Long-Term Adherence to Monitoring/Treatment in Underserved Asian Americans with Chronic HBV

项目摘要 完整研究项目1 -肝癌 服务不足的亚裔美国人慢性HBV患者对监测/治疗的长期依从性 TU FCCC：Grace X. Ma，PhD（联合负责人）和Nintage Esnaola，MD，MPH（联合负责人，URM ESI） HC：Sarit A. Golub，PhD（联合负责人）和Chibuzo Enemchukwu，MD（联合负责人，URM ESI） 虽然亚裔美国人占美国总人口的6%，但他们占美国人的50%以上， 慢性B型肝炎（CH B）与75%的肝细胞癌（HCC）相关， 肝癌的类型亚裔美国人作为肝癌差异人群， 肝癌的死亡率比非西班牙裔白人（NHWs）高60%。研究表明 每6个月进行一次血液检查，每12个月进行一次腹部超声检查，并结合抗病毒治疗 (e.g.恩替卡韦或替诺福韦）在适当的时候，是金标准的护理，以减少肝脏疾病的风险 （包括HCC）。然而，亚裔美国人对监测和抗病毒治疗指南的依从性 CHB患者的发病率低至40%-53%。医疗保健服务差和重大的文化障碍可能 阻止长期坚持监测和最佳治疗，使亚裔美国人处于困境 HCC的风险不成比例地高，并且增加了医疗费用。基于之前对患者的研究 导航员主导的干预措施，以改善不依从的亚裔美国人CHB患者的监测和护理， 由我们建立的学术-临床-社区研究团队进行，我们开发并进行了试点测试， 虚拟患者导航工具包系统（VPN工具包），以取代我们传统的患者导航仪主导的CHB 管理由于我们的初步数据和其他研究表明，短信（TM）干预， 有可能显着提高对各种疾病治疗的依从性，我们建议测试 TM与增强型移动健康干预（VPN工具包+ TM）的有效性，旨在帮助维持和 改善长期粘附性（即，24个月随访）监测和抗病毒治疗指南， 从而减少患有CHB的亚裔美国人中的癌症健康差异 我们现有的慢性乙型肝炎患者队列。具体目标是：1）评价技术管理的相对有效性 与VPN+TM相比，可提高每六个月（6- 10个月）监测（医生访视和血液检查）的长期依从性。 、12个月、18个月和24个月随访）和超声检查（12个月和24个月）; 2）比较 TM与VPN+TM在改善和维持药物依从性方面的比较（通过自我报告和 电子监测）符合抗病毒治疗指南的亚裔美国人CHB患者; 3）检查 干预有效性的介质，包括剂量-反应（即，利用TM和VPN工具包）， 信息（知识），动机和自我效能。我们对移动健康方法的比较研究将 演示如何将基于技术的干预措施最有效地整合到现实世界的临床中 减少HBV相关肝癌的差异。如果有效，这种VPN+TM干预是一种高度 可传播的干预措施，有可能对减少病毒相关癌症产生重大影响 亚裔美国人和其他高风险人群之间的差距。

PROJECT SUMMARY Full Research Project 1 – Liver Cancer Long-Term Adherence to Monitoring/Treatment in Underserved Asian Americans with Chronic HBV TU FCCC: Grace X. Ma, PhD (Co-Leader) and Nestor Esnaola, MD, MPH (Co-Leader, URM ESI) HC: Sarit A. Golub, PhD (Co-Leader) and Chibuzo Enemchukwu, MD (Co-Leader, URM ESI) Although Asian Americans make up 6% of total U.S. population, they account for over 50% of Americans with chronic hepatitis B (CHB), which is associated with 75% of hepatocellular carcinoma (HCC), the most common type of liver cancer. Asian Americans as a liver cancer disparity population are 8-13 times more likely to develop liver cancer with 60% higher death rate than non-Hispanic whites (NHWs). Research indicates that blood tests every six months and an abdominal ultrasound every 12 months, combined with antiviral treatment (e.g. entecavir or tenofovir) when appropriate, is the gold standard of care to reduce the risk of liver disease (including HCC). However, adherence to monitoring and antiviral treatment guidelines among Asian American patients with CHB is as low as 40% to 53%. Poor healthcare access and significant cultural barriers may prevent long-term adherence to monitoring and optimal treatment, placing Asian Americans at a disproportionately high risk for HCC and increased healthcare costs. Building on previous studies on a patient navigator-led intervention to improve monitoring and care among noncompliant Asian American with CHB, conducted by our established academic-clinical-community research team, we developed and pilot tested a virtual patient navigation toolkit system (VPN toolkit) to replace our traditional patient navigator-led CHB management. Since our preliminary data and other studies indicate that text messaging (TM) interventions have potential to significantly improve adherence to treatment across illnesses, we propose to test the effectiveness of TM versus enhanced mHealth intervention (VPN Toolkit + TM) designed to help sustain and improve long-term adherence (i.e., 24 months follow ups) to monitoring and antiviral treatment guidelines, thereby reducing cancer health disparities among underserved at-risk Asian Americans with CHB leveraging our existing cohort of CHB patients. The specific aims are: 1) Evaluate the comparative effectiveness of TM vs VPN+TM for improving long-term adherence to monitoring (doctor visit and blood tests) every six months (6- , 12-, 18-, and 24-month follow-ups) and ultrasound (at 12 and 24 months); 2) Compare the effectiveness of TM vs VPN+TM in improving and sustaining medication adherence (measured through self-report and electronic monitoring) among Asian Americans with CHB who meet antiviral treatment guidelines; 3) Examine mediators of intervention effectiveness, including dose-response (i.e., utilization of the TM and VPN toolkit), information (knowledge), motivation, and self-efficacy. Our comparative study of mHealth approaches will demonstrate how technology-based interventions can be integrated most effectively into real-world clinical settings to reduce HBV-related liver cancer disparities. If effective, this VPN+TM intervention is a highly disseminable intervention with the potential to have a significant impact on reducing viral-related cancer disparities among underserved Asian Americans and other highest-risk populations.