Socioecological barriers interrupting hepatitis B and liver cancer care engagement among USA immigrant groups

Introduction: In the United States, immigrant communities of Asian and Pacific Islander (API), African and Caribbean origin are disproportionately burdened by hepatitis B and primary liver cancer (hepatocellular carcinoma). The present study sought to explore the multidimensional factors spanning the top levels of the socioecological model of health (SEM) that influence these communities’ complete engagement in the hepatitis B cascade of care. Materials and methods: Researchers conducted virtual focus groups and key informant interviews with participants from 13 different highly impacted communities across the USA. Qualitative data were analyzed using thematic coding. Results: Findings demonstrate the role and intersection of different SEM constructs in increasing screening, prevention, and management of hepatitis B and hepatocellular carcinoma. The most reported barriers included cost of healthcare services, complex care systems, lack of insurance access, limited health literacy and cultural differences in care utilization. Conclusions: Based on study findings, various recommendations, ranging from systemic health policies to community-led initiatives, are proposed to alleviate the significant health disparities caused by hepatitis B and hepatocellular carcinoma in these communities.