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A Comparative Trial of Improving Care for Underserved Asian Americans Infected with Hepatitis B Virus

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Abstract

Background

Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC). Asian Americans have the highest incidence and mortality rates of HCC among all US racial/ethnic groups. Inadequate monitoring and treatment of chronic hepatitis B contribute to poor health outcomes and increased healthcare costs among Asian Americans.

Aims

The goal of this study is to assess the effect of a patient-led strategy on chronic hepatitis B monitoring and treatment adherence specifically among Asian Americans with culturally tailored Patient Navigator-led Intervention.

Methods

From 2015 to 2018, 532 eligible participants living with chronic hepatitis B in the greater Philadelphia and New York city metropolitan areas were randomly assigned to either the intervention group or the control group. Generalized linear mixed-effects models were used to estimate the odds ratio (OR) for rates of doctor visits for chronic hepatitis B and rates of alanine aminotransferase testing for evidence of liver damage.

Results

Intervention group had higher rates of doctor visits than the control group at both 6-month (77.22% vs. 45.75%) and 12-month assessments (90.73% vs. 60.61%). Significantly more intervention group participants received ALT testing than control group participants at 6-month (52.90% vs. 25.10%) and 12-month (75.40% vs. 46.75%) follow-up.

Conclusions

Culturally and linguistically appropriate intervention has strong effects on adherence to follow-up care among Asian American hepatitis B patients experiencing challenges to medication adherence and follow up care. These findings further identify opportunities for practical implementation of evidence-based intervention that could lead to reductions in disparities in chronic liver disease and liver cancer among high-risk, underserved populations.

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References

  1. World Health Organization (2016) Hepatitis B. In: WHO. http://www.who.int/mediacentre/factsheets/fs204/en/. Accessed 7 Apr 2016

  2. Sharma S, Carballo M, Feld JJ, Janssen HLA. Immigration and viral hepatitis. Journal of Hepatology 2015;63:515–522. https://doi.org/10.1016/j.jhep.2015.04.026.

    Article  PubMed  Google Scholar 

  3. Nguyen K, Van Nguyen T, Shen D, Xia V, Tran D, Banh K, Ruan V, Hu K-Q. Prevalence and Presentation of Hepatitis B and C Virus (HBV and HCV) Infection in Vietnamese Americans via Serial Community Serologic Testing. J Immigr Minor Health 2015;17:13–20. https://doi.org/10.1007/s10903-013-9975-5.

    Article  PubMed  Google Scholar 

  4. Hepatitis B Foundation (2016) Hepatitis B Foundation: FAQ: General Info. http://www.hepb.org/patients/general_information.htm#ques3. Accessed 7 Apr 2016

  5. El-Serag HB. Epidemiology of Viral Hepatitis and Hepatocellular Carcinoma. Gastroenterology 2012;142:1264-1273.e1. https://doi.org/10.1053/j.gastro.2011.12.061.

    Article  PubMed  Google Scholar 

  6. Di Bisceglie AM. Hepatitis B and hepatocellular carcinoma. Hepatology 2009;49:S56–S60. https://doi.org/10.1002/hep.22962.

    Article  PubMed  Google Scholar 

  7. Forde KA, Tanapanpanit O, Reddy KR. Hepatitis B and C in African Americans: Current Status and Continued Challenges. Clinical Gastroenterology and Hepatology 2014;12:738–748. https://doi.org/10.1016/j.cgh.2013.06.006.

    Article  PubMed  Google Scholar 

  8. Centers for Disease Control and Prevention (2016) Division of Viral Hepatitis Home Page | Division of Viral Hepatitis | CDC. http://www.cdc.gov/hepatitis/index.htm. Accessed 26 Sep 2016

  9. Cohen C, Caballero J, Martin M, Weerasinghe I, Ninde M, Block J. Eradication of Hepatitis B: A Nationwide Community Coalition Approach to Improving Vaccination, Screening, and Linkage to Care. J Community Health 2013;38:799–804. https://doi.org/10.1007/s10900-013-9699-4.

