Table 2 Themes and codes

Partnership involvement

Benefits of the ACG partnership

Synergistic Partnership With current project goals, the community partners are now contacting other communities in need and not just the population previously served:

• “So we’re able to actually tap into a Hispanic group. We also did some LGBT (lesbian, gay, bisexual, and transgender) groups, as well. And we also got into the people, PWID (people who inject drugs), so we actually get to the community as well. So with that project that actually helped us expand even further out.” (community partner)

Three organizations working together for a common goal—betterment of the community:

• “But what I do see is most of these agencies and centers never interact with the academic community. And I think this partnership is showing them or at least making them aware of the fact that the universities also see this as a problem, hepatitis B in the U.S., so I think from that end, it probably makes them feel good that they’re not the only ones who are saying this is a problem. But the universities with the big hospitals also see that’s an issue.” (community partner)

• “[…] actually bring a large segment of different areas of service of public health service to the table is a big accomplishment and a big positive.” (government member)

New Knowledge

Partnership members are gaining new knowledge regarding HBV throughout this partnership project:

• “I think we’ve learned a lot, or there’s an opportunity to learn a lot in terms of where the gaps are, what kind of things are needed to improve services for this population.” (academic member)

• “Work with the partnership has increased my awareness of HBV, my understanding of the disease and of the morbidity, mortality, statistics, and how it impacts especially our Asian immigrant and African immigrant communities, and Hispanics, not only here […] but nationally.” (community partner)

Organizations have expanded their network due to current partnership:

• “So just trying to work closely with them to better understand their networks, and how we can leverage that, in order for all of us to just be in communication and helping one another and spreading resources for the patients to reduce liver disease.” (government member)

The partnership is working together, making small incremental steps to reduce disparities for better community health:

• “So it’s small, incremental things, making positive, incremental changes, that’s what we’ve been doing. And I think what’s reflected on the community, it may not be overnight, but you can see the impact over time.” (academic member)

ACG partnership project goals and accomplishments

Year 1 Goals

Goals for ACG partnership

To achieve the goals of ACG partnership and increase communication between

partners:

• “My expectation is to achieve all our goals, and we work towards achieving the goals and hopefully to exceed as well. […] I was expecting to have better communications.” (community partner)

Quarterly reports

• “Every quarter, we have a quarterly report.” (academic member)

HBV-related Goals

Education and linkage to care:

• “We hope to during the first year… educate more people about the prevalence and have hepatitis B, and then we hope to connect them also with resources that are in the communities.” (community partner)

Screening:

• “[…] getting more people to screen […] We need more funding for more screening, more outreach.” (community partner)

Vaccination:

• “They were trying to see if they can increase the number of people who were vaccinated, those coming from the high endemic areas of hepatitis B, etc., and also increase the vaccination and follow up for pregnant women and children.” (community partner)

Resources:

• “Resources as, like I said, a lot of our patients don’t have insurance. So they …have to pay out of pocket to see a doctor. But even you know, most of our patients can’t afford that. And then on top of that, if they’re positive and their viral load is high, they need medication. And unfortunately, you know, hepatitis B has no cure. So they’re going to be on medication and monitoring their entire life. So a lot of people with that extra expense, they’re not going to be compliant with medication and getting checked every six months. So resources would be providers that see patients just for free, or medication programs for free. … So location, transportation also falls into that category [of] resources. And then the last thing is vaccination because the Asian community has a higher risk of HBV, we usually recommend that they [and] their family get vaccinated.” (community partner)

Not sure of goals:

• “I don’t know if they didn’t get or not.” (government member)

Accomplishments so far

HBV-related accomplishments

Exceeded objectives:

• “We exceeded all our deliverables. And even during this pandemic.” (community partner)

Related to COVID-19:

• “Especially with this year, COVID, there’s had to be a lot of adjustments made in terms of how to effectively reach the target population, and keep them safe.” (community partner)

ACG partnership goals

Building capacity:

• “I think things happen along the continuum. I think that we have made some progress in terms of building capacity, in terms of engaging the community, but I think the real impact is not there yet.” (academic member)

Funding and leadership:

• “And that’s funding […] and with the leadership […] has been very successful around funding.” (community partner)

Presentations:

• “All the presentations […] at least four or five on the first years and completing, finishing all the other reports quarterly report.” (academic member)

Having everyone at the table:

• “Being able to pull all the partners together at the table is definitely part of the milestone to get people or organizations involved. So, that part? Yes. The details of the execution, I think is an ongoing.” (community partner)

• “When they do test positive, there’s about 4 to 5% who test positive for B and about 2 or 3% for C, and all those individuals are contacted and linked to care services.

