Hepatitis B Screening and Awareness in the Milwaukee Hmong Community

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.

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.

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].

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.