Need: South Texas has the highest incidence of Hepatocellular Carcinoma (HCC) in the United States, about 5% higher than the rest of the country. From 2011 to 2013, the liver cancer mortality rate for Hispanics in Bexar County (14.4 per 100,000) exceeded the rate for White (6.5) and African Americans (7.9).

The Hepatitis C virus (HCV) is the major risk for HCC, and the majority of Hepatitis C Virus (HCV) positive patients are baby boomers (i.e., those born 1945-1965). In previous studies, we demonstrated that University Health System baby boomers had more than twice the prevalence of HCV when compared to national estimates. The current HCV screening rate is 11% for this age group, highlighti...

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South Texas has the highest incidence of Hepatocellular Carcinoma (HCC) in the United States, about 5% higher than the rest of the country. From 2011 to 2013, the liver cancer mortality rate for Hispanics in Bexar County (14.4 per 100,000) exceeded the rate for White (6.5) and African Americans (7.9).

The Hepatitis C virus (HCV) is the major risk for HCC, and the majority of Hepatitis C Virus (HCV) positive patients are baby boomers (i.e., those born 1945-1965). In previous studies, we demonstrated that University Health System baby boomers had more than twice the prevalence of HCV when compared to national estimates. The current HCV screening rate is 11% for this age group, highlighting the need for an expanded and comprehensive program to increase HCV screening and reduce disparities in the prevention of liver cancer.

This proposal will target baby boomers in Bexar County, specifically low-income Hispanic individuals who make up 62% of the Health System population. Critical obstacles to preventive care and cancer screening services for this population include language barriers, financial limitations, and comorbidities, in addition to low awareness of current HCV screening guidelines by both patients and health care providers.

Cultural and language barriers of the largely underserved and uninsured population will be addressed by bilingual navigators. Financial burdens associated with health care costs will be ameliorated through enrollment in eligible health care plans, discounted medication programs, and use of our institutional financial assistance program, CareLink. Complications related to comorbidities, including HIV, will be addressed by providing referrals to appropriate treatment services.

The proposed Hepatitis Viral Infection and Systematic Treatment Alliance (HepVISTA) program will capitalize on our experiences with cancer prevention, patient navigation services, and inpatient HCV screening program to improve HCV screening to reduce HCC incidence and mortality while also decreasing barriers to comprehensive care and achieving the sustainable systems change.

Overall, HepVISTA will focus on preventing HCC in baby boomers through expanded HCV screening, patient and provider education, and culturally and linguistically tailored patient navigation. We will use our Electronic Medical Records and automate laboratory orders to screen eligible patients for HCV as they receive services at a primary health care provider, urgent care clinics, or Emergency Department.

To ensure a smooth transition from diagnosis to care, our patient navigators will connect HCV positive patients to their primary care providers (PCPs) for further medical evaluation and monitoring, including referral to anti-viral treatment, hepatitis education, referrals to a hepatologist, telemedicine consults, and other specialists as needed. To guide our program evaluation, we will use a mixed methods design.

The ultimate goal of the HepVISTA program is to decrease liver cancer incidence and mortality among baby boomers through outreach, education, screening, and navigation to prevention and care. We will reach 180,000 patients with culturally tailored mail-outs and social media and create awareness about HCV and HCC. We plan to increase the screening rate by 20% over 3 years by providing HCV screening to 12,000 eligible patients. We will guide HCV positive patients to receive follow up care, cancer prevention, and hepatitis education through culturally tailored patient navigation.

HepVISTA is an innovative and first-of-its-kind cancer prevention program built on partnerships between University Health System and the University of Texas Health Science Center at San Antonio. The innovation includes the system-wide improvement in HCV screening and access to care through an automated screening process with an opt-out approach and navigation of HCV positive patients to a specialist network, including telemedicine consults.

In addition, patients and community members will be able to conveniently access educational information related to HCV screening and care through a connection to appropriate internet resources via a dynamic quick response, or QR code, that leads to our A Su Salud website containing HCV, HCC and other cancers prevention information. The sum total of these components will streamline and strengthen the collaborative relationships, thereby resulting in wider access to HCV and cancer prevention and care.

This program will address the higher prevalence of HCV and HCC among Hispanics in South Texas through decreasing barriers to screening and treatment and by reducing disparities in care seen in minority populations across the state. The reduction of HCC incidence and high utilization of health care services and readmissions associated with the end-stage liver disease management for HCV positive patients will result in downstream savings.

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