And so right now, I think there’s a little bit more effort being put into following up with those individuals to see whether or not they are actually seeking treatment and on schedule for treatment.” (community partner)

• “I think that the way in which they were able to bring a mix of academia, direct service providers, and government to the table, it’s always progress. And this is a major step towards doing much larger to have an impact on community health. I think that that was a terrific approach. And clearly, they weren’t doing that. Clearly they weren’t achieving that. But we were all at the table.” (government member)

Others:

• “I think it accomplished that particular goal. And that’s to take a program that’s on paper and to operationalize it. And to have good reporting systems, have a good relationship between the partners, which the program has. There’s excellent relationships between the partners. Good data. So I think it accomplished having the data. And I think more importantly than all of that, well, maybe as a result of all of that, what I think we all were able to, to actually to actualize was to be considered probably the best program in the country, among the five or six demonstration programs that were funded over a year ago with the system’s good data.” (community partner)

Future goals for screening

Sustainability of screening and vaccination:

• “We need to work towards the sustainability of the screening for the hepatitis screening either at the clinics or private doctor’s offices. And then the vaccination as well.” (community partner)

Involving “champions” in the community:

• “What I hope to tackle next year is to be able to build around us people like champions in the community that will be able to multiply what we do in one place to other places.” (community partner)

Birth dose:

• “Most of the clinics, and even the centers that are in this partnership do not work directly with pregnant women. And I think that’s one of the requests of the grant. So hopefully, they’ll find a way of incorporating that in the second and third year.” (community partner)

COVID-19:

• “I think it’s also going to depend on this vaccination for COVID-19. And how successful that would be because then people will then start feeling comfortable to come into the clinics and the centers. And then the providers also feel comfortable going out to meet people to do the work. So, but I think they’re doing a really, really good job.” (community partner)

Working with other community organizations, churches:

• “As we all know, the people from the endemic areas are mostly people who are very religious, and the churches are still open. So if we’re able to access the churches and do trainings in the churches, we’ll still be able to reach the target population.” (community member)

Educating community about COVID-19:

• “[…] helping to educate the population about COVID.” (academic member)

Screening, educating, vaccinating:

• “Just screen as many patients as we can, provide education, more vaccines to prevent HBV and get people treated and linked if they test positive.” (community member)

Health Fair:

• “So we are planning a health fair […] So we have more people vaccinate, and we have more people come out for the health fair, and it’s always a good way for us to boost up the number.” (community member)

Future goals for ACG partnership and recommendations

Goals for systems

Continuity of care:

• “The first area has to do with how well governmental partners such as the health departments work together with the community partners, so that there’s much more of an ability to have continuity, especially for those persons who are HBV positive, helping to make sure that the reporting systems between community and governmental entities are strengthened. Also, so that’s much more of your health information exchange goal that’s in the proposal. So I’m hoping that in Year Two and Year Three that gets attention.” (community member)

EMR, standardizing screening:

• “There is a goal related to electronic medical records so that HBV becomes a part of anyone’s care coming in through the door. […] So standardizing HBV screening and care as part of patient care is important.” (community member)

Raising awareness about HBV among minorities:

• “Raising awareness, letting people know that there’s a lot of communities like Asians and Africans, where HBV is prevalent, and it’s not just because of STDs, but it’s because of where these are from. So that people are aware that there are big groups of hepatitis B positive patients that need to be addressed. So that we aren’t spreading.” (community member)

Dissemination:

• “There could be a summit or some sort of conference. There could be a creation of some sort of case consultation, for example, around perinatal hepatitis B. There could be engagement with medical providers around hepatitis B as an issue. There could be a coordinated activity where maybe one day is selected to actually promote and provide, for example, hepatitis B-related services. Whether it’s general community education, or otherwise, an emphasis on testing, for example, but that it would happen in multiple sites at the same time and promoted by all as one group one body.” (government member)

Refine Project in the context of COVID-19 pandemic:

• “We need to now begin to think in the context of implementing this program. In the context of COVID… COVID will still be with us next year. So the issue of safety precautions and ensuring implementation of community testing and community events in a safe manner will still be very relevant, so that context needs to be built into the program. […] Nobody was thinking of COVID before. Implementing this kind of program, this academic, community, and government partnership project to reduce hepatitis B virus, needs to be built with a strong context around COVID-19 in mind.” (government member)

Other objectives

Birth dose:

• “Another thing came up more recently is the birth dose, Hep B birth dose […], engagement, and tracking and that kind of things. And mostly previously, it’s more on immigrants - African and Asian. So we need to figure out how to engage with pregnant women and get into vaccinating when they have a baby within a day. So that would be one thing we hope to accomplish with documented changes and interventions and see we can get something done.” (academic member)

Unsure

Unsure about goals for Years 2 and 3:

• “That I’m not sure.” (community member)

Need for clear communication and attendance in meetings to better understand project goals:

• “We weren’t included in more of those meetings that may help us better understand other partners who are involved in other parties that we can leverage or who may be interested in working with us.” (government member)

• “If we were to attend more meetings, I definitely think that could be advantageous to us.” (government member)

• “And so what I really do hope for the project is that they continue to work together as a partnership. And really solidify that partnership and a couple of areas that are in the grant proposal that still needs strengthening.” (community member)

• “Hopefully, we can have more engagement, communication, a meeting. So currently, for example, just some of us meeting more regularly. Hopefully will be more frequent. But this could be a downside to that. And just more time will be involved.” (academic member)

