Implementation of Community-Based Helicobacter pylori Screening and Navigation in High-Risk Immigrant Communities.

Abstract

Gastric cancer remains a major prevention gap in the United States, disproportionately affecting immigrants from high-incidence regions. Although Helicobacter pylori is the leading modifiable risk factor for non-cardia gastric cancer, systematic and equitable pathways for testing, treatment, and eradication confirmation are lacking, and evidence on downstream implementation outside hospital settings remains limited. These findings suggest that community-based H. pylori screening paired with sustained navigation is feasible, and that the principal losses in gastric cancer prevention occur downstream rather than at risk identification or therapeutic efficacy. Approaches that explicitly address multistep, time-lagged care delivery are essential for translating H. pylori eradication into population-level gastric cancer prevention in high-risk immigrant communities. We conducted a pragmatic, descriptive implementation evaluation of a culturally and linguistically tailored, community-anchored H. pylori screening and navigation program, with outcomes assessed over a 6-month follow-up period in partnership with community and faith-based organizations serving Korean American populations. The workflow included multilingual outreach, a brief survey, on-site urea breath testing, privacy-protective result disclosure, and active navigation to support clinical evaluation, treatment completion, and post-treatment assessment. Among 323 participants screened, 58 (18.0%) had active H. pylori infection, and all (100%) were successfully contacted for confidential result disclosure. Within 6 months, 31 (53.4%) completed clinical evaluation, 15 (25.9%) completed eradication therapy, and nine (15.5%) completed post-treatment retesting; eradication was confirmed in eight of nine retested participants (88.9%). Attrition occurred across the care cascade and primarily reflected structural and logistical barriers rather than treatment failure.