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Mindie Nguyen, MD, MAS, AGAF, FAASLD:
Approximately 290 million people globally are infected with HBV. Cases are not evenly distributed, with the largest disease burden from Asia and a smaller, but still substantial, burden from Africa.1
Approximately one third of patients with HBV are eligible for treatment, but just 9.9% (approximately 28.7 million people) are diagnosed, and only 1.6% (4.6 million) are on antiviral treatment. This poor care cascade leaves a large global burden of undiagnosed and untreated HBV-infected individuals, especially in Asia and Africa.
As a result, two thirds of people with HBV infection in the United States are foreign-born, and most are from either Asia or Africa.
In studies of immigrants in Europe, the prevalence of HBV was reported to be 7.4% to 15% among immigrants from sub-Saharan Africa to Western Europe and 11.7% to 15.3% among Albanian refugees in Greece. In Germany, the Turkish community comprises 20% of the population, and the HBV prevalence among this community is 5%. In England and Holland, HBV was found in 8.5% of Chinese immigrants.2
Many western countries have become destinations for immigrants, asylum seekers, and refugees from Africa, Eastern Europe, Asia, and Central America. These individuals may arrive from various situations—persecution, war, genocide, poverty—and are often destitute. Many may not speak the language of their host country, and it may be difficult for them to integrate into a new place. They may not be able to seek employment or have meaningful employment for the first several years following their arrival. Some immigrants may also want to appear healthy despite harboring HBV or other chronic diseases.2
These factors lead to numerous gaps in the care cascade for immigrants. Gaps in care include suboptimal screening, diagnosis, and evaluation. Patients who are diagnosed are less likely to be connected to appropriate care and more likely to be undertreated, based on professional society treatment guidelines. There is also suboptimal surveillance for liver cancer among this population.