Viral hepatitis and liver disease in the Mongolian community in London ('MoLo'): A mixed methods study protocol to investigate the epidemiology and burden of disease to inform clinical and public health interventions.

内容摘要

Chronic viral hepatitis infections (hepatitis B (HBV), C (HCV) and D viruses (HDV)) are responsible for over 1 million deaths annually, due to cirrhosis and liver cancer. Mongolia has a high prevalence of all these infections, resulting in the highest incidence and mortality from liver cancer in the world. Other factors, such as metabolic dysfunction-associated steatotic liver disease (MASLD) can impact viral hepatitis, although the interaction is not fully understood. Several successful viral hepatitis screening programmes have been carried out among Mongolians living in Spain, USA, and Sweden. We describe a community-informed protocol for the implementation of liver health screening among Mongolians living in London (UK), designed by a multi-disciplinary team. This observational, mixed-methods study ('Hep-MoLo') has three domains. (i) In the clinical domain, liver screening events will be held in London, in collaboration with the Mongolian Community Organisation. An awareness-raising educational component will precede point-of-care screening for blood-borne infections (HBV, HCV, HIV), liver fibrosis and steatosis, and screening for cardiometabolic risk factors (obesity, hypertension, dyslipidaemia, diabetes); (ii) Laboratory studies will focus on the interaction between HBV and MASLD; (iii) A qualitative approach will be used to explore community views on liver health screening, access and engaging in care. This protocol provides a framework for a public health intervention targeting a high-risk population, combined with laboratory and qualitative research to give a multi-dimensional insight into viral hepatitis and liver health in the London Mongolian community. This is a community-academic-clinical partnership, fostering collaboration to generate data to inform clinical and public health interventions. Liver disease is the 11th leading cause of death worldwide, due to liver scarring (cirrhosis) and liver cancer. Two major liver disease causes are long-term viral hepatitis infections (caused by hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV)), and liver stress caused by conditions such as too much liver fat, high blood pressure, diabetes, obesity and/or abnormal blood fats. The exact relationship between all these factors on liver disease is not yet fully understood. This protocol describes a liver health study among Mongolians living in London, since Mongolia has very high rates of viral hepatitis and liver disease. Clinical outreach teams have joined a Mongolian Charity and Community Organisation to plan community-based liver screening events. Researchers will use clinical information and blood samples to explore the interaction between factors that cause liver disease. They will measure fats (lipids), immune markers (cytokines) and sequence the genetic code of both the human and hepatitis B virus. Researchers will also talk with people from the Mongolian community to understand community views on viral hepatitis screening and access to healthcare. This study will develop a clinical-academic-community partnership, set the scene for future studies, and improve access to healthcare and liver-health awareness.