    Article  PubMed  Google Scholar 

  10. Chen MS, Dang J. Hepatitis B among Asian Americans: Prevalence, Progress, and Prospects for Control. World J Gastroenterol 2015;21:11924–11930. https://doi.org/10.3748/wjg.v21.i42.11924.

    Article  PubMed  Google Scholar 

  11. Centers for Disease Control and Prevention (2013) Asian Americans and Hepatitis B. http://www.cdc.gov/Features/AAPIHepatitisB/. Accessed 27 Mar 2014

  12. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, Chang T, Kitis G, Rizzetto M, Marcellin P, Lim SG, Goodman Z, Ma J, Brosgart CL, Borroto-Esoda K, Arterburn S, Chuck SL. Long-term Therapy With Adefovir Dipivoxil for HBeAg-Negative Chronic Hepatitis B for up to 5 Years. Gastroenterology 2006;131:1743–1751. https://doi.org/10.1053/j.gastro.2006.09.020.

    Article  CAS  PubMed  Google Scholar 

  13. Centers for Disease Control and Prevention (2016) Hepatitis B. http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html. Accessed 7 Apr 2016

  14. Varbobitis I, Papatheodoridis GV. The assessment of hepatocellular carcinoma risk in patients with chronic hepatitis B under antiviral therapy. Clin Mol Hepatol 2016;22:319–326. https://doi.org/10.3350/cmh.2016.0045.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Papatheodoridis GV, Chan HL-Y, Hansen BE, Janssen HLA, Lampertico P. Risk of hepatocellular carcinoma in chronic hepatitis B: Assessment and modification with current antiviral therapy. Journal of Hepatology 2015;62:956–967. https://doi.org/10.1016/j.jhep.2015.01.002.

    Article  PubMed  Google Scholar 

  16. Toy M, Demirci U, So S. Preventing Hepatocellular Carcinoma: The Crucial Role of Chronic Hepatitis B Monitoring and Antiviral Treatment. Hepatic Oncology 2014;1:255–257. https://doi.org/10.2217/hep.14.10.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Institute of Medicine of the National Academies (IOM) (2016) Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. In: Institute of Medicine. https://www.nationalacademies.org:443/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx. Accessed 6 Jan 2017

  18. World Health Organization WHO Issues Its First Hepatitis B Treatment Guidelines. In: WHO. http://www.who.int/mediacentre/news/releases/2015/hepatitis-b-guideline/en/. Accessed 6 Jan 2017

  19. Terrault NA, Bzowej NH, Chang K-M, Hwang JP, Jonas MM, Murad MH. AASLD Guidelines for Treatment of Chronic Hepatitis B. Hepatology 2016;63:261–283. https://doi.org/10.1002/hep.28156.

    Article  PubMed  Google Scholar 

  20. Post SE, Sodhi NK, Peng C, Wan K, Pollack HJ. A Simulation Shows That Early Treatment Of Chronic Hepatitis B Infection Can Cut Deaths And Be Cost-Effective. Health Aff 2011;30:340–348. https://doi.org/10.1377/hlthaff.2008.0905.

    Article  Google Scholar 

  21. Cohen C, Holmberg SD, McMahon BJ, Block JM, Brosgart CL, Gish RG, London WT, Block TM. Is Chronic Hepatitis B Being Undertreated in the United States? Journal of Viral Hepatitis 2011;18:377–383. https://doi.org/10.1111/j.1365-2893.2010.01401.x.

    Article  CAS  PubMed  Google Scholar 

  22. Eckman MH, Kaiser TE, Sherman KE (2011) The Cost-effectiveness of Screening for Chronic Hepatitis B Infection in the United States. Clin Infect Dis cir199. https://doi.org/10.1093/cid/cir199

  23. Tong MJ, Pan CQ, Hann H-W, Kowdley KV, Han S-HB, Min AD, Leduc T-S. The Management of Chronic Hepatitis B in Asian Americans. Dig Dis Sci 2011;56:3143. https://doi.org/10.1007/s10620-011-1841-5.

