The proposed 6-point plan aims to effectively prevent and manage Hepatitis B virus (HBV) in British Columbia. The plan includes: 1) Creating HBV awareness among at-risk populations through public education; 2) Changing policy to allow permanent special prescription approval; 3) Engaging physicians to promote immunization and treatment; 4) Requiring HBV testing in hospitals; 5) Improving coverage for low-income patients; and 6) Formally including HBV in chronic disease management programs. The proposal argues that HBV disproportionately impacts ethnic communities in BC and improved prevention, screening, and management could reduce related health issues.

1. Willie Kwong
June 20th, 2014

2. 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

3. 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.

4. 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

5. The MostVulnerable in B.C.The MostVulnerable in B.C.
Estimate @ 12% are infected on par with
Asia (BC = 72K in MetroVancouver). 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

6. Health Disparity and Gap in CareHealth Disparity and Gap in Care

7. Culturally appropriate (in-language) public health
education target to at-risk populations
Effective Patient Self-management
ResearchResearch--based Solutions to Problembased Solutions to Problem
Prevention & Disease ManagementPrevention & 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)

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

9. 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

10. 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

11. 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 AuthoritiesBC 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

12. 3P Partnerships3P Partnerships
SUCCESS HBV Medical Advisory Committee – UBC
Faculty of Medicine, Division of Gastroenterology,
the BC Hepatitis ProgramVGH
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)

13. Policy Ask & Funding PrioritiesPolicy 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 MetroVancouver
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, Pharma
Care coverage for low income HBV patients & formal listing of HBV
on BC Chronic Disease Management Program

14. HBV Pilot ProjectHBV 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 NewYear,
Philippine Independence Day, etc.)
Use of social media & website to increase reach target
populations and health organizations
Project evaluation & report to BC Health Ministry

15. 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

16. Thank youThank you
For more information, contact
S.U.C.C.E.S.S.