Feasibility and Acceptability of Universal Adult Screening for Chronic Hepatitis B in Primary Care Clinics

Abstract

IntroductionTwo-thirds of Americans infected with chronic hepatitis B (CHB) are unaware of their infection. In March 2023, the CDC recommended moving from risk-based to universal adult CHB screening. In April 2022, Stanford implemented CHB universal screening discussion alerts for primary care providers (PCPs). MethodsAfter 6 months, we surveyed 143 PCPs at 13 Stanford primary care clinics about universal CHB screening acceptability and implementation feasibility. We conducted semi-structured interviews with 15 PCPs and 5 medical assistants (MAs) around alerts and CHB universal versus risk-based screening. Results45% of surveyed PCPs responded. 63% reported that universal screening would identify more CHB patients. Pre-implementation, 77% ordered 0-5 CHB screenings/month. Post-implementation, 71% ordered more than 6 screenings/month. 66% shared that universal screening removed the stigma around discussing high-risk behaviors. Interview themes included: 1) Low clinical burden; 2) Current under-screening of at-risk groups; 3) Providers preferred universal screening; 4) Patients accepted universal screening; 5) Ease of CHB alert implementation. ConclusionsConsistent with CDC guidelines, implementing universal CHB screening in primary care clinics in Northern California were feasible, acceptable to providers and patients, eased health maintenance burdens, and improved clinic workflows.