Removing a Cultural Barrier to Cure

Reducing liver disease in immigrant African communities

With funding from the Mayo Clinic Office of Health Disparities Research (OHDR), a team led by Lewis Roberts, M.B., Ch.B., Ph.D., is working to help reduce high rates of liver disease in immigrant African communities.

“The diseases that we study — hepatitis and liver cancer — have a huge impact on communities, because they cause illness in individuals who are in the prime of their lives, in their most productive years,” says Dr. Roberts.

Watch Dr. Roberts describe his research in this video:

Many of Dr. Roberts’ Somali patients were coming to Mayo Clinic with hepatitis and hepatitis-induced liver cancer. A retrospective chart review of 3,000 patients found that Somalis were 10 times more likely to have hepatitis B virus (HBV) and three times more likely to have hepatitis C virus (HCV) than non-Somalis. HBV and HCV are major risk factors for liver cancer.

Somalis who test positive for HCV often do not seek treatment, even though an effective treatment is available. For example, for cultural reasons, they have tended to decline to have their liver biopsied, which is a standard of care. Mayo now offers noninvasive alternatives, including magnetic resonance elastography and Fibroscan, making it easier for patients to accept treatment and be cured of hepatitis.

Since 2010, Dr. Roberts and his team have been collaborating with the University of Minnesota and clinics in Minneapolis to promote hepatitis screening and vaccination in Somali communities.

Patients are offered free hepatitis screening, and Mayo employees help remove barriers such as transportation, language and education. Of 500 Somalis screened to date, about 15 percent have tested positive for HBV and 8 percent for HCV. The study team follows patients after testing and encourages them to seek either treatment or preventive vaccination.

Dr. Roberts is expanding his research through an OHDR Pilot Project to study hepatitis and hepatitis-induced liver cancer in immigrant populations from Ethiopia, Liberia and Kenya. This is one of several projects funded annually by the OHDR to promote research by Mayo Clinic investigators that aims to identify and eliminate health disparities.

“There’s a very strong focus on the patient, understanding the needs of the patient, understanding the cultural context the patient comes from, and focusing attention to developing health care systems that best help that patient and their community to have the best of health,” says Dr. Roberts.

— Kris Schanilec, Public Affairs