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

Grace X Ma; Lin Zhu; Yin Tan; Shumenghui Zhai; Xiaoli Ma; Olorunseun O Ogunwobi; Wei Jenny Yang; Tsunyou Ting; Sara Kim; Min Qi Wang

doi:10.1007/s10620-023-07840-5

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

Dig Dis Sci. 2023 Jun;68(6):2333-2343. doi: 10.1007/s10620-023-07840-5. Epub 2023 Feb 7.

Authors

Grace X Ma^{1

2}, Lin Zhu^{3

4}, Yin Tan³, Shumenghui Zhai⁵, Xiaoli Ma⁶, Olorunseun O Ogunwobi⁷, Wei Jenny Yang³, Tsunyou Ting⁸, Sara Kim⁹, Min Qi Wang¹⁰

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.ma@temple.edu.
² Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA. grace.ma@temple.edu.
³ Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA.
⁴ Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
⁵ School of Nursing, University of Washington, Seattle, WA, USA.
⁶ Hepatology Clinic, Philadelphia, PA, USA.
⁷ Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA.
⁸ Faith Hope Love Chinese Church, Philadelphia, PA, USA.
⁹ Korean Community Services of Metropolitan New York, New York, NY, USA.
¹⁰ Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA.

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.

Trial registration: ClinicalTrials.gov NCT02421666.

Keywords: Asian Americans; Chronic hepatitis B; Monitoring; Treatment adherence.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Asian
Carcinoma, Hepatocellular*
Hepatitis B virus
Hepatitis B* / complications
Hepatitis B, Chronic* / complications
Hepatitis B, Chronic* / drug therapy
Humans
Liver Neoplasms* / etiology
Quality Improvement

Associated data

ClinicalTrials.gov/NCT02421666

Abstract

Publication types

MeSH terms

Associated data

Grants and funding