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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

基本信息

批准号：
10251232
负责人：
GRACE X. MA
金额：
$ 42.1万
依托单位：
TEMPLE UNIV OF THE COMMONWEALTH
依托单位国家：
美国
项目类别：
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/10251232
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 Virus Diseases Visit Visual Aid base cancer health disparity cohort community based participatory research 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 text messaging intervention treatment adherence treatment arm treatment guidelines virtual patient virus related cancer

项目摘要

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.

项目概要完整研究项目 1 – 肝癌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 TU FCCC：Grace X. Ma，博士（联合负责人）和 Nestor Esnaola，医学博士、公共卫生硕士（URM ESI 联合负责人） HC：Sarit A. Golub 博士（联合负责人）和 Chibuzo Enemchukwu 医学博士（URM ESI 联合负责人）尽管亚裔美国人占美国总人口的6%，但他们却占美国人口总数的50%以上慢性乙型肝炎 (CHB)，与 75% 的肝细胞癌 (HCC) 有关，这是最常见的肝细胞癌 (HCC) 肝癌的类型。亚裔美国人作为肝癌差异人群的可能性高出 8-13 倍患肝癌的死亡率比非西班牙裔白人 (NHW) 高 60%。研究表明每六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（例如恩替卡韦或替诺福韦）在适当的情况下是降低肝病风险的黄金治疗标准（包括肝癌）。然而，亚裔美国人遵守监测和抗病毒治疗指南慢性乙型肝炎患者的比例低至40%至53%。糟糕的医疗服务和严重的文化障碍可能会妨碍长期坚持监测和最佳治疗，使亚裔美国人处于困境 HCC 风险极高，医疗费用增加。以之前对患者的研究为基础导航员主导的干预措施，以改善不合规的亚裔慢性乙型肝炎患者的监测和护理，由我们已建立的学术-临床-社区研究团队进行，我们开发并试点测试了虚拟患者导航工具包系统（VPN 工具包）取代我们传统的患者导航器主导的 CHB 管理。由于我们的初步数据和其他研究表明短信 (TM) 干预有潜力显着提高各种疾病的治疗依从性，我们建议测试 TM 与旨在帮助维持和改善的增强型移动医疗干预（VPN Toolkit + TM）的有效性提高对监测和抗病毒治疗指南的长期依从性（即 24 个月随访），从而利用 CHB 来减少服务不足的高危亚裔美国人之间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）评估 TM 的比较有效性与 VPN+TM 相比，提高每六个月监测（就诊和验血）的长期依从性 (6- 、12、18 和 24 个月的随访）和超声检查（12 和 24 个月时）； 2）比较有效性 TM 与 VPN+TM 在改善和维持药物依从性方面的比较（通过自我报告和评估来衡量）电子监测）在符合抗病毒治疗指南的慢性乙型肝炎亚裔美国人中； 3）检查干预效果的中介因素，包括剂量反应（即 TM 和 VPN 工具包的利用），信息（知识）、动机和自我效能。我们对移动医疗方法的比较研究将展示基于技术的干预措施如何最有效地融入现实世界的临床减少乙型肝炎相关肝癌差异的环境。如果有效的话，这种 VPN+TM 干预是一个高度有效的干预。传播干预措施有可能对减少病毒相关癌症产生重大影响服务不足的亚裔美国人和其他高风险人群之间的差异。