Chronic hepatitis B in remote, tropical Australia; successes and challenges

Abstract

Introduction Aboriginal and Torres Strait Islander Australians living in remote locations suffer disproportionately from chronic hepatitis B (CHB). Defining the temporospatial epidemiology of the disease-and assessing the ability of local clinicians to deliver optimal care-is crucial to improving patient outcomes in these settings. Methods The demographic, laboratory and radiology findings in all patients diagnosed with CHB after 1990, and presently residing in remote Far North Queensland (FNQ), tropical Australia, were correlated with their management and clinical course. Results Of the 602 patients, 514 (85%) identified as Aboriginal and Torres Strait Islander Australians, 417 (69%) of whom had Torres Strait Islander heritage. Among the 514 Aboriginal and Torres Strait Islander Australians, there were only 61 (12%) born after universal postnatal vaccination was introduced in 1985. Community CHB prevalence varied significantly across the region from 7/1707 (0.4%) in western Cape York to 55/806 (6.8%) in the Eastern Torres Strait Islands. Although 240/602 (40%) are engaged in care, with 65 (27%) meeting criteria for antiviral therapy, only 43 (66%) were receiving this treatment. Among 537 with complete data, 32 (6%) were cirrhotic, of whom 15 (47%) were engaged in care and 10 (33%) were receiving antiviral therapy. Only 64/251 (26%) in whom national guidelines would recommend hepatocellular carcinoma (HCC) surveillance are receiving screening, however, only 20 patients have been diagnosed with HCC since 1999. Conclusion Vaccination has had a dramatic effect on CHB prevalence in FNQ in only a generation. However, although engagement in care is the highest in Australia, this is not translating into

The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997–2017; impact of socioeconomic status on disease burden, severity and access to care

“…This paradoxical situation is not limited to RHD. The local Indigenous population, particularly those living in remote, socioeconomically disadvantaged locations bear a disproportionate burden of both infectious and non-communicable diseases, but also has less access to sophisticated healthcare [ 14 , 16 , 28 – 33 ]. And this captures the essence of the challenges in addressing the life expectancy gap between Indigenous and non-Indigenous Australians.…”

“…No fewer than 17% of the local population identify as Indigenous Australians, almost half of whom report Torres Strait Islander heritage [ 13 ]. Evolving prosperity and public health interventions have seen the elimination of malaria and filariasis in the region, while the incidence of several others–including hepatitis B, strongyloidiasis and leprosy–is in steep decline [ 14 – 16 ]. However it is also a region which still contains 3 of the 10 most socio-economically disadvantaged local government areas in Australia, all 3 are communities with a predominantly Indigenous population [ 17 ].…”

Melioidosis–a disease of socioeconomic disadvantage

“…This current study's data lead to the greater truth that while almost all the patients in this cohort presented PLOS NEGLECTED TROPICAL DISEASES acutely, their clinical presentation and death from melioidosis was, in many cases, decades in the making. Despite Australia's universal health system, this finding is not unique to melioidosis; an association with socioeconomic disadvantage is seen in a variety of infectious diseases and non-communicable diseases seen in the region [13,[26][27][28][29][30][31][32].…”

“…Determining the explanation for this higher case-fatality rate is not straightforward. In cases of melioidosis, the interplay between host, pathogen and environment is complicated and, even in Australia's well-resourced health system, there are challenges in providing optimal access to care in remote locations [12,13].…”

Chronic liver disease: Global perspectives and future challenges to delivering quality health care

“…For example, Nielsen and colleagues report that over 50% of HCV positive patients in Denmark had yet to attend specialist care, especially in regions with a likely higher rate of intravenous drug use [ 9 ]. In Australia, Hanson and colleagues report that both HBV-related and other liver-related deaths were more common in indigenous Australians when compared to the non-indigenous population [ 10 ], suggesting that hurdles still exist in providing quality healthcare to indigenous populations living with HBV in remote areas. On the other hand, treatment coverage for HCV is increasing in many newly developed and developing countries, improving quality of life in those regions.…”