A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India.
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Community-Institutional Relations
DNA, Viral
/ blood
Delivery of Health Care
/ economics
Endemic Diseases
/ economics
Female
Genotype
Hepatitis B
/ blood
Hepatitis B Antibodies
/ immunology
Hepatitis B Surface Antigens
/ immunology
Hepatitis B virus
/ immunology
Hepatitis B, Chronic
/ blood
Human Migration
/ statistics & numerical data
Humans
India
/ epidemiology
Infant
Male
Mass Screening
Middle Aged
Models, Theoretical
Prevalence
Rural Population
/ statistics & numerical data
Seroepidemiologic Studies
Social Marginalization
Vaccination
/ economics
Viral Load
Young Adult
Journal
Hepatology (Baltimore, Md.)
ISSN: 1527-3350
Titre abrégé: Hepatology
Pays: United States
ID NLM: 8302946
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
05
05
2020
received:
03
01
2020
accepted:
12
06
2020
pubmed:
14
7
2020
medline:
13
10
2021
entrez:
14
7
2020
Statut:
ppublish
Résumé
Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India. We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV. Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.
Sections du résumé
BACKGROUND AND AIMS
Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India.
APPROACH AND RESULTS
We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV.
CONCLUSIONS
Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.
Identifiants
pubmed: 32659859
doi: 10.1002/hep.31461
pmc: PMC7883670
mid: NIHMS1668619
doi:
Substances chimiques
DNA, Viral
0
Hepatitis B Antibodies
0
Hepatitis B Surface Antigens
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1261-1274Subventions
Organisme : NIDDK NIH HHS
ID : T32 DK067872
Pays : United States
Informations de copyright
© 2020 by the American Association for the Study of Liver Diseases.
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