ACG partnership project challenges and barriers

Overall challenges so far

ACG partnership

Time to communicate:

• “It’s a major barrier and challenges with the partnership. It’s coordinating the time to communicate. Coordinating and scheduling time to coordinate. […] And we were planning to do three meetings for Year One. But the third meeting, we’re not able to do because of COVID, and that’s our biggest challenge.” (community member)

Addressing birth dose:

• “One of the challenges is that one of the goals was to focus on birth dose and trying to identify the best way to look at that, measure that, examine that. So that’s been a challenge. And so I think the team has been really working hard trying to identify ways they could address birth dose.” (academic member)

Being clear on goals and outcomes:

• “One challenge, again, is that I think the whole partnership needs to be clear on what the overall goals are, and what the outcomes are. So that has not been as transparent as I think I would like.” (academic member)

HBV

Reaching out to target population:

• “The barriers during the first year I think it was basically to get the word around and then get the people we found positive to get treatment.” (community member)

Lack of ability to reach out to the community and other racial/ethnic minorities:

• “What we lack is the ability to reach out to the community and other ethnicity organizations.” (community member)

Mistrust from community:

• “We had to learn ways to adapt. […] What are you here for, there’s no such thing as free. So that’s always a barrier, is there cost or the hidden costs?” (community member)

Working with three different communities:

• “We have to be cognizant that each of these has their own dynamic within their community, how they are seeing, who they connect with, what, how they can work with their policymakers, so on and so forth, how they work within their medical and health, infrastructure within that community. I think that’s the part that may be lacking a bit. How do we build up each of our partners within the networks that they live within?” (community member)

Anticipated future challenges and barriers and recommendations to overcome challenges

Related to HBV

Continued challenges due to COVID-19:

• “The challenges so far remain just the COVID issue. […] And we hoped that it can get in control as soon as possible so we can go back to those large physical settings that we use to do in order to educate more people.” (community member)

Related to ACG Partnership

Lack of funding:

• “I think funding, funding from CDC is a major barrier and that needs to be brought to their attention.” (community member)

• “Funding is usually a major barrier.” (community member)

Transparency of partnership goals and outcomes:

• “One challenge, again, is that I think the whole partnership needs to be clear on what the overall goals are, and what the outcomes are. So that has not been as transparent as I think I would like.” (academic member)

Equitable relationship with partners:

• “I would make sure that the community partner, their relationship is equitable, that it is not so academic driven.” (academic member)

Challenges in Health Information Exchange:

• “Building up that capacity around EMR systems, I think that’s going to go on for a while. And hopefully, we can get that together so that it becomes standardized practice.” (community member)

Challenges in evaluation and sustainability of the program:

• “So I do think that heading toward the middle of Year Two and Year Three, there has to be a conversation about the partnership, whether it’s a partnership that’s going to disappear, or whether there are monies that hold the partnership together, or even without money as what other things do they have in common that really motivates them to stay together as a partnership. That’s going to be a challenge.” (community member)

Completion of the project:

• “So we have one year, a few months under our belt. And I think one challenge …, we have to be more open to different audiences, different settings, and engage with different populations. So that could be a challenge as well. So that’s why we hope for completion but the challenge for us is the pandemic.” (academic member)

Time commitment:

• “In the perspective of managing the national task force and hepatitis B, we have monthly meetings. And I think one of the biggest challenges of having standing meetings is the time to time commitment, especially, if you’re asking individuals who are not doing this as a full-time job, to carve out some time during the workweek to meet, I think that could be potentially one of the biggest challenges if this is not their full-time job.” (community member)

ACG partnership involvement in government or policy

Current involvement in government or policy

Current involvement in government or policy:

• “Your local department of health is sort of like your policy agency, in many respects, at least for local policy. So the fact that we’ve been at the table would sort of lead to that.” (government member)

Not currently involved in government or policy:

• “We are so busy doing the groundwork, doing the grassroots work. So we never have an opportunity to talk to the government or the academic.” (community member)

• “I don’t think this project is involved in any of the policy.” (community member)

Uncertain:

• “I believe so. So I myself didn’t really pay a lot of attention on the policy level, because [I am] occupied with tasks.” (community member)

• “I’m not sure about this answer, but I will, I would think yes, but I’m not sure about this answer.” (community member)

• “To the best of my knowledge, I have no idea. I really don’t.” (community member)

Future recommendations for involvement in government or policy

Increase Community Testing/Screening, Vaccination, and Education

Increase testing available to minority population:

• “Hepatitis B vaccination should be made available free for people who don’t have insurance, especially for the adult population.” (community partner)

Immigrant Health Policy

Dissemination of findings to legislatures interested in immigrant health:

• “In the Chinese community, the medical community, there are professionals trying to advocate for the community for hepatitis B, hepatitis B resource. So I know, at least like 10 years ago, a physician, […] he was able to really go to the Capitol Hill and fascinate the Congress. So we have an event like that. And he was very successful.” (community partner)