Full Research Project 1 Long-Term Adherence to Monitoring/Treatment in Underserved Asian Americans with Chronic HBV

完整研究项目 1 服务不足的亚裔美国人慢性乙型肝炎患者长期坚持监测/治疗

• 批准号: 10480817
• 负责人: Sarit A Golub
• 金额: $ 12.03万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-18 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10480817
• 关键词: Abdomen; Address; Adherence; African American; American; Asian Americans; Blood Tests; Cancer Etiology; Caring; Cessation of life; Chronic; Chronic Hepatitis B; Clinical; Communities; Community Networks; Comparative Study; Control Groups; Data; Death Rate; Disease Management; Doctor of Philosophy; Dose; Education; Effectiveness of Interventions; Environment; Ethnic group; Evidence based intervention; Feedback; Goals; Gold; Guidelines; Health Care Costs; Hepatitis B Infection; Hepatitis B Virus; Hepatitis C virus; Hispanic Americans; Incidence; Individual; Institute of Medicine (U.S.); Intervention; Knowledge; Liver diseases; Longterm Follow-up; Malignant Neoplasms; Malignant neoplasm of liver; Measures; Mediator of activation protein; Monitor; Motivation; Multilingualism; Not Hispanic or Latino; Outcome; Participant; Patient Self-Report; Patients; Persons; Population; Prevalence; Primary Health Care; Primary carcinoma of the liver cells; Randomized Controlled Trials; Research; Research Project Grants; Resources; Risk; Self Efficacy; System; Technology; Tenofovir; Text Messaging; Time; Training; Translating; Treatment Effectiveness; United States National Institutes of Health; Virus Diseases; Visit; Visual Aid; base; cancer health disparity; cohort; community based participatory research; comparative effectiveness; compare effectiveness; design; effectiveness testing; entecavir; evidence base; experience; follow-up; health care availability; high risk; high risk population; improved; innovation; mHealth; medication compliance; mortality; multidisciplinary; non-compliance; optimal treatments; patient oriented; pilot test; prevent; primary care setting; programs; racial and ethnic; response; standard care; standard of care; text messaging intervention; treatment adherence; treatment arm; treatment guidelines; ultrasound; virtual patient; virus related cancer

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.

项目摘要 完整的研究项目1 - 肝癌 长期遵守患有慢性HBV的亚裔美国人的监测/治疗 TU FCCC：Grace X. HC：Sarit A. Golub，博士（共同领导）和MD的Chibuzo Enemchukwu（Coe-Leader，URM ESI） 尽管亚裔美国人占美国总人口的6％，但他们占美国人的50％以上 慢性丙型肝炎（CHB），与75％的肝细胞癌（HCC）有关，最常见 肝癌的类型。亚裔美国人作为肝癌差异人群的可能性高8-13倍 与非西班牙裔白人（NHWS）相比，患有死亡率高60％的肝癌。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检查，并结合抗病毒治疗 （例如Entecavir或Tenofovir）在适当的情况下，是降低生命疾病风险的黄金护理标准 （包括HCC）。但是，遵守亚裔美国人监测和抗病毒治疗指南 CHB患者高达40％至53％。医疗保健的通道不良和重要的文化障碍可能 防止长期遵守监测和最佳治疗，将亚裔美国人放在 HCC和医疗保健成本增加的高风险不成比例。以先前对患者的研究为基础 Navigator主导的干预措施，以改善不合规的亚裔美国人与CHB的监测和护理， 由我们既定的学术临床社区研究团队进行的，我们开发并试点测试了 虚拟患者导航工具包系统（VPN工具包）替换我们的传统患者导航工具包CHB 管理。由于我们的初步数据和其他研究表明文本消息（TM）干预措施 有可能显着提高跨疾病治疗的依从性，我们建议测试 TM与增强MHealth干预措施（VPN Toolkit + TM）的有效性，旨在帮助维持和 提高长期依从性（即24个月的随访），以监测和抗病毒治疗指南， 从而减少服务不足的具有CHB利用的高风险亚裔美国人的癌症健康分布 我们现有的CHB患者队列。具体目的是：1）评估TM的比较有效性 VS VPN+TM每六个月改善每六个月的长期遵守（医生访问和血液检查）的长期遵守（6-- ，12个，18个月和24个月的随访）和超声检查（12和24个月）； 2）比较 TM与VPN+TM在改善和维持药物依从性方面（通过自我报告和 符合抗病毒治疗指南的CHB的亚裔美国人中的电子监测； 3）检查 干预有效性的介体，包括剂量反应（即，TM和VPN工具包的利用）， 信息（知识），动机和自我有效。我们对MHealth方法的比较研究将 证明如何将基于技术的干预措施最有效地整合到现实世界中的临床中 减少与HBV相关的肝癌分布的设置。如果有效，则此VPN+TM干预是高度 可融合的干预措施，可能对减少病毒相关癌症产生重大影响 服务不足的亚裔美国人和其他最高风险的人口之间的差异。