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Objectives. To evaluate the effectiveness of a community-based liver cancer prevention program on hepatitis B virus (HBV) screening among low-income, underserved Vietnamese Americans at high risk.
Methods. We conducted a cluster randomized trial involving 36 Vietnamese community-based organizations and 2337 participants in Pennsylvania, New Jersey, and New York City between 2009 and 2014. We randomly assigned 18 community-based organizations to a community-based multilevel HBV screening intervention (n = 1131). We randomly assigned the remaining 18 community-based organizations to a general cancer education program (n = 1206), which included information about HBV-related liver cancer prevention. We assessed HBV screening rates at 6-month follow-up.
Results. Intervention participants were significantly more likely to have undergone HBV screening (88.1%) than were control group participants (4.6%). In a Cochran-Mantel-Haenszel analysis, the intervention effect on screening outcomes remained statistically significant after adjustment for demographic and health care access variables, including income, having health insurance, having a regular health provider, and English proficiency.
Conclusions. A community-based, culturally appropriate, multilevel HBV screening intervention effectively increases screening rates in a high-risk, hard-to-reach Vietnamese American population. (Am J Public Health. 2017;107:433-440. doi:10.2105/ AJPH.2016.303600)
Worldwide, approximately 2 billion people have been infected with the hepatitis B virus (HBV).1 Of these, about 400 million are chronically infected. HBV is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma, especially in the Asia-Pacific region.2 Furthermore, an estimated 1 million people die each year from HBV and HBV-related health consequences.1,3 Although a vaccine to prevent HBV infection has been available since 1982, vaccination rates are often suboptimal in high-risk populations. Thus, HBV is a worldwide health concern with significant personal, societal, and economic costs.4
In the United States, an estimated 2.2 million residents are chronically infected with HBV,5 of which approximately 58% are Asian American. The prevalence of HBV infection is higher among Asian Americans than any other racial/ethnic group in the United States.6,7 Although Asian Americans make up about 5% ofthe US population, they account for more than 50% of all Americans with chronic HBV.8 The prevalence of chronic HBV and associated chronic diseases varies by Asian ethnicity and is highest among Vietnamese Americans (7%-14%).2,9,10
Because chronic HBV is usually asymptomatic over many years and HBV screening rates are low in the United States, the majority...