Chronic hepatitis B virus (HBV) infection is a leading cause of liver disease and hepatocellular carcinoma (HCC), the second most common cause of cancer death in the world. In the United States (US), where approximately 75% of all HBV infections (2.2 million) are undiagnosed, chronic HBV is concentrated in marginalized populations, most notably, immigrants (60%). Immigrants, particularly West African-born persons (>10%) bear a great burden of HBV infection in the US, many of whom have not been screened. Culturally-informed strategies are needed to increase screening in West African immigrants in the US. A proactive approach is particularly important because early diagnosis and treatment is the most effective way to reduce HBV-related liver failure and HCC. HBV can be detected with a simple blood test and antiviral treatment reduces disease progression. The project's central hypothesis is that HBV screening in West African-born persons can be improved by defining factors tied to culture, health literacy (HL) and limited English proficiency (LEP), and translating this information into an intervention. This project expands upon our prior work and pioneers novel approaches to increase HBV screening in an understudied population of West Africans residing in the US through community engagement. Development of strategies to increase HBV screening among this population could provide a framework for increasing HBV testing globally, where approximately 240 million persons are chronically infected.
The Specific Aims are to:
Aim 1 : Test the association of sociocultural factors in West Africans (both in English and French) with positive views on HBV screening and intent to undergo screening;
Aim 2 : Develop and refine a program to increase HBV screening that integrates best practices for communication with low HL populations with culturally targeted messaging;
Aim 3 : Pilot test the education program (both in English and French) in West African communities to determine its acceptability and feasibility. The long-term goal is to reduce the burden of chronic HBV-related liver disease and HCC in West African immigrants and to reduce health disparities in screening for hepatitis B and ultimately liver cancer in the US and globally. Earlier detection and more effective management of persons infected with HBV will reduce overall HBV-related morbidity and mortality, and decrease known cancer disparities. The immediate goals are to better define sociocultural factors to develop and pilot test the first community- based, theory-informed program to eventually increase HBV screening in West Africans. In line with the goals of PAR-17-150 to determine the role of LEP and HL and barriers to utilization of care among medical underserved high-risk populations, the development of strategies to increase HBV screening and treatment services could have a profound public health impact.
Chronic hepatitis B virus (HBV) infection is a leading cause of liver disease and hepatocellular carcinoma; it is estimated that 1.3 million foreign-born persons in the United States are living with chronic HBV including more than 9% of the African immigrants residing in New York City. A better understanding of sociocultural factors including health literacy, English language proficiency and language preference in West African immigrants will allow us to improve HBV screening through the development of an innovative, theory-informed, culturally targeted education program through community engagement, with the goal of reducing the burden of chronic HBV-related liver disease and cancer.
