Hepatitis B Screening & Student Research

Today, we spoke with Thanh Doan, an undergraduate student at Johns Hopkins University. Thanh has had various experiences assisting in and leading research projects, one of them being on Hepatitis B screening. We hope this episode will give you an insight into what it’s like being a student researcher, how to get started, and how to balance that among coursework and social life at university.

Hi Thanh, thank you for being here with me today. To start off, tell me a little bit about yourself — what you’re studying or where you’re from.

Yeah, of course. Thank you for making time for me today. So my name is Thanh. I am a sophomore at Hopkins studying Molecular and Cellular biology, Public Health, and Women’s Gender and Sexuality Studies. I am from Ho Chi Minh City, Vietnam.

How did you get into these fields?

I’ve always been interested in the intersection between health and social equity — especially through a gender and sexual lens. I find that intersection very interesting, combining all of my interests and family history.

So to jump right in, I’m aware that you were recently a part of the Stanford Care program. What exactly is that program and what projects did you work on?

So it’s basically a hybrid research but also educational/informative program on big data and disaggregated Asian American research populations. I worked on two projects — one on hepatitis B, the universal screening evaluation in Asian American populations in the Stanford Clinics, and the other on how the pandemic influences opioid mortality deaths among Asian American populations. Besides working on those projects, we also did three months of summer program where we were taught coding techniques, leadership abilities, the ability to network within the public health industry, which I found to be extremely enriching, and it affirms a lot of what I’ve already been interested in.

Can you give us a bit of a background on Hepatitis B and the objectives of your research?

Honestly, before coming into the research project, I myself didn’t know much about the Hepatitis B screening process. But this has been like a larger project that I have just been assisting in, so through being introduced to the project and those leading it, I found that Hepatitis B is extremely under-screened amongst Asian American populations, despite them being one of the populations most vulnerable and at risk for this disease. And since it’s so under-screened and under-discussed, that kind of mortality rate could have been prevented — as people were finding out that they have Hepatitis B way later on in their lives, way after the preventative state.

And something that was off note is that Hepatitis B has always been risk-based, which means that if physicians do a risk calculation and decide that you are in a certain minority/population that is often at risk, then you would be screened, but otherwise you would not be. Additionally, there are so many diagnostic tools that physicians have to utilize in that process, so it can be easy to miss potential patients. And so this research looks at a new implementation model, where instead of risk-based, we transition over to a universal screening, making sure that every patient that comes in undergoes a Hepatitis B Panel. We wanted to see whether this would be cost effective in the long run, whether it could potentially decrease medical expenditures, and just in general decrease mortality rates as it correlates with Hepatitis B.

What did your research process look like and what were kind day-to-day tasks?

It was a completely virtual experience. But basically, I read papers, scheduled interviews with several physicians in the Stanford Clinics, briefed myself on the different Hepatitis B policies — how the policies differ in California versus other states — and what the implementation model currently looks like specifically at the Stanford Clinics.

I think for a good chunk of the first one and a half months, I was just reading up on Hepatitis B and understanding the ideology, the screening model, and writing an interview guide, because I’m talking to people who have been conducting Hepatitis B for all of their professional careers. So I hoped to understand more thoroughly about what I’m discussing so I can phrase questions in a way that would be effective and reveal something about their screening practice. That, to me, was a big learning curve.

For the second half of the program, when I’m starting to feel more comfortable, I was scheduling interviews with my team, transcribing those interviews, and putting the data onto this program called NVivo that stratifies the different data into clusters of major themes from our interviews. That was my summer. So our process was mostly qualitative. And then now that we’re heading into the year, we’re combining our qualitative data with the quantitative results from the Cost Effectiveness Teams, and also scheduling interviews with other stakeholders involved in the screening practice — medical assistants, informaticists, policy makers — on what they think about the screen practice.

What were the main findings that stood out to you?

I actually am not able to disclose the full findings just yet in respect with my team and the contributors, but I’m happy to share more once our paper is undergoing manuscript. For now, I can describe the results-computing process. We actually noticed some discrepancies between what people say to us during interviews versus what people answer on surveys. I found that to be very interesting, just on a qualitative aspect. We are analyzing what that discrepancy looks like, what kind of biases might have factored into it — like social desirability, selection bias, etc. — and then finding ways to fit that discrepancy and weaving it into the narrative of the quantitative project. What do the numbers look like? What do the long-term follow- ups look like for populations who undergo universal screening versus risk-based?

