A new grant award by the National Institute on Minority Health and Health Disparities (NIMHD) will support the development of new Health Information Technology (HIT) strategies that increase screening for chronic hepatitis B and reduce the impact of hepatitis B among high-risk Asian American and Pacific Islander (AAPI) populations. Hepatitis B virus (HBV) infection is a major preventable health problem in the U.S. and the most pronounced health disparity among Asian Americans. Unfortunately, many HBV patients, especially immigrants and minorities, often do not receive recommended levels of care, indicating a critical need for developing culturally appropriate and effective strategies that can be incorporated into existing clinical practice. The investigator-initiated award was made to the Association of Asian Pacific Community Health Organizations (AAPCHO), a national association of 29 community health organizations dedicated to promoting advocacy, collaboration, and leadership that improves the health status of and access to health care for Asian Americans, Native Hawaiians, and other Pacific Islanders in the United States.
This new research grant advances multiple strategies identified in the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, first released in May 2011. To improve viral hepatitis testing, care, and treatment and prevent the long term consequences of untreated chronic viral hepatitis, including liver cancer, the Action Plan calls for the use of HIT to improve testing, access to and quality of viral hepatitis care and treatment in diverse clinical settings. It also highlights ongoing efforts to leverage resources across federal agencies participating in implementation of the Action Plan; in this case NIH investment in research to improve HBV screening in community health centers. The findings from this undertaking can then be disseminated through the other AAPCHO-affiliated health centers and the larger network of health centers supported by HRSA’s Bureau of Primary Health Care.
Approximately 1 in 12 AAPIs are living with chronic hepatitis B, but most do not know it, according to the Centers for Disease Control and Prevention (CDC). AAPIs make up 5% of the total U.S. population, but account for more than 50% of Americans living with chronic hepatitis B. Despite these high rates, many AAPIs are not tested for hepatitis B. Unaware of their infection, they do not access medical services that can help save their lives and prevent transmission (the hepatitis B virus can be transmitted sexually, perinatally and through blood exposure.). As a result, chronic hepatitis B and associated liver cancer in AAPIs is one of the most serious health disparities in the United States: hepatitis B-related liver cancer incidence is highest among AAPIs and is a leading cause of cancer deaths in this population.
To address this disparity, AAPCHO will lead a community-scientific collaboration with its federally qualified health center member, International Community Health Services in Seattle, Washington, as well as its scientific partners affiliated with the University of Washington and Virginia Mason Medical Center and members of a community-based organization, the Hepatitis B Coalition of Washington . The collaborators will use community-based participatory research (CBPR) approaches to conduct a needs assessment and develop a new culturally appropriate intervention to address HBV health disparities across Asian American communities. Methods including key informant interviews, focus groups, and surveys will be used to assess the needs for and impact of culturally proficient HIT strategies to improve HBV outcomes for underserved Asian Americans attending a community health center in Seattle. The results from the needs assessment will then be utilized to develop and pilot an intervention that incorporates HIT strategies for HBV care with participation and ownership from community-based health centers, health care providers, patients, and their families. The project will measure the effectiveness of this culturally proficient intervention in improving HBV vaccination, screening rates, and linkages to care. This project will serve as an important model for developing culturally proficient HBV care that includes key elements such as health services, HIT, and non-clinical support services for underserved communities in the United States.
“Given the significant impact of hepatitis B in the AAPI community, NIMHD is pleased to be supporting CBPR that will develop culturally competent interventions to reduce this health disparity,” observed Dr. Francisco Sy, Director of NIMHD’s Office of Extramural Research Administration. “The CBPR Initiative at NIMHD supports the development, implementation, and evaluation of intervention research and is a long-term commitment. It has three phases: a three-year research planning phase followed by a competitive intervention research phase. Afterwards, those with effective interventions compete for a three year research dissemination phase,” noted Dr. Sy, a member of the inter-agency group working to implement the Viral Hepatitis Action Plan.