    Article  CAS  PubMed  Google Scholar 

  24. U.S. Department of Health and Human Services (2020) Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025). Washington, DC

  25. Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, Kern ER, McHugh JA, Petersen GM, Rein MF, Strader DB, Trotter HT. National Institutes of Health consensus development conference statement: Management of hepatitis B. Hepatology 2009;49:S4–S12. https://doi.org/10.1002/hep.22946.

    Article  PubMed  Google Scholar 

  26. Kim AK, Singal AG. Health disparities in diagnosis and treatment of hepatocellular carcinoma. Clin Liver Dis (Hoboken) 2015;4:143–145. https://doi.org/10.1002/cld.427.

    Article  PubMed  Google Scholar 

  27. Ma GX (2012) Unpublished report from "Patient Navigator Intervention for Improving Health-Related Quality of Life in HBV Infected Patients NIH funded grant, U01 CA114582 Supp.

  28. Zhang S, Ristau JT, Trinh HN, Garcia RT, Nguyen HA, Nguyen MH. Undertreatment of Asian Chronic Hepatitis B Patients on the Basis of Standard Guidelines: A Community-Based Study. Dig Dis Sci 2012;57:1373–1383. https://doi.org/10.1007/s10620-012-2137-0.

    Article  PubMed  Google Scholar 

  29. Juday T, Tang H, Harris M, Powers AZ, Kim E, Hanna GJ. Adherence to Chronic Hepatitis B Treatment Guideline Recommendations for Laboratory Monitoring of Patients Who Are Not Receiving Antiviral Treatment. J Gen Intern Med 2011;26:239–244. https://doi.org/10.1007/s11606-010-1549-9.

    Article  PubMed  Google Scholar 

  30. Bastani R, Glenn BA, Maxwell AE, Jo AM, Herrmann AK, Crespi CM, Wong WK, Chang LC, Stewart SL, Nguyen TT, Chen MS, Taylor VM. Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles. Cancer Epidemiol Biomarkers Prev 2015;24:1341–1349. https://doi.org/10.1158/1055-9965.EPI-14-1396.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hu DJ, Xing J, Tohme RA, Liao Y, Pollack H, Ward JW, Holmberg SD. Hepatitis B Testing and Access to Care Among Racial and Ethnic Minorities in Selected Communities Across the United States, 2009–2010. Hepatology 2013;58:856–862. https://doi.org/10.1002/hep.26286.

    Article  PubMed  Google Scholar 

  32. Hwang JP, Fisch MJ, Zhang H, Kallen MA, Routbort MJ, Lal LS, Vierling JM, Suarez-Almazor ME. Low Rates of Hepatitis B Virus Screening at the Onset of Chemotherapy. JOP 2012;8:e32–e39. https://doi.org/10.1200/JOP.2011.000450.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ma GX, Zhang GY, Zhai S, Ma X, Tan Y, Shive SE, Wang MQ. Hepatitis B screening among Chinese Americans: a structural equation modeling analysis. BMC Infectious Diseases 2015;15:120. https://doi.org/10.1186/s12879-015-0854-7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ma GX, Fang CY, Seals B, Feng Z, Tan Y, Siu P, Yeh MC, Golub SA, Nguyen MT, Tran T, Wang M. A Community-Based Randomized Trial of Hepatitis B Screening Among High-Risk Vietnamese Americans. Am J Public Health 2017;107:433–440. https://doi.org/10.2105/AJPH.2016.303600.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ma GX, Tan Y, Wang MQ, Yuan Y, Chae WG. Hepatitis B Screening Compliance and Non-Compliance among Chinese, Koreans, Vietnamese and Cambodians. Clinical Medicine Insights: Gastroenterology 2010;2010:1–10. https://doi.org/10.4137/CGast.S3732.

