title: Barriers to treatment of hepatitis B in an urban Chinatown community.
abstract: OBJECTIVE
  To evaluate the net effect of a concerted effort to treat hepatitis B virus (HBV) in a Chinese immigrant population, including barriers to initiating and continuing therapy and antiviral efficacy.
  
  
  BACKGROUND
  Oral antiviral agents for HBV achieve high rates of viral suppression. However, there is limited information about the impact of attempts to treat HBV in high prevalence immigrant communities.
  
  
  METHODS
  Sixty-nine patients were identified in an urban Chinatown Internal Medicine practice who had indications for treatment of HBV. A coordinated effort was made to provide antiviral therapy to these patients. Barriers to starting treatment and reasons for discontinuation were categorized on the basis of a systematic review of medical records. Suppression of HBV DNA to undetectable levels was considered a treatment response.
  
  
  RESULTS
  Twenty-six percent (18/69) of patients did not start medication because of failure to follow-up or treatment refusal. Oral antiviral therapy was initiated in 74% (51/69) of cases and 38 of 39 patients who remained on treatment achieved viral suppression. Twelve patients discontinued medication because of social, economic, or other reasons. In total, 55% (38/69) of treatment candidates achieved undetectable HBV DNA levels on therapy.
  
  
  CONCLUSIONS
  Although oral antiviral therapy was highly effective in achieving viral suppression in patients who were maintained on treatment, only 55% of treatment candidates reached this endpoint. Barriers to care kept nearly one half of patients from initiating or continuing therapy. A multidisciplinary approach including education and social and financial support is needed to maximize the benefit of available HBV treatment in this urban immigrant population.
authors.affiliation: Department of Medicine, Section of Hepatology, University of Illinois, Chicago, IL 60612, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Malespin
authors.forename: Shirley
authors.initials: S
authors.lastname: Wong
authors.forename: Fabiolla
authors.initials: F
authors.lastname: Siqueira
authors.forename: Brian
authors.initials: B
authors.lastname: Luc
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ravaee
authors.forename: Charles
authors.initials: C
authors.lastname: Vainder
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cotler
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001213:Asian; D004279:DNA, Viral / Q000097:blood; D054242:Emigrants and Immigrants; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000208:ethnology / Q000276:immunology; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D016312:Treatment Refusal; D014505:Urban Population
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral