Improving Chronic Hepatitis B Virus Screening at a Safety-Net Primary Care Clinic

Hepatitis B Virus (HBV) is a type of virus that affects the liver. Chronic hepatitis B is usually asymptomatic and many HBV carriers remain unaware of their viral status, thereby may unknowingly transmit the disease. If left untreated or undetected, it could lead to cirrhosis, hepatocellular carcinoma or mortality. Although this virus is endemic in some parts of the world such as Asia and Africa, it is important to note that HBV has become a global problem. The Centers for Disease Control and Prevention (CDC) in conjunction with the United States Preventive Services Task Force (USPSTF) estimates that about 700,000 to 2.2 million people in the United States have chronic hepatitis B (CHB) and about 14,000 die yearly as a result of complications from the virus. Hence, they recommend that screening be offered to individuals at high risk for hepatitis B virus. People at risk include but are not limited to individuals born in countries of high HBV endemicity (³2%), injection drug users, men who have sex with men, HIV positive patients, household and sexual contacts of people with HBV, individuals who are incarcerated, and people infected with hepatitis C virus. This Doctor of Nursing Practice (DNP) quality improvement project was conducted at the Order of Malta Clinic in Oakland, California, a safety-net clinic that provides free health care services to individuals who are uninsured, low income and the working poor in the community. This clinic serves a huge population of immigrants (about 90% of their patient population) eligible for chronic hepatitis B screening but based on observations and review of patients’ chart, it was noted that only about 33% of eligible patients were screened. There is currently no protocol for chronic hepatitis B screening at this clinic, instead patients are screened based on presenting symptoms. Hence, this project sought to improve the screening rates for chronic hepatitis B from 33% to 70% at the Order of Malta clinic using the HBsAg blood test by October 2019. This was accomplished by interviewing the providers individually and providing in-service training to physicians and nurse practitioners on the current HBV screening guidelines. A random retrospective review of patients’ chart was done in order to get a sense of the overall percentage of eligible patients that were screened. This included a 3-4 weeks of intervention period and 10 weeks of implementation. After the intervention and implementation, patients’ charts were once again randomly reviewed in order to evaluate the outcome of the project. The motivation for carrying out this project was to improve the screening rate for chronic hepatitis B, and treat individuals with a positive result so as to delay or prevent the sequelae that comes with the virus. The long-term benefit would be to improve overall health and wellbeing, and also decrease the cost of treating hepatitis B associated complications such as cirrhosis, liver failure and liver cancer