A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India

Hepatology. 2021 Apr;73(4):1261-1274. doi: 10.1002/hep.31461. Epub 2021 Jan 22.


Background and aims: Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India.

Approach and results: We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV.

Conclusions: Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Community-Institutional Relations
  • DNA, Viral / blood
  • Delivery of Health Care / economics
  • Delivery of Health Care / statistics & numerical data*
  • Endemic Diseases / economics
  • Endemic Diseases / prevention & control
  • Endemic Diseases / statistics & numerical data
  • Female
  • Genotype
  • Hepatitis B / blood
  • Hepatitis B / epidemiology*
  • Hepatitis B / etiology
  • Hepatitis B / therapy
  • Hepatitis B Antibodies / immunology
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B virus / immunology
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / epidemiology
  • Hepatitis B, Chronic / etiology
  • Hepatitis B, Chronic / therapy
  • Human Migration / statistics & numerical data*
  • Humans
  • India / epidemiology
  • Infant
  • Male
  • Mass Screening
  • Middle Aged
  • Models, Theoretical
  • Prevalence
  • Rural Population / statistics & numerical data
  • Seroepidemiologic Studies
  • Social Marginalization
  • Vaccination / economics
  • Vaccination / statistics & numerical data
  • Viral Load
  • Young Adult


  • DNA, Viral
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens