Viral Hepatitis in Hawai‘i – Differing Perspectives
V. The Future of Hepatitis in Hawai‘i
A. Advocacy Programs:
Kenneth Akinaka
pp. 14-15
The Hepatitis Support Network of Hawai‘i (HSNH) is the oldest hepatitis prevention, education, treatment and advocacy organization in Hawai‘i. With fourteen active programs and over 100 volunteers, the program provides free community presentations by experts in the field of hepatitis and other infectious diseases and free hepatitis B and C screenings and hepatitis B vaccinations to hundreds of people every year. The goals and objectives of the program are to provide prevention, education, treatment, support, medical case management, and counseling for those who are infected with chronic viral hepatitis including those who are co-infected with HIV. The HSNH has outreach services that target the underserved including Native Hawaiians in rural areas, the poor, immigrants, homeless, prisoners, substance users, and those who are uninsured as well as those with medical insurance. Hawai‘i has the highest rate of liver cancer in the United States.28 It is a leading cause of cancer death among Native Hawaiian, Filipino, and Chinese men in Hawai‘i.28-29 The average rate of hepatitis B in the United States is 0.5% to 1%, while Asian and Pacific Island countries generally have greater than 10% of their populations affected (Table 4). Hawai‘i’s immigrant population, largely derived from these affected areas, makes up 17% of the total population, and accounts in part for the high rate of HBV in Hawai‘i. These patients require monitoring every six months for liver cancer even if their viral load is low, and it is recommended that family members are vaccinated to protect them from infection. It is suggested that physicians and local health care clinics start following CDC recommended guidelines, which is to screen all immigrants and migrants from countries that have chronic viral hepatitis B rates of over 2%.30
There are a number of problems that need to be addressed by healthcare advocates if the course of these silent epidemics in Hawai‘i is to change. These primary problems include a lack of public education and awareness and issues with accessing testing and treatment.
Public Awareness and Education
Because there is a significant delay in the signs and symptoms that accompany viral hepatitis infection, many individuals who once may have led a risky lifestyle may not realize that they are infected until many years later. Nursing education often does not include adequate courses on hepatitis B and C, and physician education classes may also be outdated. A specific focus on these epidemics in Hawai‘i is necessary, as prevalence is higher than that on the continental US. Testing, case management, and earlier medical interventions are necessary for infected individuals including the working poor who often do not have medical insurance or are homeless. Medical case management is needed for referrals for services and to dispel some of the myths and fears about treatment side effects that often prevent people from seeking treatment. The HSNH sponsors a number of programs to address these issues, including outreach office sites and prison classes as well as the Save-a-Life Safety Kit Campaign which encourages healthcare service organizations, civic clubs, and churches to distribute free razors, toothbrushes, nail clippers, and prevention education materials to the homeless population. The network also supports community education by presenting at health fairs, sponsors speakers at various medical venues, and assists in the training of volunteer case managers and medical education training programs. Educational campaigns and outreach programs sponsored by pharmaceutical and local advocacy groups targeted at the general public have also resulted in increased screening by printing material in several languages, advertising on the radio, television and internet, and more.
Testing and Treatment
Advocacy in Hawai‘i needs to encourage physicians, nurse practitioners, and physician assistants to test, counsel and consider treatment for people who have risk exposure histories. Often primary care physicians do not test for hepatitis, or wait until a patient has complaints or symptoms of liver disease to refer for treatment. Quite frequently patients do not feel ill until it is too late to successfully treat the infection. Often there is no funding to provide medical case management or treatment for people infected with HBV and HCV who do not have health insurance or who cannot afford the co-payment cost of treatment. The HSNH provides community education, testing, and vaccination programs, as well as an HIV/hepatitis C co-infected support group and a Micronesian outreach healthcare program to assist in this effort. Telemedicine and accessing rural populations is another issue, as many people cannot afford to travel to Honolulu for treatment. Currently the HSNH, in partnership with Access Care Today Clinics, is working to improve their Telemedicine and Rural and Neighbor Island Infectious Disease Treatment Expansion Program to accommodate these populations.
