Abstract
Background
Helicobacter pylori (H. pylori) infection is a major cause of stomach cancer and disproportionately affects Māori and Pacific peoples in Aotearoa New Zealand (Aotearoa). International evidence suggests that organised H. pylori screen-and-treat programmes may reduce future stomach cancer incidence. However, there is currently limited evidence on how such programmes could be implemented equitably within the Aotearoa context. The H. pylori in Aotearoa New Zealand (HpANZ) study was established to determine the prevalence of H. pylori infection in Aotearoa New Zealand. During study development, a centralised whānau-centred case management pathway was developed to support participants who tested positive for H. pylori infection.
Methods
This protocol describes the case management component embedded within the HpANZ prevalence study. Participants aged 12–69 years will be recruited nationally, with stool antigen testing used to identify active H. pylori infection. Participants with a positive stool antigen test will be offered entry into a centralised case management pathway coordinated by the University of Otago Wellington in partnership with Tū Kotahi Māori Asthma and Research Trust.
The pathway includes notification of positive test results, nurse-led clinical assessment, prescribing and treatment coordination, adherence support, follow-up stool retesting, and second-line therapy where required. The pathway is delivered primarily through telephone and text-based contact and supported through a purpose-built REDCap database incorporating automated alerts, workflow tracking, and participant monitoring. General practitioners will be notified at key stages of the pathway to support continuity of care.
The pathway is designed to provide treatment and follow-up at no cost to participants while also modelling how a future population-based H. pylori screen-and-treat programme could operate within a whānau-centred framework, with all participant engagement being Māori-led.
Evaluation
The pathway will be evaluated in relation to feasibility, effectiveness, and acceptability. Evaluation measures will include treatment uptake, treatment completion, eradication rates following first and second-line therapy, adverse events, participant engagement, operational complexity, and staff time requirements. Qualitative interviews with healthcare professionals and whānau will explore acceptability, cultural safety, workforce implications, and considerations for future implementation and scale-up.
Discussion
This protocol describes one of the first centralised H. pylori case management pathways developed in Aotearoa. Findings from this work will contribute evidence regarding the practical implementation of equitable H. pylori screen-and-treat approaches and may help inform future stomach cancer prevention strategies for populations at high-risk of H.pylori infection and stomach cancer, most likely Māori and Pacific populations.