Hepatitis B Prevalence and Risk Factors in Foreign-Born Asians and Pacific Islanders at a Federally Qualified Health Center in Hawai'i, 2015-2020.

The objective of this study was to estimate the prevalence of chronic hepatitis B infection in foreign-born Asians and Pacific Islanders at Kalihi-Palama Health Center in Honolulu, Hawai'i, and to assess the association between both chronic and resolved hepatitis B infection and risk factors such as household exposure to hepatitis B virus and geographic location of birthplace. The study involved cross-sectional data from 997 participants who accessed medical services at Kalihi-Palama Health Center between September 2015 and July 2020. The prevalence of chronic hepatitis B was 10.7%. On multivariable logistic regression analysis, the adjusted prevalence odds ratio of chronic hepatitis B infection was 3.3 times greater (95% confidence interval: 1.1, 9.2) for those who reported household contact with a person with hepatitis B infection than those who reported no such contact. No association was found with place of birth in this study population. Age was a significant predictor of chronic hepatitis B, with participants between 35-44 years of age having the highest prevalence. Age was also a significant predictor of resolved hepatitis B infection, with participants 65 years of age or older having the highest prevalence. These findings emphasize the need for targeted screening and appropriate follow-up-including vaccination or treatment-in this at-risk population.

Systems of Care Implications in Hawai'i: Sexual and Gender Minorities.

Sexual and gender minorities (SGM) are diverse groups of people who do not identify as heterosexual or cisgender. SGM communities include Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals as well as people of other sexual orientations and gender identities. SGM communities are disproportionately affected by substance use disorders, with differential use of specific substances among persons based on sexual or gender identity. As understood through the minority stress model, substance use and misuse among SGM people are tied to risk and resiliency factors at all levels of the social ecological paradigm. Despite the disproportionate burden of substance use disorders on SGM people in Hawai'i, very few resources or programs exist to ameliorate the impact of substance use on this community. Although some models of care could be useful for SGM people, community-specific interventions are scarce, especially in Hawai'i. To successfully meet the needs of SGM people in Hawai'i, multi-level transformation of the substance use prevention and treatment landscape must address: culturally appropriate service delivery; workforce recruitment and development; nimble and adequate financing; consistent data collection and reporting; and systems-level policy updates.

Prevalence of Risk and Protective Factors Associated with HIV and HCV Infections Among Male High School Students Who Have Sex with Males-Hawai'i, 2013, 2015, and 2017.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are increasing among young adults, and males who have sex with males (MSM) are at high risk for both infections. Limited Hawai'i data exists on the extent to which populations, such as MSM, are engaging in behaviors that place them at increased risk for either infection. This analysis quantified the proportion of Hawai'i public high school students who are MSM and are at risk for HCV and HIV infections. Data from the 2013, 2015, and 2017 Hawai'i Youth Risk Behavior Surveys (YRBS) were combined (n=16,751) to investigate the prevalence of risk factors associated with HIV and HCV infections (eg, sexual risk behaviors, substance use) and protective factors among MSM public high school students. Among sexually experienced male students (n=3,391), 13.1% were classified as MSM and among these, 40.3% identified as heterosexual despite reporting same-sex sexual contact. Multivariate modeling demonstrated that MSM students are significantly more likely than non-MSM students to engage in behaviors that increase their risk for HIV and HCV infections (composite risk variable; adjusted Prevalence Ratio: 1.40, 95% CI 1.15 - 1.70) and are significantly less likely to have protective factors. Evidence-based prevention strategies for reducing HIV and HCV risk behaviors while improving protective factors among sexual minority youth in Hawai'i are necessary and must address sexual behavior along with other dimensions of sexual orientation.

Hepatitis B Prevalence and Risk Factors in a Foreign-Born Asian and Pacific Islander Population at a Community Health Center in Hawai'i.

Hawai'i has one of the highest rates of liver cancer in the United States. This is in large part due to undiagnosed chronic hepatitis B (CHB) infection among foreign-born Asian and Pacific Islanders (APIs). In order to estimate the prevalence of CHB infection among foreign-born APIs in Hawai'i, the Hawai'i State Department of Health conducted a cross-sectional study from August 2013 through August 2015 of patients of a federally qualified health center serving the largest population of medically underserved APIs in the state. Among 1261 patients surveyed, the prevalence of CHB infection (based on HBsAg seropositivity) was 5.6% (71/1259). No significant differences were detected by place of birth, age, or gender; however, the adjusted prevalence ratio of CHB infection was 6.0 times higher among persons reporting household contact with hepatitis B virus compared with those without such contact. Our findings underscore the need for targeted screening of at-risk individuals and their household contacts.

Hepatitis C virus antibody prevalence, demographics and associated factors among persons screened at Hawai'i community-based health settings, 2010-2013.

We sought to determine the prevalence of HCV infection and identify factors associated with HCV infection among clients presenting to community-based health settings in Hawai'i from 2010-2013. An earlier report on this study population covered the period from December 2002 through May 2010. Since 2010, the HCV screening inclusion criteria have been relaxed, and the program has greatly expanded. Clients from 26 community-based sites were administered questionnaires, and were screened for HCV antibodies from January 2010 through April 2013 (N = 8,588). Univariate and multivariate logistic regression analyses were performed. HCV antibody prevalence was 5.9% compared with 11.9% from 2002-2010. Persons aged 45-65 years had the highest HCV antibody prevalence (8.4%) compared with all other age groups. Significant independent variables associated with HCV antibody prevalence were injection drug use, blood transfusion before July 1992, and having an HCV-infected sexual partner. While characteristics associated with HCV infection remained essentially unchanged from those identified in the earlier analysis, the expansion of screening sites and less restrictive inclusion criteria led to a much larger study population and a concurrent decrease in overall HCV antibody prevalence. However, while the highest age-specific prevalence remained the same for both screening periods, the prevalence among younger persons (< 30 years old) doubled (from 2.4% to 4.7%). By expanding the HCV screening program and relaxing the inclusion criteria, a greater number of HCV-infected persons and a greater proportion of younger persons with HCV infection were identified while still maintaining a focus on at-risk individuals.