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Addressing Disparities in California’s Testing and Treatment for Hepatitis B and C

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The Centers for Disease Control and Prevention, the United States Preventive Services Task Force, and the American Association for the Study of Liver Disease all recommend testing of adults for hepatitis B and C.

SACRAMENTO, CA — Assemblymember Evan Low (D-Silicon Valley) and Assemblymember Mike A. Gipson (D-Carson) on Monday announced the introduction of AB 789 to close disparities in diagnosis and treatment of hepatitis B and C by expanding testing and referral to care.

The bill, which is co-sponsored by the Health Trust and State Treasurer Fiona Ma, was created in collaboration with the Asian Liver Center at Stanford University. Passage of the bill — co-authored by Assemblymember David Chiu (D-San Francisco) — would make California the first state in the country to require health facilities to offer voluntary hepatitis B and C testing. “Even before the pandemic, we saw firsthand the devastating inequities in California’s health care system,” Assemblymember Low said. “Hepatitis B and C affect communities of color — most notably Asian and Pacific Islander Americans and the Black community — at a disproportionate scale that is unjust and demands immediate action. We can save lives, as well as improve the quality of life for thousands of people, by mandating tests that cost as little as $10. Anything less than getting this bill passed would be a disgraceful failure to act.” A 2018 study found that approximately 88% of people with chronic hepatitis B in California are members of the Asian and Pacific Islander (API) community. Meanwhile, Black Americans have the second-highest prevalence of chronic hepatitis B infection. If left undiagnosed and untreated, 15-25% of people with chronic hepatitis B will die prematurely from complications caused by the infection, including liver cirrhosis and liver cancer. Asian Americans are eight times more likely to die from hepatitis B than non-Hispanic White Americans, while Black Americans are 2.6 times more likely to die than non-Hispanic White Americans. Hepatitis C disproportionately impacts Black Americans, who are 2.9 times more likely to test positive than other racial groups. Black Americans account for about 15% of California residents with hepatitis C despite representing just 6.5% of the state’s population. “Hepatitis B and C are chronic illnesses that disproportionately impact marginalized communities,” Assemblymember Gipson said. “AB 789 is an important step forward in our fight to improve health for all Californians.”

The Centers for Disease Control and Prevention, the United States Preventive Services Task Force, and the American Association for the Study of Liver Disease all recommend testing of adults for hepatitis B and C. These services are covered by the Affordable Care Act and Medicare/Medicaid as routine preventive services. However, awareness of infections among patients remains critically low. Less than a third of people who have hepatitis B were aware of their condition, while only 60% of hepatitis C patients had knowledge of their infection, according to The Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025).

“Increasing access to screenings is crucial to improving health outcomes,” Assemblymember Chiu said. “This new effort will give patients the information they need and help save lives.” Treasurer Ma, who is co-sponsoring the bill, has made the expansion of proper testing and treatment a priority since she first learned of her condition. “For the past 15 years, I have been on the front lines around testing and vaccinations within the Chinese American community specifically,” Treasurer Ma said. “I was born with Hepatitis B. However, my doctors never really tested me for my first 40 years. The stigma, coupled with a lack of awareness by many medical doctors, pushed me to come out in 2007 to talk about my condition, and I have been the leading spokesperson of the SF Hep B Free Campaign ever since. This is why I am so proud to partner with Assemblymember Low and the Health Trust, in collaboration with the Asian Liver Center, on this bill that will save lives.” Hispanic Americans, Asian and Pacific Islander Americans, and American Indian/Alaska Natives account for an estimated 29% of individuals with hepatitis C in California. American Indian/Alaska Natives are nearly three times as likely to die from hepatitis C than non-Hispanic White Americans. “AB 789 comes as viral hepatitis cases continue growing and prevention and treatment efforts have stalled, especially among communities that are also disproportionately impacted by the COVID-19 pandemic,” said Michele Lew, CEO of the Health Trust, a Silicon Valley-based nonprofit operating foundation focused on improving health outcomes. “This legislation is a significant step forward toward building health equity and eliminating viral hepatitis B and C infections in California. We are honored to have this effort championed by Assemblymembers Low and Gibson, State Treasurer Ma and our partners at the Stanford Asian Liver Center, who address the devastating impacts these diseases have on our communities every day.” Dr. Samuel So, a Professor and the Director of the Asian Liver Center at Stanford University, noted that this legislation would help save the lives of people suffering from preventable diseases.

“Chronic hepatitis B and C infection have taken the lives of thousands of Californians and it is a major cause of liver transplantation,” Dr. So said. “Most of the complications — liver failure, cirrhosis, and cancer — as well as deaths are preventable, beginning with a simple one-time screening test followed by care and antiviral treatment recommended for persons who tested positive. AB 789 can eliminate a major health disparity that disproportionately affects our vibrant Asian American and Black communities.” Liver disease and liver cancer caused by hepatitis B and C account for more than a third of the liver transplants in California. Many lives can be saved with a one-time routine screening test for chronic viral hepatitis which costs as little as $10 and $14 for hepatitis B and hepatitis C, respectively. By mandating health facilities to offer voluntary testing at routine medical appointments, and providing care for treatment for persons who test positive, AB 789 will save lives and California taxpayer dollars. Assemblymember Low was first elected to the State Assembly in 2014. He represents District 28 constituents in Campbell, Cupertino, Los Gatos, Monte Sereno, and parts of San Jose. He is Chair of the Committee on Business and Professions, Chair of the Legislative LGBTQ Caucus, Vice Chair of the Asian & Pacific Islander Legislative Caucus, and co-Chair of the Legislative Technology & Innovation Caucus.

Additional Media Contacts:

Fiona Ma, California State Treasurer

Samuel So, MD

Victoria Ramirez, Health Trust


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