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

项目总结 完整研究项目1--肝癌 服务不足的慢性乙肝亚裔美国人长期坚持监测/治疗 TU fccc：Grace X.Ma博士(联席领导)和Nestor Esnaola医学博士，公共卫生硕士(URM ESI联席领导) HC：Sarit A.Golub博士(联席主管)和Chibuzo Enemchukwu医学博士(URM ESI联席主管) 虽然亚裔美国人占美国总人口的6%，但他们占美国人口总数的50%以上 慢性乙型肝炎(CHB)，与75%的肝细胞癌(肝细胞癌)有关，这是最常见的 一种类型的肝癌。亚裔美国人作为肝癌差异人群的可能性是其他人群的8-13倍 罹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波检查，同时进行抗病毒治疗 (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护理标准 (包括肝癌)。然而，亚裔美国人遵守监测和抗病毒治疗指南 慢性乙肝患者低至40%至53%。较差的医疗保健机会和重大的文化障碍可能 防止长期坚持监测和最佳治疗，将亚裔美国人置于 高得不成比例的肝癌风险和增加的医疗成本。建立在先前对患者的研究基础上 导航员主导的干预措施，以改善对不符合条件的慢性乙肝亚裔美国人的监测和护理， 由我们建立的学术-临床-社区研究团队领导，我们开发并试行了一种 虚拟患者导航工具包系统(VPN工具包)取代我们传统的以患者导航员为主导的CHB 管理层。因为我们初步数据和其他研究表明，短信(TM)干预 有可能显著提高跨疾病治疗的依从性，我们建议测试 TM与增强型mHealth干预(VPN工具包+TM)的有效性旨在帮助维持和 改善对监测和抗病毒治疗指南的长期遵守(即24个月的跟踪)， 从而减少未得到充分服务的高危亚裔美国人中的癌症健康差异，利用CHB杠杆 我们现有的CHB患者队列。具体目标是：1)评价TM的相对有效性 VS VPN+TM，提高每六个月监测(就诊和验血)的长期依从性(6- 、12个月、18个月和24个月的随访)和超声(12个月和24个月)；2)比较 TM与VPN+TM在改善和维持服药依从性方面(通过自我报告和 电子监测)在符合抗病毒治疗指南的慢性乙肝亚裔美国人中；3)检查 干预效果的介体，包括剂量-反应(即TM和VPN工具包的使用)， 信息(知识)、动机和自我效能。我们对移动健康方法的比较研究将 演示基于技术的干预如何最有效地集成到现实世界的临床中 减少与乙肝病毒相关的肝癌差异的设置。如果有效，这种VPN+TM干预是一种高度 有可能对减少病毒相关癌症产生重大影响的可传播干预措施 未得到充分服务的亚裔美国人和其他高危人群之间的差距。

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.