Feasibility and Acceptability of Universal Adult Screening for Chronic Hepatitis B in Primary Care Clinics

Richie V Chu; Sai Sarnala; Thanh Viet Doan; Armaan Jamal; Anuradha Phadke; Sam So; Richard So; Hang Pham; Joceliza Chaudhary; Robert Huang; Gloria Kim; Latha Palaniappan; Karina Kim; Malathi Srinivasan

doi:10.1016/j.focus.2024.100240

Feasibility and Acceptability of Universal Adult Screening for Chronic Hepatitis B in Primary Care Clinics

AJPM Focus. 2024 May 17;3(6):100240. doi: 10.1016/j.focus.2024.100240. eCollection 2024 Dec.

Authors

Richie V Chu^{1

2

3}, Sai Sarnala^{1

4}, Thanh Viet Doan^{1

5}, Armaan Jamal^{1

6}, Anuradha Phadke⁷, Sam So^{8

9}, Richard So^{9

10}, Hang Pham^{8

9}, Joceliza Chaudhary¹¹, Robert Huang^{1

8

9}, Gloria Kim^{1

12}, Latha Palaniappan^{1

12}, Karina Kim^{1

7}, Malathi Srinivasan^{1

7}

Affiliations

¹ Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California.
² Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
³ Department of Asian American Studies, College of Social Sciences, University of California Los Angeles, Los Angeles, California.
⁴ Department of Chemistry, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Department of Public Health, Johns Hopkins University, Baltimore, Maryland.
⁶ Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁷ Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California.
⁸ Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
⁹ Asian Liver Cancer Center, Department of Surgery, Stanford University School of Medicine, Stanford, California.
¹⁰ San Francisco Hep B Free, San Francisco, California.
¹¹ Primary Care Clinical Services, Stanford University Medical Partners, Los Gatos, California.
¹² Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.

Abstract

Introduction: Two thirds of Americans infected with chronic hepatitis B are unaware of their infection. In March 2023, the Centers for Disease Control and Prevention recommended moving from risk-based to universal adult chronic hepatitis B screening. In April 2022, Stanford implemented chronic hepatitis B universal screening discussion alerts for primary care providers.

Methods: After 6 months, the authors surveyed 143 primary care providers at 13 Stanford primary care clinics about universal chronic hepatitis B screening acceptability and implementation feasibility. They conducted semistructured interviews with 15 primary care providers and 5 medical assistants around alerts and chronic hepatitis B universal versus risk-based screening.

Results: Forty-five percent of surveyed primary care providers responded. A total of 63% reported that universal screening would identify more patients with chronic hepatitis B. Before implementation, 77% ordered 0-5 chronic hepatitis B screenings per month. After implementation, 71% ordered >6 screenings per month. A total of 66% shared that universal screening removed the stigma around discussing high-risk behaviors. Interview themes included (1) low clinical burden, (2) current underscreening of at-risk groups, (3) providers preferring universal screening, (4) patients accepting universal screening, and (5) ease of chronic hepatitis B alert implementation.

Conclusions: Consistent with Centers for Disease Control and Prevention guidelines, implementing universal chronic hepatitis B screening in primary care clinics in Northern California was feasible, was acceptable to providers and patients, eased health maintenance burdens, and improved clinic workflows.

Keywords: Hepatitis B; implementation; primary care; universal screening.