Title: AN INNOVATIVE EDUCATIONAL INTERVENTION TO IMPROVE UPTAKE OF HEPATITIS B AND C TESTING IN SOUTH EAST ASIANS: INTERVENTION DEVELOPMENT AND A FEASIBILITY STUDY FOR A RCT
Funder: Department of Health and Social Care

Abstract: Background: HBV and HCV represent a major public health problem in the UK, with mortality & morbidity from chronic viral hepatitis rising disproportionately amongst ethnic minorities groups. Currently, ethnic minorities have 7-10 times more HCV related end stage liver disease (ESLD) and 16-35 times more hepatocellular carcinoma, than Caucasians. Despite recent NICE guidelines making the testing and treatment of hard to reach groups a priority, currently, there is limited robust published evidence on effective interventions to promote testing for HBV and HCV. In our recent pilot work (supported by the National Gilead Fellowship Award) we established that first generation South East Asians (SEA) living in Surrey were much more likely than the general population to experience an admission for, or to die from liver disease and were more likely to be diagnosed and treated before progression to ESLD. Because of cultural, language and educational barriers to disease awareness, testing and treatment and because the disease is often asymptomatic, SEA patients have typically, have not engaged with their GP or other health services. As set out by NICE, to prevent further death and disease spread we need to find new ways of informing and testing this hard to reach group. We asked SEA people (both men and women) what mode of communication was preferable and a video intervention was stated as preferential. Hence, we will firstly develop an educational intervention (a video) that informs this population. Secondly, we will conduct hepatitis testing in a non-health setting more familiar to patients, as recommended by NICE (mosques/community health centres/faith schools). Once developed, we will conduct a feasibility study for conducting a RCT. A final goal is to particularly target the involvement of local South East Asian women. In our early pilot work this group were hardest to reach, yet the involvement of local women is critical, in terms of changing family behaviours. Aim: The overall aim of the application is to increase the uptake of viral hepatitis screening in South East Asian people living in the UK, by 1) developing an outreach educational video aimed at improving the uptake of hepatitis screening in the SEA population across different community settings 2) determining the feasibility of conducting a pragmatic Randomised Control Trial (RCT). Plan of investigation: The project will be executed in 2 phases. First, we will conduct Participative Action Research with local SEA people. Using patient experiences and stories we will together develop an educational intervention (a video) that addresses cultural barriers and increases awareness of chronic viral hepatitis (CVH) and the uptake of testing and treatment. Second, we conduct a feasibility study for a full-scale RCT by generating primary outcome measures to determine attitudes, knowledge and behaviours before and after exposure to our video, assessing the feasibility of our methodological procedures. We will then conduct community testing, assess recruitment and retention rates and sample size calculations for the main trial. Outcomes: This is a feasibility study for a RCT. If successful, we will conduct a full definitive pragmatic trial. We anticipate that the intervention will lead to a significant change in knowledge, attitudes and behaviours to testing; with 40% of participants watching the educational intervention uptaking testing - an increase of 50% on previous pilot work in the area conducted by the PI (that has shown uptake of screening without an intervention in community setting is 15-20%). To disseminate the findings via public meetings/forum groups, mosques/community centres, user members (e.g.The Hepatitis C Trust) newsletters, electronic media and healthcare professionals, via publication in peer-reviewed journals and through a series of national and local meetings.

Lay abstract: Hepatitis B (HBV) and C virus (HCV) cause infection in the liver and if not diagnosed and treated result in life threating liver scarring (cirrhosis), liver cancer and end stage liver disease (ESLD). Previously, HBV & HCV have been perceived as incurable. Advances in the available and emerging therapies mean HCV infection is potentially curable and HBV treatable. However, HBV & HCV is rising disproportionately, with ethnic minorities having 7-10 times more HCV related end stage liver disease (ESLD) and 16-35 times more hepatocellular carcinoma, than Caucasians.Our experience, at Frimley Park Hospital, shows a that large number of first generation South East Asian (SEA) patients present to our Liver Unit with already advanced,untreated liver disease. This group typically, have not previously engaged with their GP or other health services. This is due to the disease being asymptomatic, hence not diagnosed until presentation with cirrhosis. Through earlier pilot work we also realise a lack of engagement by the SEA population is due to cultural, language and educational barriers to disease awareness, testing and treatment. As set out by NICE, to prevent further death and disease spread we need to find new ways of informing and testing this hard to reach group. The aim of this project is to use culturally sensitive local knowledge to address these barriers so together we can increase the awareness and the importance of undertaking hepatitis testing and treatment. We will firstly develop an educational intervention (a video) that informs this population and secondly, conduct hepatitis testing in a non-health setting more familiar to patients, as recommended by NICE(mosques/community health centres). Once developed, we will conduct a feasibility study to assess the recruitment potential of this new intervention at different sites prior to conducting a clinical trial to test its effectiveness (beyond the scope of this study).

Research activity codes: 4.3 INFLUENCES AND IMPACT
Health categories: INFECTION