliminating STHs and show that concluding efforts should incorporate additional measures for vaccine development as well as improved educational efforts that are sensitive to the region's traditions and cultures.
