There was a festive feel in the parking lot outside the Village at Roosevelt apartments on San Antonio’s southside on a recent warm afternoon, where residents stopped by to check out food samples at a tent while upbeat music blared from the back of a San Antonio Food Bank truck.
After residents tried the chips and salsa and collected bags of fresh fruit and veggies, Abigail Grace and her team of community health workers were waiting nearby to talk with residents about liver cancer prevention and their health.
Grace is a program manager for GRASSROOTS HEALTH, a program created at UTHealth Houston School of Public Health to advance liver cancer prevention through access to testing, vaccines and treatment for hepatitis B and C. Since last fall, Grace and her team have been going door-to-door offering testing and hepatitis B vaccines to residents at apartment complexes managed by Prospera Housing Community Services, a non-profit, affordable housing developer.
The partnership with Prospera is essential to GRASSROOTS’ operations in San Antonio. The program also teams up with many other local partners, including the UT Health San Antonio School of Nursing, which provides nursing students for blood draws and vaccines, and the San Antonio Food Bank, which comes to some sites to offer residents access to fresh groceries on their doorstep.
GRASSROOTS is funded by a three-year, nearly $2 million grant from the Cancer Prevention Research Initiative of Texas (CPRIT) that was awarded last year to Vanessa Schick, PhD, associate professor in the Department of Management, Policy and Community Health, and Jack Tsai, PhD, professor and regional dean of UTHealth Houston School of Public Health in San Antonio.
Schick had already been running the program in Houston for several years through an initial CPRIT grant. The grant awarded in 2022 was an extension of the Houston program and an expansion, allowing Tsai to oversee the creation of a San Antonio version of GRASSROOTS.
“Many low-income communities lack access to critical preventive care services,” Tsai said. “With the support of CPRIT, the GRASSROOTS program helps address that problem by offering education, testing, and services for hepatitis. We’ve reached hundreds of low-income San Antonio and Houston residents so far.”
Grace said the program’s three primary goals are education, vaccination and treatment, with education being first because most residents do not understand or are misinformed about hepatitis B and C and how it’s related to liver cancer. The most common risk factor for liver cancer is a long-term infection with hepatitis B or C, which can cause liver cirrhosis and, eventually, cancer. The viruses are contracted through exposure to contaminated blood or bodily fluids and are more common among populations that have experienced homelessness or are at risk of homelessness.
“Our number one goal is to provide education before everything else because many people are unlikely to get tested out of fear or because they feel it’s unnecessary,” Grace said.
While there is no vaccine yet for hepatitis C, patients who test positive will be connected to treatment, Grace said, which is effective and causes minimal side effects.
There is no cure yet for hepatitis B, but if a patient hasn’t contracted the disease, the vaccination can effectively prevent the disease when the full series is administered. Grace said upwards of 90 percent of San Antonio residents who have been tested don’t have any immunity to hepatitis B, especially the older residents. The Baby Boomer and older generations missed out on the vaccine, Grace said, because it wasn’t available when they were babies, while it is now part of the regular vaccination schedule for children.
“Of the people who test negative, about 50 percent get vaccinated,” she said. “We recommend it, and we have a nurse with us, and we can do it right away for free, and when they need the second dose, we’ll come back to their door.”
Pamela Love said that ease of access and convenience allowed her and her husband to get tested and vaccinated. She’s a resident at the Village at Roosevelt who said she was very impressed with the GRASSROOTS program, especially how residents were informed about when the team would be on site.
“Two days before [the event], I got a knock on my door, and they explained what it involved,” Love said. “I thought that was very beneficial because it not only included the hepatitis shots but also checking for liver cancer, and that got my attention.”
Love said the GRASSROOTS staff was welcoming and patient with her fear of needles, and she was grateful when they hand-delivered her blood test results a few days later.
“And then, if you needed it, the vaccine could be given to you right there on the spot - that’s awesome,” Love said.
Her husband needed the hepatitis B vaccine and got the shot right away, while Love herself was relieved to find out from the blood test that she was up to date on her vaccines.
“Knowledge is power,” Love said. “And knowing how [hepatitis] can be transmitted helps you stay alert because I do not want to get it. Overall, I think this is truly necessary in the community and I’m just glad that I was able to be a part of it.”
The San Antonio team has visited 10 sites, tested more than 200 residents, administered a first dose of the hepatitis B vaccine to 76 residents, and 49 residents are fully vaccinated, Grace said.
Those statistics mean the program is ahead of schedule, so Grace said they are considering adding more sites in San Antonio.
GRASSROOTS was initially developed by Schick in 2018 and lost momentum during set-up and launch as the COVID-19 pandemic was starting.
When GRASSROOTS started up again, Schick said, it wasn’t always easy building a brand-new program from the ground up.
“GRASSROOTS Health has been the most challenging project I’ve ever worked on,” Schick said. “Because, in some ways, we were organizing pop-up clinics every week. I was used to doing research, and all of a sudden, I was pulling together a team capable of offering no-barrier care to individuals with many barriers and often limited trust in healthcare and other systems. So, it’s the hardest thing I’ve done, but I think it has also been the most rewarding. This is the first project where you see the immediate benefit on people’s lives, where we can see that we’ve cured hepatitis and potentially prevented liver cancer. It feels dramatic to say that we’ve saved someone’s life, but our team may have managed to do that for some folks.”
Over the past four years, Schick said her Houston team has tested hundreds of residents, vaccinated hundreds, educated thousands, and completed treatment for and cured dozens of residents who tested positive for hepatitis C.
“We take them through the whole continuum of care,” Schick said. “One of the goals of this model was always to make it sustainable. In the real world, sometimes funding dries up, which was one of the reasons for partnering with the School of Nursing and bringing in public health students. We were trying to integrate into existing opportunities that that don’t necessarily require additional funding.”
Schick and Tsai said they would continue to apply for grants to fund the work in various regions of Texas as long as necessary and hope to be able to expand the program.
“We’re looking forward to continuing this work, and we think there’s some exciting next steps down the road,” she said. “GRASSROOTS is a healthcare delivery model for reaching a historically underserved population, not just hepatitis specific. We’ve seen what we can do, so why not eliminate additional barriers and offer as many services as possible?”