|
1
|
Afolabi IB, Aremu AB, Koryom MJP, Buh A, Bainbridge SA, Phillips KP. Predictors of Medication Non-Adherence Among Hepatitis B Patients in South Sudan: A Health-Facility-Based Cross-Sectional Study. Patient Prefer Adherence 2025; 19:981-996. [PMID: 40230460 PMCID: PMC11995916 DOI: 10.2147/ppa.s514283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 04/07/2025] [Indexed: 04/16/2025] Open
Abstract
Background Despite the effectiveness of hepatitis B virus (HBV) antiviral treatment therapy in reducing the risk of liver-related complications, such as cirrhosis and hepatocellular carcinoma among chronically infected patients, medication non-adherence continues to hamper the successful management of the infection. The extent of HBV treatment adherence, associated facilitators, and barriers in South Sudan is not established. This study aimed to explore the predictors of medication non-adherence among HBV patients attending a public health facility in, South Sudan. Methods We conducted a facility-based cross-sectional study of 392 convenience-selected patients using a pretested interviewer-administered questionnaire premised on the information-motivation-behavioral skills (IMB) adherence model between December 2023 and March 2024. The relationship between medication non-adherence and antecedent variables was ascertained by logistic regression analysis. Results The sample was predominantly male (64.3%), and the mean age was 31.06 (30.19-31.93) years, with 28.1% reporting no formal education. The patients demonstrated inadequate HBV information (4.33±1.93), low motivation (8.20±2.69), and inadequate behavioral skills toward medication adherence (8.45±2.99), as measured on their respective rating scales. Further, more than two-thirds of the patients (70.2%) were HBV medication non-adherent. Younger age (AOR = 4.74, 95% CI = 2.13-10.56), being currently unmarried (AOR = 3.25, 95% CI = 1.76-6.01), unemployment (AOR = 4.19, 95% CI = 1.84-9.56), and increased behavioral skills (AOR = 1.12, 95% CI = 1.84-9.56) significantly influenced medication non-adherence. Lower education (AOR = 0.21, 95% CI = 0.10-0.46) and information adequacy (AOR = 0.63, 95% CI = 0.53-0.75) were associated with lower odds of non-adherence. Conclusion The study highlights key factors influencing the concerning rate of medication non-adherence among HBV patients in South Sudan. While these identified factors may explain the lingering burden of HBV-related complications, targeted interventions addressing demographic, socioeconomic barriers, and HBV-specific education are essential to enhance adherence and improve health outcomes.
Collapse
Affiliation(s)
- Ismail Bamidele Afolabi
- Department of Public Health, Cavendish University, Kampala, Uganda
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Musa Jal-Paul Koryom
- Department of Public Health, Cavendish University, Kampala, Uganda
- Department of Public Health, Juba Teaching Hospital, Juba, South Sudan
| | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon A Bainbridge
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
|
2
|
Kwon SC, Kranick JA, Islam NS, Wyatt LC, Patel S, Alam G, Chebli P, Ravenell J, Pong P, Kim SS, Raveis VH, Trinh-Shevrin C. Applying Social Marketing Principles for Community-Based Cancer Screening Programs: Two Case Studies. HEALTH EDUCATION & BEHAVIOR 2025:10901981251322806. [PMID: 40099859 DOI: 10.1177/10901981251322806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
Minoritized communities often experience worse health outcomes on the cancer continuum. Mainstream strategies may have limited reach and utility to populations experiencing inequities in real-world settings. Through the combined use of community-based participatory research (CBPR) and social marketing strategies, which highlight community-centered and culturally adapted processes, we provide an approach to inform future intervention research across various health topics that has been successful in engaging minoritized and understudied communities. We present two case studies that used participatory social marketing principles to culturally adapt evidence-based cancer screening programs for two communities in New York City. The first program is a campaign to increase screening and vaccination for hepatitis B among Korean and Chinese American immigrants. The second is a culturally adapted program to increase breast and cervical cancer screening among a multiracial and ethnic population of Muslim women. These case studies illustrate the benefits of integrating social marketing and CBPR approaches as a key strategy when developing public health campaigns to effectively reach and influence health behaviors in partnership with communities that have been socially marginalized and historically underserved.
