Increasing Hepatitis B screening for Hmong adults: Results from a randomized, controlled trial

Background: Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per hundred thousand, Hmong Americans experience liver cancer at a rate that is 6-7 times greater than that of non-Hispanic Whites. Serological testing for the hepatitis B virus (HBV) is a principal means for the prevention and earlier detection of liver cancer. Methods: From 2006-2011 academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a randomized controlled trial testing a lay health worker intervention to promote HBV testing among 260 Hmong adults aged 18-64 through in-home education and patient navigation. Results: Intervention group participants were more likely to report receiving serological testing for HBV during the study period (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 (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3-9.2), change 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 being tested was having a doctor's recommendation. Conclusions: Lay health workers were effective in outreach and education. However, doctor visits and adherence to doctors' recommendations for testing were the most pivotal in assuring HBV testing. Participation of health care providers is essential to increase HBV testing in this population.