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

服务不足的亚裔美国人慢性乙型肝炎患者长期坚持监测/治疗

• 批准号: 10015225
• 负责人: GRACE X. MA
• 金额: $ 24.89万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-19 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10015225
• 关键词: Abdomen; Address; Adherence; African American; American; Antiviral Agents; Asian Americans; Blood Tests; Cancer Etiology; Caring; Cessation of life; Chronic; Chronic Hepatitis B; Clinical; Communities; Community Networks; Comparative Study; Control Groups; Data; Death Rate; Disease Management; Doctor of Philosophy; Dose; Education; Effectiveness of Interventions; Environment; Ethnic group; Evidence based intervention; Feedback; Goals; Gold; Guidelines; Health Care Costs; Hepatitis B Virus; Hepatitis C virus; Hispanic Americans; Incidence; Individual; Institute of Medicine (U.S.); Intervention; Knowledge; Liver diseases; Longterm Follow-up; Malignant Neoplasms; Malignant neoplasm of liver; Measures; Mediator of activation protein; Monitor; Motivation; Multilingualism; Not Hispanic or Latino; Outcome; Participant; Patient Self-Report; Patients; Persons; Population; Prevalence; Primary Health Care; Primary carcinoma of the liver cells; Randomized Controlled Trials; Research; Research Project Grants; Resources; Risk; Self Efficacy; System; Technology; Tenofovir; Testing; Text Messaging; Time; Training; Translating; Treatment Effectiveness; Ultrasonography; United States National Institutes of Health; Viral; Virus Diseases; Visit; Visual Aid; base; cancer health disparity; cohort; comparative effectiveness; compare effectiveness; design; effectiveness testing; entecavir; evidence base; experience; follow-up; health care availability; high risk; high risk population; improved; innovation; mHealth; medication compliance; mortality; multidisciplinary; non-compliance; optimal treatments; patient oriented; prevent; primary care setting; programs; racial and ethnic; response; standard care; standard of care; treatment adherence; treatment arm; treatment guidelines; virtual

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.

项目总结