Collapse
Affiliation(s)
| | | | | | | | - Shilpa Patel
- Center for Health Care Strategies, Trenton, NJ, USA
| | | | - Perla Chebli
- NYU Grossman School of Medicine, New York, NY, USA
| | | | - Perry Pong
- Charles B. Wang Community Health Center, New York, NY, USA
| | - Sara S Kim
- Korean Community Services of Metropolitan New York, Bayside, NY, USA
| | | | | |
Collapse
|
|
3
|
Twersky SE, Jefferson R, Garcia-Ortiz L, Williams E, Pina C. The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review. Healthcare (Basel) 2024; 12:364. [PMID: 38338249 PMCID: PMC10855368 DOI: 10.3390/healthcare12030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.
Collapse
Affiliation(s)
- Sylvia E. Twersky
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Rebeca Jefferson
- R. Barbara Gitenstein Library, The College of New Jersey, Ewing Township, NJ 08618, USA;
| | - Lisbet Garcia-Ortiz
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Erin Williams
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Carol Pina
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| |
Collapse
|
|
4
|
Kardashian A, Serper M, Terrault N, Nephew LD. Health disparities in chronic liver disease. Hepatology 2023; 77:1382-1403. [PMID: 35993341 PMCID: PMC10026975 DOI: 10.1002/hep.32743] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022]
Abstract
The syndemic of hazardous alcohol consumption, opioid use, and obesity has led to important changes in liver disease epidemiology that have exacerbated health disparities. Health disparities occur when plausibly avoidable health differences are experienced by socially disadvantaged populations. Highlighting health disparities, their sources, and consequences in chronic liver disease is fundamental to improving liver health outcomes. There have been large increases in alcohol use disorder in women, racial and ethnic minorities, and those experiencing poverty in the context of poor access to alcohol treatment, leading to increasing rates of alcohol-associated liver diseases. Rising rates of NAFLD and associated fibrosis have been observed in Hispanic persons, women aged > 50, and individuals experiencing food insecurity. Access to viral hepatitis screening and linkage to treatment are suboptimal for racial and ethnic minorities and individuals who are uninsured or underinsured, resulting in greater liver-related mortality and later-stage diagnoses of HCC. Data from more diverse cohorts on autoimmune and cholestatic liver diseases are lacking, supporting the need to study the contemporary epidemiology of these disorders in greater detail. Herein, we review the existing literature on racial and ethnic, gender, and socioeconomic disparities in chronic liver diseases using a social determinants of health framework to better understand how social and structural factors cause health disparities and affect chronic liver disease outcomes. We also propose potential solutions to eliminate disparities, outlining health-policy, health-system, community, and individual solutions to promote equity and improve health outcomes.
Collapse
Affiliation(s)
- Ani Kardashian
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| |
Collapse
|
|
5
|
Daniels D, Imdad A, Buscemi-Kimmins T, Vitale D, Rani U, Darabaner E, Shaw A, Shaw J. Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2131168. [PMID: 36332155 PMCID: PMC9746503 DOI: 10.1080/21645515.2022.2131168] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.
Collapse
Affiliation(s)
- Danielle Daniels
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA,CONTACT Danielle Daniels 750 East Adams St. Room 5400, Syracuse, NY13210, USA
| | - Aamer Imdad
- Department of Pediatrics, Karjoo Family Center for Pediatric Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Danielle Vitale
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Uzma Rani
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ellen Darabaner
- Hunter-Rice Health Sciences Library, Samaritan Medical Center, Watertown, NY, USA
| | - Andrea Shaw
- Department of Pediatrics, Department of Internal Medicine, Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jana Shaw
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
|
6
|
Min E, Min J, Kim R. Age-specific seroprotection after Hepatitis B virus vaccination among Korean American pediatric population in Queens, New York. Hum Vaccin Immunother 2022; 18:2053404. [PMID: 35378050 PMCID: PMC9225381 DOI: 10.1080/21645515.2022.2053404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Hepatitis B Virus (HBV) infection is a major health issue among Asian Americans. The prevalence of chronic Hepatitis B infection in New York City is estimated to be 2.7% compared with .3% in the overall United States. The efficacy and long-term immunity of HBV vaccination in the Korean American pediatric population in Queens, NY, are not well explored. This study aimed to 1) determine the age-specific prevalence of anti-HBs seropositivity in the Korean American pediatric population and 2) assess biologic/demographic factors influencing immunologic response to HBV vaccine. We performed a retrospective chart review of patients registered to a pediatric health clinic located in Queens, NY, from October 2014 to October 2020. Out of 604 medical records of patients aged ≤18 years who received a completed series of HBV vaccines during infancy, we analyzed 91 medical records where HBV serology test (HBsAg and anti-HBs) results were available. Three out of 91 subjects were born to HBsAg-positive mothers. Eight out of 91 subjects were born in South Korea. Overall, 54.9% of subjects were anti-HBs-seropositive. The seropositive rate in the 15 to 18-years-old-age group (14.3%) was significantly lower than that in other age groups: < 1 year (100%) (p = .015), 1–4 years (52.6%) (p = .033), 5–9 years (63.3%) (p = .0034), and 10–14 years (64%) (p = .0063). The mean duration since vaccination in seropositive subjects was 96.5 ± 53.9 months, and that in seronegative subjects was 121.7 ± 64.2 months (p < .047). Gender, BMI, and foreign birth were not significant risk factors affecting the nonseroprotective status. The role of routine screening of anti-HB titers and booster vaccination in this endemic community needs to be further explored.
