University of Wisconsin–Madison Medical College of Wisconsin

Hepatitis B Screening and Awareness in the Milwaukee Hmong Community

Sindalana Hean, MD; Tuong Van Nguyen, MD; Tim Wang, MD; Steven Hur, MD; Chris Johnson, MD; Alina Leung, MD; Heather Chou, MD; Janna Lam Keenan, MD; Anna Patel, MD; Kia Saeian, MD, MSc Epi

WMJ. 2021;120(2):114-119.

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Introduction: Hepatitis B virus (HBV) infection disproportionately affects the Hmong ethnic group, with reported US prevalence rates up to 20%, but data for Wisconsin’s large Hmong community is lacking. We assessed the prevalence of HBV at Hmong screening events and whether small-group counseling affects HBV knowledge.

Methods: Free HBV screening events were held in Milwaukee, Wisconsin at a Hmong market, a local church, and annual Hmong New Year festival. Eligible Hmong subjects age 18 years and older also were invited to complete a 15-point survey on HBV knowledge at baseline and after education sessions. Hmong interpreters were available, and free HBV screening was offered.

Results: A total of 187 participants were tested for HBV, and 161 completed surveys. After education sessions, the mean knowledge score rose to 10.6 (71%) vs the pre-education score of 6.7 (45%) (P < 0.0001). Active HBV [HBsAg(+) HBsAb(-)] was diagnosed in 18 participants (9.6%), 53 (28.3%) were susceptible [HBsAg(-) and HBsAb(-)], 5 (3.4%) were in the gray zone [HBsAg(-) with low/inadequate HBsAb(+) titer], and the remaining 110 (58.8%) were immune [HBsAg(-)/HBsAb(+)]. Of the 18 individuals with active HBV, 13 were male and 5 were female [age range 24-66].

Conclusion: Despite evidence that small-group education with visual aids is effective in enhancing HBV knowledge in the Hmong population, a significant knowledge gap remained on post-education scores, suggesting that better tools or repeated interventions may be warranted. While we acknowledge that this convenience sampling may have introduced biases, the rate of active HBV infection in Wisconsin is much higher than general US population reports, and a quarter of those tested were found to be susceptible to HBV.

Author Affiliations: Department of Internal Medicine, OptumCare Medical Group, Torrance, California (Hean); Department of Obstetrics and Gynecology, Kaiser Permanente, Orange County, California (Ngueyn); Department of Gastroenterology & Hepatology, UCSF Fresno, Fresno, California, (Wang); Department of Anesthesiology, Medical Anesthesia Consultants, Walnut Creek, California (Hur); Department of Anesthesiology, Valley Anesthesiology Consultants, Phoenix, Arizona (Johnson); Department of Pediatrics, Kaiser Permanente, Tracy, California (Leung); Department of Pediatrics, Kaiser Permanente, Sacramento, California (Chou); Department of Pediatrics, The Everett Clinic, Marysville, Washington (Keenan); Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin (Patel, Saeian).
Corresponding Author: Kia Saeian, MD, MSc Epi, Konrad H. Soergel MD and Walter J. Hogan MD Endowed Professor, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 414.955.6848; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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