persons (16%), men who have sex with men (18%), and injection-drug users (IDUs; 23%) as having a higher prevalence of chronic hepatitis B than Chinese immigrants (Lai et al., 2007). In the same study, 30% of the respondents were not able to identify the correct test to use for diagnosing chronic HBV infection.
A cross-sectional survey conducted among 217 members of the New Jersey Academy of Family Physicians found that a higher proportion of family physicians recommended screening for hepatitis B among men who have sex with men (93%), IDUs (95%), and HIV-infected patients (96%) than for immigrants from Southeast Asia (68%) or sub-Saharan Africa (57%)—areas that are highly endemic for HBV with over 8% seroprevalence of hepatitis B surface antigen (HBsAg) (Ferrante et al., 2008). Only 50% of survey participants recommended screening household contacts of persons who had chronic HBV infection—an established high-risk population. Finally, 21% of the New Jersey family physicians did not know what step to take next if a patient tested positive for HBsAg or would refer such a patient to a specialist for followup (Ferrante et al., 2008). However, 83% of the respondents were interested in receiving education about chronic viral hepatitis.
Chu (2009) presented data at the 2009 International Symposium on Viral Hepatitis and Liver Disease that showed that only 18–30% of Asian American primary care providers who treat Asian American adult patients reported routinely testing them for HBV infection in their practice. That finding illustrates the incomplete knowledge even among primary care providers who themselves constitute a group at high risk for chronic HBV infection.
At the 2007 Society of General Internal Medicine annual meeting, Dulay et al. (2007) reported on the results of a multiple-choice hepatitis B knowledge survey completed by 196 attendees at a university-based continuing-medical-education conference for primary care providers, including nurse practitioners and physician assistants. Of the respondents, 55% were not able to identify HBsAg as the determinant for chronic HBV infection. Knowledge about the appropriate use of the HBsAg test was substantially higher among primary care providers who were Asian (68%) than those of other ethnicities (43%), among physicians (56%) than nonphysicians (23%), and among providers who had more years of experience or more time spent in the clinic. Some 44% of the respondents did not know that chronic HBV infection could be controlled with medication, and 25% incorrectly responded that chronic HBV infection is curable.
Given that the probability of developing chronic hepatitis B is highest when infants are exposed to HBV through their mothers at birth, both the US Preventive Services Task Force and the US Centers for Disease Control and Prevention (CDC) recommend testing all pregnant women for HBsAg