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

项目摘要/摘要 2017年，德克萨斯州是美国肝癌发病率最高的州，排名第二。 与癌症相关的死亡率和发病率最高的是南得克萨斯州。2001-2015年间，德克萨斯州 肝癌发病率年均增长3.9%，全国平均每年增长3.8% 同一时期。德克萨斯州南部的人口中有70%是西班牙裔，其中87%是墨西哥裔美国人。 南得克萨斯州拉美裔人口经历了社会经济和医疗保健方面的差距，导致 与传染病相关的癌症，包括肝癌，发病率高得不成比例。2012-2017年间， 西班牙裔人群中的肝癌发病率和死亡率高于非西班牙裔人群 德克萨斯州的白人。此外，墨西哥裔美国人因慢性丙型肝炎而导致的全因死亡率是其他人的七倍。 与非西班牙裔白人和非西班牙裔黑人相比，与之相关的疾病。 慢性丙型肝炎病毒感染是肝癌的主要危险因素。我们的长期目标是通过解决 通过慢性丙型肝炎病毒感染的二级预防措施，可以缓解我国肝癌发病的差距。 南得克萨斯州西班牙裔。为了实现这一目标，本研究提出了两个具体目标：(1)有效地使用复制 计划(REP)主要在两个临床系统实施循证停止-肝细胞癌-丙型肝炎计划 为南得克萨斯州三个持续贫困县的低收入、服务不足的西班牙裔社区提供服务；(2) 通过对患者使用情况的实证分析，评价Stop-HCC-HCV循证计划的效果 结果和利益相关者反馈。为这项提议选择的县有伊达尔戈、斯塔尔和卡梅伦 位于德克萨斯州南部并被指定为持续贫困地区的县，卫生专业人员短缺 地区和医疗服务不足的地区。 长期贫困地区的公共卫生系统有被长期忽视的趋势。 这项拟议的干预措施将为两个社区诊所提供可持续的基础设施，使用 远程咨询、远程指导、改进工作流程和导航、提供教育 资源，以及提高丙型肝炎病毒筛查、治疗和治愈率的技术评估。站牌- 肝细胞癌-丙型肝炎病毒计划显著增加了南得克萨斯州婴儿潮一代的筛查和治疗比例 对于慢性丙型肝炎；通过为新人群量身定做这一计划，我们可以加强初级预防 通过丙型肝炎病毒的二级预防预防肝癌，并为实现消除 丙型肝炎。此外，从该计划收集的数据将为未来预防措施的发展提供参考 与南得克萨斯州拉美裔人口直接相关的战略。

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.