P-2184. Antiviral Use among Immigrants with Chronic Hepatitis B (HBV) in Metropolitan-DC

Abstract Background Globally, 296 million people are infected with chronic hepatitis B (HBV) and at risk for cirrhosis and hepatocellular carcinoma. In the Metropolitan-DC area, chronic hepatitis B infection (HBV) is 10 times more common in Asian, African, and Latin American communities (5% prevalence) than non-immigrants communities. Therefore, HBV-related liver disease, including cancer, is a major health disparity for immigrants. Antivirals reduce cancer risk but require long-term adherence. Immigrants face barriers to HBV antiviral adherence, including language, high cost of antivirals, and establishing care for HBV management. We examine antiviral use in a cohort of people with HBV. Methods HOPE is a natural history study at the University of Maryland, Baltimore. HOPE enrolls adults with HBV and includes TEMUL, a sub-study providing free tenofovir alafenamide (TAF) for 2 years. After completing 2 years of TEMUL, participants are transitioned to receiving antivirals through their non-study healthcare providers. We describe antiviral use while on TEMUL and at a 2-year follow-up. Results From May 2017 to March 2024, 92 people received TAF through TEMUL. Eighty-four were foreign-born (78 born in Asia and 6 born in Africa). Most (67%) had mild liver fibrosis at baseline. Eleven were withdrawn (3 lost to follow-up, 3 moved out of state, 5 voluntarily withdrew). Eighty-one completed TEMUL with sustained adherence to TAF. Fifty-eight completed a 2-year follow-up. At follow-up, 36 of 58 (62%) remained on TAF without interruption. Twelve (21%) switched antivirals because of insurance coverage. This caused lapses in antiviral use ranging from 1 month to 2 years in 5 (9%). Ten (17%) stopped antivirals due to loss of health insurance, high copay, and inability to follow-up with a healthcare provider. All 10 were foreign-born, Asian, and non-English speaking. Of these 10, 9 were viremic at follow-up and resumption of antivirals was clinically indicated in all. Conclusion Language and inadequate health insurance coverage hinder antiviral adherence in immigrants with HBV. Foreign-born, non-English speaking patients may be especially vulnerable to lapses in antiviral use. Interventions to improve access to antivirals tailored to this patient group are needed. Disclosures Lydia Tang, MBChB, Arbutus Biopharma: Grant/Research Support|Gilead Sciences: Grant/Research Support