Need: Hepatocellular cancer (HCC) is the fastest growing cancer in Texas. The age-adjusted incidence of liver cancer in Texas is the highest in the U.S. The majority of HCC is due to viral hepatitis, primarily hepatitis C (HCV) in the US and hepatitis B virus (HBV) globally. HCV is curable and HBV is a vaccine-preventable disease. To reduce HCC burden, we are targeting counties in North and South Texas with high HCC incidence and significant need to increase prevention through HCV and HBV screening, immunization, and treatment. Recent changes in national guidelines recommend screening for HCV in all adults 18-79 years old and universal hepatitis B vaccination for adults 19-59 years old to re...

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Need: Hepatocellular cancer (HCC) is the fastest growing cancer in Texas. The age-adjusted incidence of liver cancer in Texas is the highest in the U.S. The majority of HCC is due to viral hepatitis, primarily hepatitis C (HCV) in the US and hepatitis B virus (HBV) globally. HCV is curable and HBV is a vaccine-preventable disease. To reduce HCC burden, we are targeting counties in North and South Texas with high HCC incidence and significant need to increase prevention through HCV and HBV screening, immunization, and treatment. Recent changes in national guidelines recommend screening for HCV in all adults 18-79 years old and universal hepatitis B vaccination for adults 19-59 years old to reduce HCC burden and eliminate viral hepatitis. Low income, minority populations have higher risk of HCC due to lack of screening and access to prevention programs. This program especially targets minority, low-income populations with a disproportionate need for HCC prevention and poor access to HCV and HBV screening and treatment. Overall Project Strategy: Through this program, we plan to increase our screening from one focused on Baby Boomers (BB), those born between 1945 to 1965, to all adults 18 to 79 years of age. Hepatitis B screening and vaccination was focused on those with liver disease or high-risk individuals, but it will expand to universal screening and vaccination for those age 19-59. To implement these expansions, we will use a multi-faceted comprehensive intervention including patient and provider education; electronic medical record (EMR) with alerts for eligibility; performance monitoring and feedback, patient navigation; and treatment/cure of HCV and treatment/vaccination for HBV. Our sites will include those from our current CPRIT program comprising 13 clinics in Dallas County, affiliated with the Parkland safety-net system and 4 federally qualified health centers (FQHCs) in South Texas. We see important opportunities for improvement by leveraging health information technology (HIT) systems to improve data collection, analytics and enhance our ability to provide evidence-based quality improvement. In the 4 large South Texas FQHCs, we will use evidence-based quality improvement (EBQI) methods through an informatics-driven software approach to inform and optimize HCV screening and HBV vaccination rates. In Dallas County, we will use the current Best Practice Alert (BPA) within the COPC's EMR for HCV screening adjusted to include all eligible adults aged 18-79. We will add hepatitis B screening and vaccination to a health maintenance alert in their EMR for eligible adults aged 19-59. There, we also will explore the use of the MyChart patient portal messaging for patient activation. For all locations, we are developing navigation for patients with chronic HCV to curative therapy. Lastly, we continue our partnership with a community-based program screening immigrant and other high-risk groups for HBV and HCV to provide resources to offer immunizations and link patients with chronic infection to care. Specific Goals: Goal 1: To increase and expand HCC prevention: Increase HCV treatment and HBV vaccination among eligible adults in accordance with guidelines across 15 medically underserved counties in Dallas County and South Texas. Goal 2: Provide navigation to care for HCC, HCV, and HBV cases among adults ages 18-79 Through this grant we will provide services (1) HCV screening, (2) linkage and facilitation of HCV treatment, known to reduce risk of liver cancer; (3) HBV screening, (4) HBV vaccination to those who are not immune, known to reduce risk of liver cancer. Through this grant we plan to serve 60,000 unique individuals and provide 77,075 services. Innovation: Our program will reduce the incidence of HCC using several innovative evidence-based services: 1) expansion of age group from BB who are currently age 57-77 to those age 18-79; 2) expansion of hepatitis B screening and universal vaccination to all age 19-59 from one focused on those with liver disease. 3) Use technology innovation to facilitate EBQI and data reporting. 4) utilize MyChart to facilitate HCV & HBV screening and universal vaccination; and 5) continue to leverage a community-based program for HCV and HBV screening and HBV vaccination, and treatment with antiviral medications for high-risk, low-income, immigrant populations. Significance and Impact: Our project involves primary care clinics in Dallas County and 4 FQHCs in 14 counties in South Texas; South Texas has one of the highest rates of HCC incidence and mortality in Texas. HCC prevention must be a top priority given its rising incidence and mortality, especially in low income, racial/ethnic minority populations at increased risk of viral hepatitis and HCC. This program will offer valuable models of expanding prevention through rigorous primary care-based and community-based HCV and HBV screening and treatment and HBV immunization.

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