Factors associated with access to antiviral treatment in a multicentre cross‐sectional study of patients with chronic hepatitis B in Italy

Abstract

A multicentre cross-sectional survey was performed to provide an accurate picture of patients with chronic hepatitis B (CHB) cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes factors associated with access to the treatment of CHB in a country where barriers to treatment are not expected to exist because of comprehensive coverage under the National Health System (NHS). The study was performed in 74 IDCs. The analysis focused on 3305 patients with CHB of 3760 HBsAg-positive patients enrolled from March to September, 2008. To account for missing values, a Multiple Imputation method was used. Treatment was reported in 2091 (63.3%) patients. In the multivariate analysis, an increased chance of getting treatment was independently associated with 10 years increase of age at diagnosis (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.1-1.3, P < 0.001), HBeAg positivity (aOR 1.8, 95% CI 1.1-2.8, P < 0.001), cirrhosis (aOR 3.6, 95% CI 2-6.3, P = 0.012), HDV (aOR 1.6, 95% CI 1.02-2.5, P = 0.042) and HIV positivity (aOR 6.5, 95% CI 4-10.8, P < 0.001). Conversely, a decreased chance was associated with female gender (aOR 0.6, 95% CI 0.5-0.7, P < 0.001), immigration (aOR 0.6, 95% CI 0.5-0.9, P = 0.009), alcohol consumption (aOR 0.7, 95% CI 0.5-0.98, P = 0.04) and HCV positivity (aOR 0.5, 95% CI 0.3-0.8, P = 0.005). Our study shows that Italian IDCs treat a high percentage of patients with CHB. Nevertheless, disparities exist which are not related to the severity of disease limiting access to antiviral therapy of CHB, even in a country with a universal healthcare system.

Immigration and viral hepatitis

“…Estimates suggest that 31 US outreach programs active in 2008 screened only 21,000 individuals [74]. Studies on viral hepatitis treatment rates and efficacy among immigrants are limited [76][77][78]. One Italian study showed that immigrants were significantly less likely than Italian-born patients to receive HBV antiviral therapy [76].…”

“…Studies on viral hepatitis treatment rates and efficacy among immigrants are limited [76][77][78]. One Italian study showed that immigrants were significantly less likely than Italian-born patients to receive HBV antiviral therapy [76]. However, other studies have shown no difference in treatment uptake rates among immigrants [79].…”

Differences in the availability of diagnostics and treatment modalities for chronic hepatitis B across Europe

“…In some Asian countries, HCC is one of the top three causes of death in males largely due to HBV infection [16]. In most European countries, immigrants are responsible for a substantial proportion of chronic HBV patients [17][18][19]. [20].…”

Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries

“…Undocumented migrants and asylum seekers are rarely screened for viral hepatitis and, if found chronically infected, do not actually reach secondary care 31 . Previous studies also found lower preventative health care usage and poorer health outcomes from viral hepatitis among migrant groups 32 , 33 …”