ABSTRACT The Hawaii Clinical Research Network for Health Equity (HICRN-HE) proposed 2 pilot projects involving non-alcoholic fatty liver disease (NAFLD), now more recently called metabolic dysfunction-associated steatotic liver disease (MASLD) using transient elastrography (TE) [‘FibroScan’], a noninvasive ultrasound technique that can provide measurements of both liver fat and fibrosis in a one-step evaluation. These 2 projects targeted urban primary care community settings on the Island of Oahu where our medical school is located with the goal to assess its relationship to social determinants of health and to see if FibroScan assessments should be part of standard of care within primary care settings. This Administrative Supplement application now proposes to expand the study to the rural neighbor islands – specifically to the Big Island of Hawaii, Kauai and Molokai. We propose to increase the current target sample of 878 participants to an additional 600 participants – 200 at each site. In expanding the sample size of the 2 projects, we seek to expand the study both from our current urban emphasis to Hawaii’s rural population (our ‘neighbor’ islands) and to capture broadly the representative ethnic diversity of the population in Hawaii. We will be able to obtain a more complete understanding of the relationship between social determinants of health and NAFLD, and whether ‘point of care’ testing with FibroScans should be advocated as a public health policy.