Sirisha Gaddipati, MD

While hepatitis B virus (HBV) screenings are difficult to implement within the community, a new dried blood sample testing program could help improve screening numbers, particularly in communities with large immigrant populations.

A team, led by Sirisha Gaddipati, MD, University of Miami/Jackson Health System, assessed the feasibility of dried blood spot tests to screen for HBV at medical-student run, free community health fairs and to understand factors influencing acceptability of this type of test.

The data was presented during the 2022 American College of Gastroenterology Annual Meeting in Charlotte.

HBV in the Community

Chronic HBV infections are a major global health problem, with rates in Florida higher than the national average, which reflect immigration patterns.

There also remains certain barriers in place that prevent better screening for HBV.

The Pilot Study

In the pilot study, the investigators invested participants to attend 2 of the University of Miami’s Mitchell Wolfson Sr. Department of Community Service (DOCS) health fairs in December 2021 and April 2022.

Each patient was invited to participate and complete a questionnaire assessing HBV screening acceptability. Each individual who agreed to screening had fingerstick performed and dried blood sport testing. The DBS samples were processed for hepatitis B surface antigen, with the results returned to DOCS student personnel.

Each individual was provided results through either a letter or a telephone call according to a pre-specified schema over 3-4 weeks.

Concerns

Overall, 82 participants agreed to receive DBS testing, 28% of which reported that the aspects of the program made them feel uncomfortable, largely (78.2%) because of the long turnaround time for results. Additionally, 69.9% said a lack of financial resources should treatment have necessarily made them uncomfortable. However, 72% found the proposed screenings acceptable.

However, this group said other community members could be uncomfortable with screening because of a lack of immediate results (33.9%) and a lack of resources for treatment (30.5%).

As for the actual testing results, 73 patients tested negative, 8 patients had insufficient samples for adequate screening and 1 patient received preliminary positive findings for HBV infection.

“In a community health fair setting, we found that using DBS to screen for HBV was acceptable among most participants receiving similar health screenings,” the authors wrote. “Offering screening tests with faster turnaround time for results could improve acceptability.”

However, there is now a need to improve how clinicians and screeners use dried blood tests.

“The finding of insufficient samples highlights the need for quality improvement training to obtain adequate blood samples,” the authors wrote. “Participant concern regarding lack of financial resources if treatment is needed has been reported in other studies. Future studies will examine acceptability at other health fairs with different demographics and a cost-benefit analysis of routine screening for HBV amongst vulnerable patients.”

The study, “Acceptability and Feasibility of Hepatitis B Screening Using Dried Blood Spots in a Free Community Health Fair Setting,” was published online by ACG.