title: A Novel Strategy to Increase Identification of African-Born People With Chronic Hepatitis B Virus Infection in the Chicago Metropolitan Area, 2012-2014.
abstract: Most research on hepatitis B virus (HBV) infection in the United States is limited to Asian populations, despite an equally high prevalence among African immigrants. The purpose of this study was to determine testing and detection rates of HBV infection among African-born people residing in the Chicago metropolitan area.
  
  
  
  A hepatitis education and prevention program was developed in collaboration with academic, clinical, and community partners for immigrant and refugee populations at risk for HBV infection. Community health workers implemented chain referral sampling, a novel strategy for recruiting hard-to-reach participants, targeting African-born participants. Participants were tested in both clinical and nonclinical settings. To assess infection status, blood samples were obtained for hepatitis B surface antigen (HBsAg), core antibody, and surface antibody testing. Demographic information was collected on age, sex, health insurance status, country of origin, and years residing in the United States. Participants were notified of testing results, and HBsAg-positive participants were referred for follow-up medical care.
  
  
  
  Of 1,000 African-born people who received education, 445 (45%) agreed to participate in HBV screening. There were 386 (87%) participants tested in clinical and 59 (13%) tested in nonclinical sites. Compared with participants who were tested in clinical settings, participants tested in nonclinical settings were older, were less likely to have health insurance, and had lived in the United States longer (P < .005 for each). Of these, most were from the Democratic Republic of the Congo (14%), Nigeria (13%), Ghana (11%), Somalia (11%), or Ethiopia (10%). There were 35 (8%) HBsAg-positive people, 37% had evidence of past infection, and 29% were immune.
  
  
  
  Chain referral sampling identified many at-risk African-born people with chronic HBV infection. The large proportion of HBsAg-positive people in this sample reinforces the need for health promotion programs that are culturally appropriate and community-driven.
authors: Asian Health Coalition, 180 West Washington St, Office 1000, Chicago, IL 60602. Email: edwin@asianhealth.org.
authors: Edwin
authors: E
authors: Chandrasekar
authors: Asian Health Coalition, Chicago, Illinois.
authors: Sharon
authors: S
authors: Song
authors: Asian Health Coalition, Chicago, Illinois.
authors: Matthew
authors: M
authors: Johnson
authors: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Aaron M
authors: AM
authors: Harris
authors: Sinai Health System, Mount Sinai Hospital Touhy Health Center, Chicago, Illinois.
authors: Gary I
authors: GI
authors: Kaufman
authors: Heartland Health Centers, Chicago, Illinois.
authors: David
authors: D
authors: Freedman
authors: University of Chicago, Division of the Biological Sciences and Office of Community Engagement and Cancer Disparities, Chicago, Illinois.
authors: Michael T
authors: MT
authors: Quinn
authors: University of Chicago, Division of the Biological Sciences and Office of Community Engagement and Cancer Disparities, Chicago, Illinois.
authors: Karen E
authors: KE
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People; D002641:Chicago / Q000453:epidemiology; D054242:Emigrants and Immigrants; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D062486:Public Health Surveillance; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D055815:Young Adult; D001741:Black or African American
chemical_list: D006514:Hepatitis B Surface Antigens