Willie Kwong

June 20th, 2014

Proposed Policy Change: Proposed Policy Change: SixSix--Point Plan to Effectively Prevent & Manage HBVPoint Plan to Effectively Prevent & Manage HBV

� Create awareness of Hepatitis B among the most at-risk ethnic populations in BC via government funded HBV public health education

� Change existing policy on special prescription authority from annual renewal to permanent approval in order to reduce red tape, physician paperwork and compromise on drug treatment efficacy due to lapse time

� Build capacity by engaging BCMA (GPSC) to promote immunization, � Build capacity by engaging BCMA (GPSC) to promote immunization, treatment and management via educating the physicians

� Recommend HBV to be included in mandatory blood testing at health settings like HCV & HIV at hospital emergency to address pervasive under-diagnosis

� Improve PharmaCare coverage for low income HBV patients who drop-out of anti-viral drug treatment due to affordability

� Improve health management of HBV patients to prevent liver diseases by formally listing HBV on the Chronic Disease Management Program of BC

� Infectious disease that leads to life-threatening chronic conditions, such as cirrhosis, liver cancer, and death

� Symptoms are not apparent - HBV infection and liver diseases are often discovered too late for treatment and the liver is severely damaged

Hepatitis B (HBV)Hepatitis B (HBV)

the liver is severely damaged

� No complete cure is currently available, early detection and treatment can improve liver functions and improve survival outcome however

� In BC, majority of the infected individuals are Asian who contracted HBV at birth via vertical transmission. African and Aboriginal populations in Canada are also highly infected.

� Childhood / universal immunization program

� Early screening, diagnosis & intervention

� Effective anti-viral drug

Prevention, Treatment, and ManagementPrevention, Treatment, and Management

� Effective anti-viral drug treatment (if required) to slow down progression or reverse condition

� Chronic disease management (by patient & by physician)

� Liver transplant for liver cancer or death at end stage

The Most Vulnerable in B.C.The Most Vulnerable in B.C.

� Estimate @ 12% are infected on par with Asia (BC = 72K in Metro Vancouver). 1 in 17 new immigrants in BC each year is infected with chronic Hepatitis B

� Immigrant & descendent of Chinese, Korean, Filipino, South Asian and SE Asian origins

� Worldwide 78% liver cancer is caused by HBV

� HBV infected individuals have 100 times higher chance of developing liver cancer than non infected individuals

� WHO: 15%–25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis

Health Disparity and Gap in CareHealth Disparity and Gap in Care

� Culturally appropriate (in-language) public health education target to at-risk populations

� Effective Patient Self-management

ResearchResearch--based Solutions to Problem based Solutions to Problem Prevention & Disease Management Prevention & Disease Management

� Extending from a specialist treatment model to prevention & chronic disease management by GP

� Increase access to care by either training more ethnic language-speaking doctors or incorporate innovative projects (e.g. Medeo for accessing doctors online)

Sizable HBV AtSizable HBV At--risk Population in BC has no family doctor risk Population in BC has no family doctor and do not have annual check up including a blood test by a and do not have annual check up including a blood test by a

family physicianfamily physician

� U.S. Viral Hepatitis Action Plan ◦ http://aids.gov/pdf/viral-hepatitis-action-plan.pdf

� WHO 67th World Health Assembly “Hepatitis Response Plan” ◦ http://www.who.int/mediacentre/news/releases/2014/WHA-20140522/en/

External Evidences Supporting Proposed SixExternal Evidences Supporting Proposed Six--Point Plan & HBV Intervention SolutionsPoint Plan & HBV Intervention Solutions

◦ http://www.who.int/mediacentre/news/releases/2014/WHA-20140522/en/http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R6-en.pdf?ua=1

� U.S. recommended HBV screening to at-risk populations ◦ http://www.uspreventiveservicestaskforce.org/bulletins/hepbbulletin.pdf

� Canada recommended HIV screening to at-risk populations (as guideline for HBV) ◦ http://www.health.gov.bc.ca/pho/pdf/hiv-testing-guidelines-bc.pdf

Policy StrategyPolicy Strategy

Listing HBV on Chronic Disease

Management Program of BC

Policy Change in Special

Prescriptions Authority

Mandatory HBV

End Goal:Improved HBV

Health Outcomes

HBV education in Physician Education Program BCMA

Government funded HBV Public Education in At-risk

Populations Cultural Language

Mandatory HBV Testing in BC

hospitals & labs

Improve PharmaCare

coverage for low income HBV

patients

Stakeholder EngagementStakeholder Engagement

� At-risk ethnic communities (outreach & public health education) –“Seek & Educate”

� BC Health Ministry, BCMA (GPSC) – General Practice Services Committee

� BC Centre of Disease Control, BC Health Authorities � BC Centre of Disease Control, BC Health Authorities (immunization, epidemiology, health promotion & new initiatives)

� Medical & health allied professional, ethnic medical doctors associations

� Community based groups that offer health programs (e.g. Chronic Disease Self Management Education (CDSMP) to share knowledge

3P Partnerships3P Partnerships

� SUCCESS HBV Medical Advisory Committee – UBC Faculty of Medicine, Division of Gastroenterology, the BC Hepatitis Program VGH

Intercultural Online Health Network (iCON), � Intercultural Online Health Network (iCON), Canadian Liver Foundation (CLF)

� Private pharmaceutical firms – resource sponsorship (e.g. physician education program, health education program promotion)

Policy Ask & Funding Priorities Policy Ask & Funding Priorities Call for ActionCall for Action

� Funding of $xxx,xxx to SUCCESS for a Pilot Project to provide HBV education in ethnic languages to Chinese, Korean, Filipino, South Asian & SE Asian communities in Metro Vancouver

� Issue a Ministerial Order to change policy regulation of the special prescription authority from annual application to indefinite approvalprescription authority from annual application to indefinite approval

� Include mandatory blood test for HBV at hospital emergency and routine screening at BC laboratories like HIV & HCV

� BC Health Ministry commitment to be engaged by SUCCESS to work on BCMA (GPSC) to address physician education on HBV, PharmaCare coverage for low income HBV patients & formal listing of HBV on BC Chronic Disease Management Program

HBV Pilot Project HBV Pilot Project ImplementationImplementation

� Project Charter, Advisory Committee, Staff team, budget, work plan, targets and schedules

� Culturally appropriate education curriculum incorporating available health resources in BC to “activate” public to take actions (i.e. get tested for HBV)

Targeting at-risk ethnic populations (Korean, Chinese, � Targeting at-risk ethnic populations (Korean, Chinese, South Asian and Filipino) via existing and new community networks to disseminate / deliver HBV education

� Participating in cultural events to promote HBV education opportunities (e.g. Chinese New Year, Philippine Independence Day, etc.)

� Use of social media & website to increase reach target populations and health organizations

� Project evaluation & report to BC Health Ministry

Evaluation & Outcome MeasuresEvaluation & Outcome Measures

� Contract an external health education program evaluator (iCON)

� Pre- and post- design with follow ups to determine change in awareness, attitudes, and health behaviors of targets reachedtargets reached

� Patient Activation Measurement (PAM) to measure “activation” level and the effectiveness of culturally appropriate program on changing health behaviors

� Program evaluation indicators (metrics) to determine reach and effectiveness of the program

Thank youThank you

For more information, contact S.U.C.C.E.S.S.