Increasing hepatitis b screening for hmong adults: Results from a randomized controlled community-based study

Background: Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. Methods: Academic researchers andHmongleaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. Results: Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P=0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P=0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation. Conclusions:LHWswere effective in bringing aboutHBVscreening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. Impact:LHWscan significantly increaseHBVscreening rates forHmongbut their doctors' recommendation is highly influential and should be pursued. Cancer Epidemiol Biomarkers Prev; 22(5); 782-91.