Collapse
Affiliation(s)
- Esther Min
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.,Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.,Herricks High School, New Hyde Park, NY, USA
| | - Jae Min
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Roger Kim
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| |
Collapse
|
|
7
|
Khalili M, Kim NJ, Tsoh JY, Walsh JME, Goldman LE, Gildengorin G, Wong C, Tran MT, Yu E, Sharp MT, LeTran VH, Nguyen VV, Nguyen TT. Health Within Reach-a Patient-Centered Intervention to Increase Hepatitis B Screening Among Asian Americans: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:3242-3250. [PMID: 34993863 PMCID: PMC9550928 DOI: 10.1007/s11606-021-07232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are few studies to date of interventions to increase viral hepatitis screening among Asian Americans, who have high rates of chronic hepatitis B (HBV) infection. OBJECTIVE To develop, implement, and test the efficacy of a mobile application (Hepatitis App) delivered in four languages to increase HBV screening among Asian Americans. DESIGN Cluster-randomized clinical trial. PARTICIPANTS Four hundred fifty-two Asian American patients ≥ 18 years of age, who had no prior HBV testing, and received primary care within two healthcare systems in San Francisco, CA. INTERVENTIONS The intervention group received the Hepatitis App, delivering interactive video education on viral hepatitis in English, Cantonese, Mandarin, or Vietnamese and a provider printout (Provider Alert) and Provider Panel Notification. The comparison group received a mobile application delivering nutrition and physical activity education and Provider Panel Notification. MAIN MEASURES Primary outcomes were patient-provider discussion about HBV and documentation of a HBV screening test within 3 months post-intervention. Secondary outcome was documentation of an order for a HBV screening test. KEY RESULTS Participants had a mean age of 57 years and were 64% female, 80% foreign-born, and 44% with limited English fluency. At post-visit, over 80% of intervention participants reported they liked using the Hepatitis App. At 3-month follow-up, the intervention group was more likely than the comparison group (all P < 0.001) to have discussed HBV with their provider (70% vs.16%), have a HBV test ordered (44% vs.10%), and receive a HBV test (38% vs.8%). In multivariable analyses, the intervention odds ratio for HBV test ordering was 7.6 (95% CI: 3.9, 14.8) and test receipt was 7.5 (95% CI: 3.6, 15.5). CONCLUSIONS A multi-lingual educational intervention using a mobile application in primary care clinics was well received by Asian American patients, enhanced patient-provider communication about HBV, and increased HBV screening. Technology can improve healthcare quality among Asian Americans. TRIAL REGISTRATION ClinicalTrials.gov NCT02139722 ( https://clinicaltrials.gov/ct2/show/NCT02139722 ).
Collapse
Affiliation(s)
- Mandana Khalili
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.
