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

BACKGROUND Access to basic health needs remains a challenge for most of world's population. In this study, we developed a novel care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh (AP), the northeastern-most state of India. METHODS We performed patient screening, interviews, and obtained blood samples in remote villages of Arunachal Pradesh via 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. Blood tests performed included liver function tests, HBV serologies and HBV genotyping. HBV vaccination was provided as appropriate. RESULTS A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the five westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n=419). 34.6% were hepatitis B e-antigen (HBeAg) 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 seroprevalance, 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. CONCLUSION 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.