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

描述（由申请方提供）：B型肝炎病毒（HBV）感染是全球最常见和最严重的肝脏病毒感染。它可以导致过早死亡的肝脏疾病或肝癌。在美国，亚裔美国人和太平洋岛民（AAPI）中慢性HBV感染和由HBV引起的肝癌是最严重但经常被忽视的健康差异问题之一。AAPI占130万慢性乙型肝炎B病例和HBV感染死亡的一半以上。这种过度的风险可以归因于HBV感染率高（特别是在第一代移民中）以及由于文化，语言和经济障碍导致的HBV筛查和疫苗接种率低。HBV感染不成比例地影响亚裔美国人，因此与其他种族/族裔群体相比，它导致亚裔美国人之间的巨大肝癌差异。 为了应对这些癌症差异，该项目的目标是建立一个可持续的、以社区为基础的非专业卫生工作者（LHW）参与者计划，他们可以在亚裔美国人的高危群体中促进肝癌预防计划。这项拟议的研究试图通过在巴尔的摩-华盛顿大都会区的外展，筛查，教育，研究和培训，为中国，韩国和越南裔美国人实施文化整合的肝癌预防计划。具体目标是：（1）为LHWs制定培训方案和证书计划;（2）评估HBV感染的流行率;（3）根据筛查测试结果实施干预计划;（4）评估LHWs干预对未受保护人群坚持HBV疫苗接种的有效性。 将从社区招募18岁及以上的亚裔美国成年人（每组200名中国人、韩国人和越南人）共600名。经过培训和认证的LHW将在社区组织和无B型肝炎筛查活动中招募参与者。所有符合条件的参与者将完成自填式问卷并接受肝癌教育。然后，他们将接受B型肝炎检测。每个参与者将通过邮件或电话收到筛选测试的结果。我们会为受感染者提供转介治疗服务。对于那些未受保护的人，我们将实施干预计划，使用随机对照设计在6个月内增加一系列疫苗接种。在邮寄结果七个月后，我们将对那些未受保护的人进行电话采访。完成随访后，对照组将接受延迟的LHW干预。从这一拟议的LHW干预中获得的见解将在实施其他高风险非英语人群的肝癌预防计划方面具有价值，并将解决移民人口之间的健康差异。

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.