Submitted by Beatrice Zovich, MPH Public Health Program Coordinator for the Hepatitis B Foundation

Of the estimated 2.4 million people currently living with hepatitis B in the United States, 60% were born in another country. The prevalence of chronic hepatitis B virus (HBV) in African immigrant communities is estimated to be as high as 8-15% – yet, fewer than 20% of community members are aware of their infection. Limited access to the birth dose vaccine, which prevents mother-to-child transmission of HBV (the most common form of transmission in sub-Saharan Africa) contributes to the high burden of the infection in these communities.

The population of African immigrants in the United States is ever-growing with a 500% increase between 1980 and 2016. Because of the high prevalence of HBV in Africa, the risk-based guidelines from the CDC recommend that individuals born in Africa themselves or born in the US with at least one African-born parent be prioritized for hepatitis B testing. Unfortunately, rates of testing, vaccination, and linkage to care remain low among these communities, due to multiple barriers, including stigma, fear, lack of awareness and knowledge, language barriers, traditional values, limited access to healthcare services, low acculturation, social and economic marginalization, and lower rates of health insurance – the same barriers that present challenges in general healthcare access among many immigrant communities in the US. Given the silent nature of hepatitis B, many people do not become aware of their infection until they exhibit symptoms, at which point advanced liver disease has likely already occurred.

Hepatocellular carcinoma (HCC) or liver cancer is a major cause of death for members of the African diaspora. Around 60% of liver cancer cases overall can be attributed to hepatitis B, and people of African descent who develop HCC because of hepatitis B tend to receive this diagnosis decades earlier than members of other groups – often in their 40s, 30s, or even 20s. On top of this earlier age at diagnosis, life expectancy in Africans with HCC is shortened compared with other groups. More research is crucial to determine the reasons behind these disheartening trends.

Several potential solutions exist to help close some of the disparities in hepatitis B and liver cancer diagnosis, prevention, and care among African immigrant and refugee communities in the United States. These include:

1. Dis-aggregation of data – African immigrants and refugees are frequently misclassified as “Black” or “African American” in disease surveillance, due to not collecting or reporting on information about country of origin.
2. Acknowledgment of and respect for the ethnic and cultural diversity that exists within the African diaspora, as well as the divergent histories of different groups within the US, and creation of appropriately tailored health communication methods and materials.
3. Increased awareness and knowledge among healthcare and social service providers and among African communities themselves about the higher risk of hepatitis B and liver cancer and existing opportunities for prevention, diagnosis, and treatment.

The Hepatitis B Foundation has worked to address some of these goals with the creation of Hepatitis B Educational Resources for African Immigrant Communities, Educators and Physicians, created as part of the CDC’s Know Hepatitis B campaign. These flip charts, presentations, takeaway cards, and other resources, available in French, Swahili, Arabic, and Amharic, as well as English, are working to bridge gaps in awareness and knowledge and dismantle stigma around HBV, to promote testing, vaccination, & management of the infection. Additionally, storytellers like Bright, William, and Bunmi, all of whom have participated in the Hepatitis B Foundation’s #justB storytelling campaign, help to humanize the disease and provide hope and empowerment to others.

As more and more African immigrants become long-term U.S. residents, it will be increasingly important to provide screening, prevention, and treatment of hepatitis B before its development into liver cancer with a culturally and linguistically sensitive approach. This Liver Cancer Awareness Month let’s consider the numerous factors that can shape the course of hepatitis B and liver cancer in different communities and work together for better outcomes.

Please visit www.hepb.org for more information

This article brought to you with the generous support of Mallinckrodt Pharmaceuticals