Ameer Abutaleb1,2, Mousumi Khatun3, Jean Clement1, Ayana Baidya3, Pratibha Singh4, Simanti Datta3, Sk Mahiuddin Ahammed3, Koshy George4, ParthaSarathi Mukherjee5,6, Amal Santra3,6, Suvadip Neogi6, Sachin Parikh6,7, Vivek Pillai6,7, Shyam Kottilil1, Abhijit Chowdhury3,5,6. 1. Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD. 2. Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, MD. 3. Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India. 4. Baptist Christian Hospital, Tezpur (Emanuel Hospital Association), Tezpur, Assam, India. 5. Indian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India. 6. John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India. 7. CTIS, Inc., Rockville, MD.
Abstract
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.
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.
Authors: Kate L Mandeville; Justus Krabshuis; Nimzing Gwamzhi Ladep; Chris J J Mulder; Eamonn M M Quigley; Shahid A Khan Journal: World J Gastroenterol Date: 2009-06-21 Impact factor: 5.742
Authors: Nick Scott; Anna Palmer; Christopher Morgan; Olufunmilayo Lesi; C Wendy Spearman; Mark Sonderup; Margaret Hellard Journal: Lancet Glob Health Date: 2018-06 Impact factor: 26.763