| | - Nicole J Kim
- Division of Gastroenterology, University of Washington, Seattle, WA, USA
| | - Janice Y Tsoh
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Judith M E Walsh
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - L Elizabeth Goldman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ching Wong
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mi T Tran
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Edgar Yu
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Michael Thanh Sharp
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vivian H LeTran
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vi-Van Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tung T Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
|
8
|
Stahl HJ, Wu AK, Li H, Hu D, Liu W, Lam SK. Elucidating a Silent Illness: Hepatitis B Knowledge Among Asian Individuals in an Urban Center. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:417-424. [PMID: 35389958 DOI: 10.1097/phh.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite comprising less than 6% of the US population, Asian individuals make up more than half of the approximately 1.6 million chronic hepatitis B virus (HBV) infections in the United States. The purpose of this investigation was to identify characteristics associated with HBV knowledge in this disproportionately affected population. METHODS A cross-sectional, multilingual survey study using convenience sampling was conducted in a Midwestern urban city to collect information on respondents' demographics, health care access, and HBV knowledge. Hepatitis B virus knowledge was categorized into epidemiology, natural history, transmission, and vaccination. Data were analyzed using Kruskal-Wallis and Spearman correlation tests. RESULTS Of the 174 individuals who completed surveys, 139 (79.9%) were Asian. Characteristics of univariate analyses associated with higher knowledge scores included younger age (18-49 years), proficiency in reading English, college education, current employment status, physician using preferred language, last physician's visit in 2018 or prior, perceived lack of time to see a physician, use of emergency department, prior HBV vaccination, prior HBV testing, higher level of self-reported knowledge about HBV, and acquiring health information from the Internet, messaging applications, friends, and family (P < .05). In the multivariable analysis, shorter residency in the United States (0-10 years), current employment status, having heard of HBV, and confidence in their HBV knowledge were associated with higher knowledge scores. CONCLUSION Knowledge deficits existed in our study population regarding HBV transmission, vaccination, and epidemiology, while knowledge was higher regarding HBV natural history. Education efforts should be designed to improve knowledge deficits about HBV for individuals with risk factors using culturally sensitive Internet and social media platforms.
Collapse
Affiliation(s)
- Heidi J Stahl
- Case Western Reserve University School of Medicine, Cleveland, Ohio (Mss Stahl and Wu, Messrs Li and Hu, and Dr Lam); Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (Ms Liu); Cleveland Clinic Children's, Department of Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, Ohio (Dr Lam); and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Lam)
| | | | | | | | | | | |
Collapse
|
|
9
|
Bhimla A, Zhu L, Lu W, Golub S, Enemchukwu C, Handorf E, Tan Y, Yeh MC, Nguyen MT, Wang MQ, Ma GX. Factors Associated with Hepatitis B Medication Adherence and Persistence among Underserved Chinese and Vietnamese Americans. J Clin Med 2022; 11:870. [PMID: 35160319 PMCID: PMC8837110 DOI: 10.3390/jcm11030870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection disproportionately affects Asian Americans in the United States, while this population faces low adherence to HBV treatment. Using the information-motivation-behavioral skills model (IMB), the study aims to examine medication adherence and persistence among Chinese and Vietnamese people with HBV. METHODOLOGY Study participants were recruited between March 2019 and March 2020 and were enrolled through multiple recruitment approaches in the Greater Philadelphia Area and New York City. The study is an assessment of the baseline data on medication adherence, HBV-related knowledge, motivation of HBV medication treatment, self-efficacy about HBV medication treatment, and socioeconomic status. RESULTS Among 165 participants, 77.6% were Chinese and 22.4% were Vietnamese Americans. HBV-related knowledge/information, motivation, and self-efficacy were all positively associated with having medium/high medication adherence. Multilevel mixed-effects generalized linear regression revealed that living more than 10 years in the U.S. (OR = 4.24; p = 0.028) and greater information-knowledge about HBV (OR = 1.46; p = 0.004) were statistically associated with higher odds of medium/high medication adherence. Moreover, greater HBV-related knowledge/information (OR = 1.49; p = 0.023) and greater motivation towards HBV treatment adherence (OR = 1.10; p = 0.036) were both associated with a higher likelihood of medication persistence. CONCLUSION Our findings provided significant implications in designing behavioral interventions focused on self-efficacy, information, and motivation to promote better medication adherence among Asian Americans living with HBV.
Collapse
Affiliation(s)
- Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
| | - Sarit Golub
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave., New York, NY 10065, USA; (S.G.); (C.E.)
| | - Chibuzo Enemchukwu
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave., New York, NY 10065, USA; (S.G.); (C.E.)
