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A Comparative Trial of Improving Care for Underserved Asian Americans Infected with Hepatitis B Virus
Grace X Ma1,2, Lin Zhu3,4, Yin Tan3
1Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA. grace.ma@temple.edu.
Insights
A culturally tailored patient navigator intervention significantly improved monitoring and treatment adherence for chronic hepatitis B among Asian Americans. This strategy addresses disparities in liver disease and cancer care for high-risk populations.
Area of Science:
- Hepatology and Public Health
- Cancer Prevention and Health Disparities
Background:
- Hepatitis B virus (HBV) is a primary cause of hepatocellular carcinoma (HCC).
- Asian Americans face the highest HCC incidence and mortality rates in the US.
- Suboptimal chronic hepatitis B management exacerbates health outcomes and costs in this demographic.
Purpose of the Study:
- To evaluate a patient-led strategy using a culturally tailored Patient Navigator-led Intervention.
- To assess the impact on chronic hepatitis B monitoring and treatment adherence in Asian Americans.
Main Methods:
- A randomized controlled trial involving 532 participants with chronic hepatitis B from 2015-2018.
- Participants were assigned to either an intervention or control group.
- Generalized linear mixed-effects models analyzed doctor visit and alanine aminotransferase (ALT) testing rates.
Main Results:
- The intervention group showed significantly higher rates of doctor visits at 6-month (77.22% vs. 45.75%) and 12-month (90.73% vs. 60.61%) follow-up.
- Intervention participants had substantially higher ALT testing rates at 6-month (52.90% vs. 25.10%) and 12-month (75.40% vs. 46.75%) follow-up.
Conclusions:
- Culturally and linguistically appropriate interventions effectively improve follow-up care adherence.
- This evidence-based approach can reduce disparities in chronic liver disease and liver cancer.
- Highlights opportunities for implementing interventions in underserved, high-risk populations.
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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