Insights from the development of an online toolkit to promote community-engaged substance use research in the Southwest Borderlands Region.

Chronic liver disease (CLD) and cirrhosis are significant health problems worldwide [,]. There is a high prevalence of CLD in Pakistan, which has been linked to low socioeconomic status [], poor sanitary infrastructure [], and limited public awareness of liver disease risk factors []. In the region, more than 75% of liver cirrhosis and hepatocellular carcinoma are caused by viral hepatitis, namely, hepatitis B virus (HBV) and hepatitis C virus (HCV) []. Severe distortion of the liver architecture, portal hypertension, and subsequent hepatic decompensation occur due to progressive liver fibrosis. Patients with decompensated cirrhosis and ascites are particularly vulnerable to developing spontaneous bacterial peritonitis (SBP) []. SBP is thought to result from "leaky gut" or from the passage of enteric bacteria through a damaged intestinal mucosal barrier []. This is exacerbated by impaired host immunity and decreased reticuloendothelial clearance in advanced liver disease []. SBP is a major turning point in the natural history of cirrhosis and is associated with significant risk of systemic sepsis and renal failure and in-hospital mortality rates of 10-20% [-]. In developing areas, where access to healthcare is often limited, it is crucial to identify patients most at risk of SBP so they can be treated promptly. The Model for End-Stage Liver Disease (MELD) score was developed to predict survival among patients undergoing transjugular intrahepatic portosystemic shunt procedures at the Mayo Clinic [] and is now widely used as a prognostic indicator. The MELD score is based on objective laboratory values, avoiding the subjective clinical factors that comprise the traditional Child-Turcotte-Pugh (CTP) classification [].