Lay Health Worker Model to Reduce Liver Cancer Disparities in Asian Americans

描述（由申请人提供）：乙型肝炎病毒（HBV）感染是全球最常见和严重的肝脏病毒感染。它会导致因肝脏疾病或肝癌而过早死亡。亚裔美国人和太平洋岛民（aapi）中由HBV引起的慢性HBV感染和肝癌是美国最严重但经常被忽视的健康差异问题之一。在130万慢性乙型肝炎病例和因HBV感染而死亡的人中，aapi占一半以上。这种额外的风险可归因于HBV感染率高（特别是在第一代移民中），以及由于文化、语言和经济障碍而导致的HBV筛查和疫苗接种率低。HBV感染对亚裔美国人的影响不成比例，因此与其他种族/族裔相比，亚裔美国人患肝癌的比例存在巨大差异。为了应对这些癌症差异，本项目的目标是建立一个可持续的、以社区为基础的、由非专业卫生工作者（LHWs）参与的项目，他们可以在亚裔美国人的高风险群体中推广肝癌预防项目。本研究旨在通过外联、筛查、教育、研究和培训，在巴尔的摩-华盛顿大都会区为华裔、韩裔和越南裔美国人实施文化一体化的肝癌预防计划。具体目标是：(1)为LHWs制定培训方案和证书计划；(2)评估HBV感染的流行情况；(3)根据筛选试验结果实施干预方案；(4)评价LHW干预对无保护人群乙肝疫苗接种依从性的影响。将从社区中招募年龄在18岁及以上的600名亚裔美国成年人（每组200名中国人、韩国人和越南人）。经过培训和认证的LHWs将在社区组织和免费乙肝筛查活动中招募参与者。所有符合条件的参与者将完成一份自我填写的问卷，并接受肝癌教育。然后，他们将接受乙肝检测。每位参与者将通过邮件或电话收到筛选测试的结果。我们将为感染者提供转诊治疗服务。对于那些未受保护的人，我们将实施干预计划，在6个月内使用随机对照设计增加一系列疫苗接种。邮寄结果七个月后，我们将对未受保护的人进行电话采访。随访完成后，对照组接受延迟LHW干预。从这一建议的LHW干预中获得的见解将对其他高风险非英语人群实施肝癌预防计划有价值，并将解决移民人群之间的健康差异。

DESCRIPTION (provided by applicant): Hepatitis B virus (HBV) infection is globally most common and serious viral infection of the liver. It can cause premature death from liver diseases or liver cancer. Chronic HBV infection and liver cancer caused by HBV among Asian Americans and Pacific Islanders (AAPIs) is one of the most serious - but frequently neglected-health disparity issues in the U.S. AAPIs account for over half of the 1.3 million chronic hepatitis B cases and deaths from HBV infection. This excess risk can be attributed to high rates of HBV infection (particularly among first-generation immigrants) in combination with low rates of HBV screening and vaccination due to cultural, linguistic, and financial barriers. HBV infection affect Asian Americans disproportionately, and thus it leads to a huge liver cancer disparity among Asian Americans compared to other racial/ethnic groups. In response to these cancer disparities, the objective of this project is to build a sustainable, community-based, participator program of lay health workers (LHWs) who can promote liver cancer prevention programs among high-risk groups of Asian Americans. This proposed study attempts to implement culturally integrated liver cancer prevention programs for Chinese, Korean, and Vietnamese Americans through outreach, screening, education, research, and training in the Baltimore-Washington Metropolitan Area. The specific aims are: (1) To develop a training protocol and certificate program for LHWs; (2) To assess the prevalence of HBV infection; (3) To implement intervention programs, based on screening test results; and (4) To evaluate the effectiveness of LHW intervention on adherence to HBV vaccinations among those unprotected. A total of 600 Asian American adults (200 Chinese, Koreans, and Vietnamese in each group), 18 years of age and older will be recruited from the community. Trained and certified LHWs will recruit participants at community-based organizations and hep B free screening events. All the eligible participants will complete a self-administered questionnaire and receive liver cancer education. Then, they will receive hepatitis B test. Every participant will receive the results of screening tests by mail or phone. We will provide referral services for treatment to those infected. For those unprotected, we will implement intervention programs to increase a series of vaccinations within 6 months using a randomized controlled design. Seven months after mailing the results, we will conduct telephone interviews among those unprotected. Upon completing follow-up, those in the control will receive the delayed LHW intervention. The insights gained from this proposed LHW intervention will be valuable in implementing liver cancer prevention programs for other high-risk non-English speaking populations and will address health disparities among immigrant populations. PUBLIC HEALTH RELEVANCE: We will develop and build a sustainable, community-based participatory program to promote live cancer prevention programs for Asian Americans through outreach, education, screening, diagnosis, monitoring, and treatment of chronic HBV infection in the Baltimore Washington Metropolitan Area.