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HBV in Key Communities

CE / CME

HBV in Key Communities: Strategies to Overcome Barriers and Elevate Care

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.75 Nursing contact hour

Released: March 12, 2026

Expiration: March 11, 2027

Su Wang
Su Wang, MD, MPH, FACP
CME/CE Information

Activity

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Course Completed

Burden Of Chronic Hepatitis B Virus

Chronic HBV infections are the most common chronic infectious disease in the world. It is 6 times more prevalent than HIV and 5 times more prevalent than hepatitis C.1-4 In 2022, HBV resulted in 1.1 million deaths, primarily from liver cancer, which comes out to approximately 1 HBV-associated death every 30 seconds.1

It is also the leading cause, globally, of primary liver cancer. Unfortunately, liver cancer has quite a high mortality compared to other cancers and is the fastest-growing cause of cancer death in the United States.2

HBV is transmitted through contact with infectious blood only, not through casual contact or respiratory particles. The most common transmission route is mother-to-infant (vertical) transmission, which accounts for the majority of new cases globally. However, other mechanisms for HBV transmission include unsafe injection practices, sexual transmission, household contact with infectious blood, and horizontal transmission during childhood.1

Unlike HBV acquired in adulthood, almost all HBV infections in infancy and early childhood become chronic or lifelong. Thus, prevention early in life is key. The increased risk for chronic HBV in pediatric patients is a key reason why healthcare professionals (HCPs) put so much emphasis on infant and childhood vaccinations.1

In the United States, unfortunately, we are still seeing many acute cases of HBV in adults among people who are not vaccinated or not adequately vaccinated. Many new cases of acute hepatitis B in adults are likely fueled largely by the opioid epidemic and injection drug use.1 

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We are in the Era of Viral Hepatitis Elimination

Fortunately, despite the large number of new infections, we are in the era of viral hepatitis elimination. That is, we do have the tools for eliminating viral hepatitis B and C, such as screening diagnostics and effective prevention strategies, namely, vaccines. There is also treatment to help suppress virus replication and prevent disease sequelae.5,6 

Because we have these tools, in 2016, the World Health Organization (WHO) adopted the goal of viral hepatitis elimination by 2030, which is just around the corner. In the race towards this goal, great progress has been made with childhood vaccinations, blood safety, and injection safety. However, progress in diagnosis and treatment is lagging behind.5

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HBV and Inequity

This lag in diagnosis and treatment reflects inequity in access to HBV screening care.

These disparities can result from social determinants of health, such as education, employment, and access to healthcare. Hepatitis B, specifically, affects many people who are immigrants or migrants. These populations often face significant financial, cultural, and lingual barriers to healthcare access in the countries that they've moved to.7

Without intervention, the factors depicted in this slide create a vicious cycle in terms of barriers to healthcare, the social determinants of health, and negative health outcomes.

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High-Burden Communities

In the United States, certain key communities bear the brunt of the hepatitis B burden. Asian Americans, immigrants from Africa, and veterans have very high rates of hepatitis B and are often diagnosed at a later stage.8,9

Asian Americans make up over 50% of hepatitis B cases in the US, and perinatal transmission is common in this group. A significant barrier to care is language. This can be a very difficult obstacle to surmount, as Asian Americans are a very heterogeneous group, and there are many Asian languages. There is also stigma within the community that sometimes keeps people from even accessing care. Fragmented care, that is, healthcare occurring across multiple different facilities with different HCPs, makes it even more difficult for people to maintain continuity of care and ongoing access to care.10,11

Among immigrants from sub-Saharan Africa, there is a high rate of HBV prevalence. In Africa, HBV is the dominant risk factor for hepatocellular carcinoma (HCC), which is a major cause of premature death. This is likely due to the effects of HBV infection working in tandem with other environmental factors, such as exposures to aflatoxin or other carcinogens that also increase the risk of HCC.12,13

Finally, veterans also have a high rate of HBV prevalence of approximately 1%. This is almost 3 times the national prevalence of 0.3% to 0.5%.14 

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