    Article  Google Scholar 

  36. Strong C, Lee S, Tanaka M, Juon H-S. Ethnic Differences in Prevalence and Barriers of HBV Screening and Vaccination Among Asian Americans. J Community Health 2012;37:1071–1080. https://doi.org/10.1007/s10900-012-9541-4.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Shankar H, Blanas D, Bichoupan K, Ndiaye D, Carmody E, Martel-Laferriere V, Culpepper-Morgan J, Dieterich DT, Branch AD, Bekele M, Nichols K, Perumalswami PV. A Novel Collaborative Community-Based Hepatitis B Screening and Linkage to Care Program for African Immigrants. Clin Infect Dis 2016;62:S289–S297. https://doi.org/10.1093/cid/ciw090.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Williams WW, Lu P-J, O’Halloran A, Kim DK, Grohskopf LA, Pilishvili T, Skoff T, Nelson NP, Harpaz R, Markowitz LE, Rodriguez-Lainz A, Bridges CB (2016) Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014. MMWR Surveill Summ 65:. https://doi.org/10.15585/mmwr.ss6501a1

  39. Xu JJ, Tien C, Chang M, Rhee J, Tien A, Bae HS, Ho FC-S, Chan LS, Fong T-L. Demographic and Serological Characteristics of Asian Americans with Hepatitis B Infection Diagnosed at Community Screenings. J Viral Hepat 2013;20:575–581. https://doi.org/10.1111/jvh.12073.

    Article  CAS  PubMed  Google Scholar 

  40. Upadhyaya N, Chang R, Davis C, Conti MC, Salinas-Garcia D, Tang H. Chronic Hepatitis B: Perceptions in Asian American Communities and Diagnosis and Management Practices Among Primary Care Physicians. Postgrad Med 2010;122:165–175. https://doi.org/10.3810/pgm.2010.09.2213.

    Article  PubMed  Google Scholar 

  41. Lieveld FI, van Vlerken LG, Siersema PD, van Erpecum KJ. Patient Adherence to Antiviral Treatment for Chronic Hepatitis B and C: A Systematic Review. Ann Hepatol 2013;12:380–391.

    Article  CAS  PubMed  Google Scholar 

  42. Burman BE, Mukhtar NA, Toy BC, Nguyen TT, Chen AH, Yu A, Berman P, Hammer H, Chan D, McCulloch CE, Khalili M. Hepatitis B Management in Vulnerable Populations: Gaps in Disease Monitoring and Opportunities for Improved Care. Dig Dis Sci 2014;59:46–56. https://doi.org/10.1007/s10620-013-2870-z.

    Article  PubMed  Google Scholar 

  43. Liu CY, Chandrasekar PH, Masood A, Schiffer CA. Adherence to Hepatitis B Screening and Prophylactic Lamivudine for Prevention of Rituximab-Associated Hepatitis B Reactivation. J Oncol Pharm Pract 2013;19:18–23. https://doi.org/10.1177/1078155212447975.

    Article  CAS  PubMed  Google Scholar 

  44. Wu Y, Johnson KB, Roccaro G, Lopez J, Zheng H, Muiru A, Ufere N, Rajbhandari R, Kattan O, Chung RT. Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center. Am J Gastroenterol 2014;109:867–875. https://doi.org/10.1038/ajg.2014.72.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Chong SK, Ali SH, Ðoàn LN, Yi SS, Trinh-Shevrin C, Kwon SC (2022) Social Media Use and Misinformation Among Asian Americans During COVID-19. Frontiers in Public Health 9:

  46. Chao SD, Chang ET, Le PV, Prapong W, Kiernan M, So SKS. The Jade Ribbon Campaign: A Model Program for Community Outreach and Education to Prevent Liver Cancer in Asian Americans. J Immigrant Minority Health 2009;11:281–290. https://doi.org/10.1007/s10903-007-9094-2.

    Article  Google Scholar 

  47. Ma GX, Bhimla A, Zhu L, Beeber M, Aczon F, Tan Y, Quinn SB, Khan O, Gadegbeku CA. Development of an Intervention to Promote Physical Activity and Reduce Dietary Sodium Intake for Preventing Hypertension and Chronic Disease in Filipino Americans. J Racial Ethn Health Disparities 2021;8:283–292. https://doi.org/10.1007/s40615-020-00781-z.

    Article  PubMed  Google Scholar 

  48. Huang Y-C, Garcia AA. Culturally-tailored interventions for chronic disease self-management among Chinese Americans: a systematic review. Ethnicity & Health 2020;25:465–484. https://doi.org/10.1080/13557858.2018.1432752.

    Article  Google Scholar 

  49. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Education Monographs 1974;2:354–386. https://doi.org/10.1177/109019817400200405.

    Article  Google Scholar 

  50. Hyun CS, Ko O, Lee S, McMenamin J. Long term outcome of a community-based hepatitis B awareness campaign: eight-year follow-up on linkage to care (LTC) in HBV infected individuals. BMC Infectious Diseases 2019;19:638. https://doi.org/10.1186/s12879-019-4283-x.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ma GX, Zhu L, Lu W, Tan Y, Truehart J, Johnson C, Handorf E, Nguyen MT, Yeh M-C, Wang MQ. Examining the Influencing Factors of Chronic Hepatitis B Monitoring Behaviors among Asian Americans: Application of the Information-Motivation-Behavioral Model. International Journal of Environmental Research and Public Health 2022;19:4642. https://doi.org/10.3390/ijerph19084642.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Joachim GL, Acorn S (2016) Living with Chronic Illness: The Interface of Stigma and Normalization. Canadian Journal of Nursing Research Archive 32:

  53. Lee H, Fawcett J, Yang JH, Hann H-W. Correlates of Hepatitis B Virus Health-Related Behaviors of Korean Americans: A Situation-Specific Nursing Theory. Journal of Nursing Scholarship 2012;44:315–322. https://doi.org/10.1111/j.1547-5069.2012.01468.x.

    Article  PubMed  Google Scholar 

  54. Smith-Palmer J, Cerri K, Sbarigia U, Chan EKH, Pollock RF, Valentine WJ, Bonroy K. Impact of Stigma on People Living with Chronic Hepatitis B. Patient Relat Outcome Meas 2020;11:95–107. https://doi.org/10.2147/PROM.S226936.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Research reported in this study was funded by Patient-Centered Outcomes Research Institute® (PCORI®) Award (award number: AD-1403-12613, PI: Grace X. Ma, PhD). The study was registered at ClinicalTrials.gov (ID: NCT02421666). The statements presented in this paper are solely the responsibility of the authors and do not necessarily represent the views of PCORI®, its Board of Governors or Methodology Committee. This research project was partially supported by TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership, Award Number U54 CA221704(5) from the National Cancer Institute of National Institutes of Health (NCI/NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCI/NIH.

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Authors and Affiliations

  1. Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA

    Grace X. Ma, Lin Zhu, Yin Tan & Wei Jenny Yang

  2. Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

    Grace X. Ma & Lin Zhu

  3. School of Nursing, University of Washington, Seattle, WA, USA

    Shumenghui Zhai

  4. Hepatology Clinic, Philadelphia, PA, USA

    Xiaoli Ma

  5. Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA

    Olorunseun O. Ogunwobi

  6. Faith Hope Love Chinese Church, Philadelphia, PA, USA

    Tsunyou Ting

  7. Korean Community Services of Metropolitan New York, New York, NY, USA

    Sara Kim

  8. Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA

    Min Qi Wang

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  1. Grace X. Ma
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Contributions

GMM contributed to conceptualization, methodology, writing—review, and editing. LZ contributed to software, formal analysis, data curation, writing–original draft, writing–review, and editing. YT contributed to conceptualization, methodology, writing–review, and editing. SZ contributed to methodology and investigation. XM contributed to methodology and resources; OOO contributed to writing—review and editing; WJY contributed to writing—original draft. TT and SK contributed to resources. .MQW contributed to methodology and formal analysis.

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Correspondence to Grace X. Ma.

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Ma, G.X., Zhu, L., Tan, Y. et al. A Comparative Trial of Improving Care for Underserved Asian Americans Infected with Hepatitis B Virus. Dig Dis Sci 68, 2333–2343 (2023). https://doi.org/10.1007/s10620-023-07840-5

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