Tuberculosis and chronic hepatitis B virus infection screening among non-U.S.—born persons in an integrated health system in California

Abstract

Background Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection both disproportionately affect non-U.S.—born persons. Early identification and treatment are critical to reduce transmission, morbidity and mortality, but little is known about screening in the United States. Methods We conducted a cross-sectional study in a large, integrated California health system in September 2022 assessing TBI and HBV screening among persons aged ≥18 years born in countries with high TB (TB disease incidence rates ≥20/100,000 population) and/or HBV (hepatitis B surface antigen seroprevalence >2%) burden. Results Of 510,361 non-U.S.—born persons born in countries with high TB burden, 322,027 (63.1%) were born in countries with high HBV burden and 188,334 (36.9%) were born in countries with only high TB burden. Among persons born in countries with high TB and HBV burden, 29.6% were screened for TBI, 64.5% were screened for HBV, and 23.4% were screened for both TBI and HBV; 9.9% had TBI and 3.1% had HBV infection. Among persons born in countries with high TB burden only, 27.9% were screened for TBI and 7.5% had TBI. Conclusions Among non-U.S.—born persons from countries with high TB and HBV burden, we found low screening rates and elevated prevalence of TBI and chronic HBV infection. Co-testing for TBI and HBV infection in non-U.S.—born persons from countries with high TB and HBV burden might improve outcomes by identifying persons who warrant TBI treatment, HBV treatment, or HBV vaccination. Increased screening is the first step in reducing health inequities and overall disease burden.