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, 3401 N. Broad St., Philadelphia, PA 19140, USA;
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, 695 Park Ave., New York, NY 10065, USA;
| | - Minhhuyen T. Nguyen
- Department of Medicine, Section of Gastroenterology, Fox Chase Cancer Center, Temple University Health System, 3401 N. Broad St., Philadelphia, PA 19140, USA;
| | - Min Qi Wang
- School of Public Health, University of Maryland, 4200 Valley Dr., College Park, MD 20742, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA
| |
Collapse
|
|
10
|
Healthcare Disparities Identified Between Hmong and Other Asian Origin Groups Living with Chronic Hepatitis B Infection in Sacramento County 2014-2017. J Community Health 2021; 45:412-418. [PMID: 31612369 DOI: 10.1007/s10900-019-00763-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic hepatitis B (CHB) disproportionately affects non-US born Asians. The Hmong have been shown to have the highest rates of CHB and mortality from liver cancer compared to other Asian groups. From September 2014 to September 2017, testing for CHB within Sacramento County was conducted through community-based testing events and an electronic health record alert that identified Asian patients by surname. Demographic and laboratory data were collected for analysis and patients were followed through the study period to assess linkage to care and treatment to compare differences between Asian origin groups. Of 4350 patients tested for CHB, 318 (7.3%) were HBsAg positive, including 90 Chinese, 47 Hmong, and 101 Vietnamese. Hmong were more likely to have Medicaid insurance compared to other Asian origin groups (15%, p < 0.001). Hmong had significantly lower rates of hepatitis B DNA testing (p < 0.001), referral to hepatology (p < 0.001), attendance of first (p < 0.001) and second medical visit (p = 0.0003), and lower rates of antiviral treatment compared to other Asian origin groups. Hmong also had the highest proportion of non-English speakers (p < 0.001). Hmong patients in the Sacramento CHB testing and linkage to care program experience socioeconomic disadvantages compared to Vietnamese and Chinese patients. These factors may contribute to decreased linkage of care and decreased anti-viral treatment rates for CHB.
Collapse
|
|
11
|
Lyu J, Wang S, He Q, Pan C, Tang AS. Hep B Moms: A cross-sectional study of mother-to-child transmission risk among pregnant Asian American women with chronic hepatitis B in New York City, 2007-2017. J Viral Hepat 2020; 27:168-175. [PMID: 31638292 DOI: 10.1111/jvh.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 01/01/2023]
Abstract
Mother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B virus (HBV) infections worldwide. Despite timely HBV immunoprophylaxis of neonates, MTCT can occur in infants born to mothers with high levels of HBV viremia. We performed a retrospective cross-sectional analysis of Asian American women with chronic HBV evaluated with HBV DNA during prenatal care at two community health sites in New York City from 2007 to 2017. We described patient's demographic and clinical characteristics, categorized their HBV disease phase and analysed for variables associated with high MTCT risk (defined by HBV DNA level >200 000 IU/mL) using multivariable logistic regression. A total of 1298 pregnancies among 1012 mostly China-born (97.6%) women with chronic HBV were included in the study. Of the 1241 pregnancies among women not on antiviral treatment, 22.4% were considered high risk for MTCT and, of these, 255 (91.7%) were HBV e antigen (HBeAg)-positive and 19 (6.8%) were HBeAg-negative. HBeAg-positive status and ALT levels between 26 and 50 U/L were associated with higher likelihood for being high risk for MTCT. Only 0.8% of pregnancies low risk for MTCT were in the immune active phase while the majority (58.4%) were in the inactive chronic HBV phase of infection. Approximately one in five (22.4%) pregnancies among Asian American women with chronic HBV was considered high risk for MTCT and met criteria for antiviral therapy. Full assessment of HBV pregnant women and early coordinated care is needed to deliver interventions to prevent MTCT during critical windows of time.
Collapse
Affiliation(s)
- Janice Lyu
- Charles B. Wang Community Health Center, New York, NY, USA
| | - Su Wang
- Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, USA
| | - Qingqing He
- Charles B. Wang Community Health Center, New York, NY, USA
| | - Calvin Pan
- New York University Langone Health, New York, NY, USA
| | - Amy S Tang
- Charles B. Wang Community Health Center, New York, NY, USA
| |
Collapse
|
|
12
|
Alpern JD, Leventhal TM, Bahr NC. Improving Hepatitis B Care in the US: A Case for a New "Ryan White" Program. J Health Care Poor Underserved 2020; 31:1037-1043. [PMID: 33416677 DOI: 10.1353/hpu.2020.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic hepatitis B infection is common in the United States, yet only a minority of eligible people are screened, vaccinated, and receive treatment. The Ryan White HIV/AIDS program has been a key tool for ensuring that socioeconomically disadvantaged HIV-infected patients have access to care. Many of the same disease and patient attributes that make the Ryan White program necessary and effective for HIV exist in chronic hepatitis B. Thus, we believe that the current Ryan White program should be expanded to care for people with hepatitis B under similar regulations. Considering recent changes proposed to the health insurance marketplace, policymakers should strongly consider inclusion of chronic hepatitis B in the safety-net Ryan White Program.
Collapse
|