Aside from this, have you worked on any other research projects in the past, either at Johns Hopkins or outside of school?

I was very lucky to be exposed to research since high school. I was working at the University of Sciences on natto beans and the Bacillus subtilis bacterial strand. Coming to Hopkins, I’m currently involved in some other research projects, one on endometriosis, which ties into my interest in reproductive health sciences, and another on reproductive health services and utilizations among adolescents and Vietnamese youths in the three provinces of Hanoi, Lao Cai, and Thanh Hoa.

Which one are you most passionate about and why?

That’s definitely a very tough choice. I’ve just recently started in both of these projects, so my interest and contributions will likely change over time as the projects go on; but right now I honestly can’t choose between either of them because they lie at the intersection of everything I’ve been interested in for so long. It’s such an honor to be a part of these projects and I’m learning so much.

For reproductive health services and utilizations, I’m realizing the different ways that people in Vietnam, my home country, are lacking access and are in demand for reproductive health services. Even when it’s there, they’re facing increasing stigma and the pressure from family members, coupled with the lack of educational resources. It’s very interesting to be able to parse out the data and to look at what the data represents and how we can translate them onto a policy level. Is there a way to translate these into policy impacts and what does that process look like? It is a very long-term goal. That’s one of the biggest things that I’ve realized, but I feel like as long as the research exists and continues, there is grounds for some momentum and change.

In terms of endometriosis, I’ve heard so much about it. Being involved in this process, I realized that there are so many different layers of this pathology disease that still haven’t been discovered, and that research still has a long way to go. Endometriosis shares many characteristics with a benign form of cancer. So I have been looking at what the implications are for patients who receive a diagnosis of endometriosis. What does that mean in terms of a future genetic model is to unravel these diseases and perhaps invent therapeutic treatments to more effectively engage with patients with endometriosis. These are all questions that are extremely interesting to me. My biggest thing is, I’m so early and so inexperienced in this process that it’s again learning curves after learning curves; but I trust the process.

I’m sure many of us encounter issues/topics that capture our attention, but how do you transform that interest into actual projects? How do you get started?

Yeah, that’s a great question. I think, for me, it will be first to explore the resources that are right near you. I’m very lucky to be at Hopkins, a community where there’s an abundance of research going around, but one problem that I face is not being able to narrow down on which path or which resources would be a better use of my time, and balancing that on top of coursework and other activities that require my commitment. I’d say just be proactive and be able to just communicate your interest. Don’t withhold what you genuinely and authentically feel about certain projects, because your excitement and your interest does translate, even with just an email. But at the same time, don’t be discouraged when things don’t work out a certain way.

Actually I’ve been interested in the endometriosis project since coming to Hopkins my freshman year. I sent out various emails my first week of freshman fall, though I actually didn’t receive any replies at all because the lab at that point was at capacity and they were hesitant to take on more people; but I never gave up. I knew that that was something I was interested in pursuing, and I kept following up with them months after months after months, and it was only during sophomore fall when they followed up and said: Hey, you’ve shown that you’ve been interested in us and we just had a spot open, would you like to join?

Things never worked out as linearly as I thought. But I feel like as long as you’re committed and you know that you’re interested in something, people will respect that and see that somehow.

Do you think breaks are important to keep the balance between research/classes/social life or is it about momentum and keeping going?

I believe that rest is radical and you should block out time just for yourself — to keep yourself going but at the same time, checking back to see if this is something that you’re genuinely interested in pursuing. But to be very transparent, it’s something that I’m still learning as I go through my college journey. There are days that would be very difficult. The learning process is extremely interesting, but at the same time can be very grueling and demotivating. And there are days when you question if it is worth it to keep on moving. Should I pivot? Should I cut back? And I honestly don’t think there’s any one-size-fits-all advice on this. Rather, just consistently reflect and check back on yourself. Take care of yourself. But even when there are moments that require too much of your time, just remember yourself and remember that you are here and you belong here for a reason. You’re interested for a reason. Check back on those reasons to keep yourself going. And generally, if at a point where it’s hard to maintain momentum and you need to preserve yourself, that’s also completely okay.

Thank you for tuning in. We hope this will inspire you to explore your passions and pursue projects that interest you. Vital also introduces students to the various opportunities within the healthcare realm, so keep updated through our weekly newsletters, slack channels, and website. We hope to see you next time!