Addressing liver cancer health disparities among the South Texas Hispanic population residing in three persistent poverty counties using the STOP-HCC-HCV program as a framework

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Project Summary/Abstract In 2017, Texas had the highest incidence of liver cancer in the United States and ranked second in liver cancer-associated mortality and the highest incidence rates occur in South Texas. Between 2001-2015, Texas had an average annual increase in liver cancer incidence of 3.9%, the national average was 3.8% per year for the same period. The population in South Texas is 70% Hispanic, 87% of whom identify as Mexican Americans. The South Texas Hispanic population experiences socioeconomic and healthcare disparities, leading to disproportionately higher rates of infectious disease-related cancer, including liver cancer. Between 2012-2017, the liver cancer incidence and mortality rate were higher among the Hispanic population than non-Hispanic whites in Texas. Additionally, Mexican Americans have a seven-fold all-cause mortality due to chronic HCV- associated disease compared to non-Hispanic whites and non-Hispanic blacks. Chronic HCV infection is a major risk factor for liver cancer. Our long-term goal is that by addressing chronic HCV infection through secondary prevention measures, we can assuage the liver cancer disparity in South Texas Hispanics. To achieve this goal, this study proposes two specific aims: (1) use Replicate Effective Programs (REP) to implement the evidence-based STOP-HCC-HCV program in two clinic systems primarily serving low-income, underserved Hispanic communities in three South Texas persistent poverty counties; (2) evaluate the effect of the STOP-HCC-HCV evidence-based program through empirical analysis of patient use outcomes and stakeholder feedback. The counties selected for this proposal are Hidalgo, Starr, and Cameron Counties, located in South Texas and designated as a Persistent Poverty Area, Health Professional Shortage Area, and Medically Underserved Area. There is a tendency for the public health system in persistent poverty areas to be chronically neglected. This proposed intervention will provide sustainable infrastructure to two community clinics using teleconsultations, tele-mentoring, making improvements to workflow and navigation, providing educational resources, and a technical evaluation to improve the HCV screening, treatment, and cure rates. The STOP- HCC-HCV program significantly increased the proportion of South Texas baby boomers screened and treated for chronic HCV; by tailoring this program for use in novel populations, we can strengthen the primary prevention of liver cancer through secondary prevention of HCV and contribute to the national strategic goal of eliminating HCV. Additionally, the data collected from this program will inform the development of future preventive strategies directly relevant for the South Texas Hispanic population.