Hepatitis B in West African-Born Persons Living in New York City: Is Linkage to Care Enough?
Bibliographic record
Abstract
Introduction: Hepatitis B virus (HBV) infection in the US disproportionately affects foreign-born persons. West African nations have among the highest rates of HBV infection worldwide (≥8%) but little is known about West Africans living in the US. Our aims were to test the effectiveness of a community screening and link-to-care program that relies on culturally targeted patient navigators (PNs). Methods: From October 2012 to April 2015, community screenings were conducted targeting persons from countries with a high prevalence of HBV (≥2%). Individuals completed a survey and were tested for HBV (HBsAg, HBcAb, HBsAb). Subjects were identified as having HBV infection (HBsAg+) or as being HBV exposed (HBcAb+). PNs contacted patients with results and linked HBsAg+ persons to care. Data was analyzed using Chi-Square to compare HBV infection, exposure, and factors potentially associated with linkage or retention to care between West Africans and non-West Africans. Follow-up retention data were obtained. Results: In total, 2,455 subjects were screened for HBV, representing 91 high-prevalence countries. The cohort was predominantly from Africa (64%) or Asia (25%). 1,528 (61.6%) individuals were from West African nations: Senegal (42%), Ghana (7.7%), Guinea (7.7%), Ivory Coast (7.5%) and Burkina Faso (6.7%). The overall HBsAg+ rate was 10% (n=243), though higher in West Africans (12%, n=183). West Africans were more likely than non-West Africans to be HBsAg+ (12.0% vs. 6.5%, p < .0001), HBcAb+ (78.6% vs. 39.9%, p < .0001), but less likely to be insured (24.9% vs. 34.4%, p < .0001), or have a primary care physician (26.6% vs. 37.0%, p < .0001). A PN successfully contacted 98% of HBsAg+ individuals. In West African HBsAg+ subjects, 137 (74.9%) have attended an appointment, 35 (19.1%) are actively being linked to care, and 11 (6.0%) refused care or were lost to follow up. In those who attended an initial appointment, 49 (35.8%) were retained in care (one visit in the past 4 months). Conclusion: The high rate of patients who attended an appointment with a hepatitis provider establishes the effectiveness of culturally targeted patient navigation in linking at-risk African persons to access HBV care. Yet, the low rates of insurance, established primary care, and retention in care among West African patients highlight the vulnerability of this population to become lost after initial linkage unless ongoing culturally targeted PN and care coordination programs are enacted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".