Addressing the Burden of Liver Cancer in Texas’ Southern Border Region
Introduction
Hepatitis C virus (HCV) infection, the most common blood-borne disease in the United States, is a significant risk factor for developing Hepatocellular Carcinoma (HCC), a primary liver malignancy. HCC is the fastest-rising cause of cancer-related deaths in the United States. Systemic hurdles in screening and treatment led to South Texas having the highest incidence of HCC in the nation. University Health, in partnership with Mid Rio Grande Border – Area Health Education Center (MRGB-AHEC) and City of Laredo Health Department (CLHD), has established the Hep C - C.A.R.E. (Colonias Advancing & Restoring Esperanza) program that expands outreach, hepatitis screening, comprehensive patient and provider education, vaccinations, and tailored navigation services to the underserved communities of South Texas.
Methods
The disproportionate burden of liver cancer in Texas’ southern border region was addressed through multifaceted collaborations and patient navigation. MRGB-AHEC leads community outreach and education throughout the Mid Rio Grande Border Region, focusing on disease state, screening guidelines, and linkage to testing services. CLHD leads best practices in an HCV test-to-treat model for the uninsured in Webb County that entails navigating patients to screening utilizing reflex testing (HCV Ab to HCV RNA PCR), hepatitis B vaccination services, and treatment consultation appointments. Individuals with a positive HCV RNA PCR test are scheduled for a follow-up visit, educated on Hepatitis B and C infection, encouraged to be vaccinated for HBV, and navigated to treatment options. Eligible patients are navigated to treatment administered by a primary care provider at CLHD or partner organizations as per their healthcare needs.
Results
From September 2021 to June 2023, Hep C – C.A.R.E. educated 649 providers and staff and reached 67,942 community members; 1,021 individuals received an HCV Ab test, of which 12% (n=118) had a reactive HCV Ab result. Of these, 99% (n=117) received a confirmatory HCV RNA PCR test. Of these, 64% (n=75) were identified as active HCV infections and 87% (n=65) were navigated to treatment. Among those screened, 220 were educated on viral hepatitis infections, prevention and risks, and 64 received HBV 2-dose vaccine. A total of 1,139 individuals were navigated to screening, vaccination, and/or follow-up appointments. The patient navigator helped with building trust, reducing fear, patient-provider communication support, improved outreach, scheduling of and adherence to appointments, improved patients’ health literacy and overall care, and helped narrow health disparities for the underserved patient population in South Texas.
Conclusion
Hep C - C.A.R.E. expands services to underserved minority communities of South Texas to reduce liver cancer incidence with patient navigation having an integral role in improving healthcare delivery and promoting health equity. Concurrently, the program decreases barriers to comprehensive care and implements systemic changes while decreasing high-cost healthcare utilization and addressing the health literacy of the border community.