Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA.
Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Dig Dis Sci. 2023 Jun;68(6):2333-2343. doi: 10.1007/s10620-023-07840-5. Epub 2023 Feb 7.
Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC). Asian Americans have the highest incidence and mortality rates of HCC among all US racial/ethnic groups. Inadequate monitoring and treatment of chronic hepatitis B contribute to poor health outcomes and increased healthcare costs among Asian Americans.
The goal of this study is to assess the effect of a patient-led strategy on chronic hepatitis B monitoring and treatment adherence specifically among Asian Americans with culturally tailored Patient Navigator-led Intervention.
From 2015 to 2018, 532 eligible participants living with chronic hepatitis B in the greater Philadelphia and New York city metropolitan areas were randomly assigned to either the intervention group or the control group. Generalized linear mixed-effects models were used to estimate the odds ratio (OR) for rates of doctor visits for chronic hepatitis B and rates of alanine aminotransferase testing for evidence of liver damage.
Intervention group had higher rates of doctor visits than the control group at both 6-month (77.22% vs. 45.75%) and 12-month assessments (90.73% vs. 60.61%). Significantly more intervention group participants received ALT testing than control group participants at 6-month (52.90% vs. 25.10%) and 12-month (75.40% vs. 46.75%) follow-up.
Culturally and linguistically appropriate intervention has strong effects on adherence to follow-up care among Asian American hepatitis B patients experiencing challenges to medication adherence and follow up care. These findings further identify opportunities for practical implementation of evidence-based intervention that could lead to reductions in disparities in chronic liver disease and liver cancer among high-risk, underserved populations.
乙型肝炎病毒（HBV）是肝细胞癌（HCC）的主要病因。在所有美国种族/族裔群体中，亚裔美国人的 HCC 发病率和死亡率最高。慢性乙型肝炎监测和治疗不足导致亚裔美国人健康状况不佳和医疗保健费用增加。
本研究旨在评估患者主导策略对慢性乙型肝炎监测和治疗依从性的影响，特别是针对具有文化适应性的患者导航员主导干预的亚裔美国人。
2015 年至 2018 年，在大费城和纽约市大都市区居住的 532 名符合条件的慢性乙型肝炎患者被随机分配到干预组或对照组。使用广义线性混合效应模型估计医生就诊率和丙氨酸氨基转移酶检测率以评估慢性乙型肝炎的证据。
干预组在 6 个月（77.22%比 45.75%）和 12 个月（90.73%比 60.61%）评估时就诊率均高于对照组。在 6 个月（52.90%比 25.10%）和 12 个月（75.40%比 46.75%）随访时，干预组接受 ALT 检测的患者明显多于对照组。
文化和语言适当的干预对亚裔美国乙型肝炎患者在药物治疗依从性和随访方面具有很强的影响，这些患者在药物治疗依从性和随访方面存在挑战。这些发现进一步确定了实施循证干预的实际机会，这可能会减少高风险、服务不足人群中慢性肝病和肝癌的差异。
