The cascade of care for Australians living with chronic hepatitis B: measuring access to diagnosis, management and treatment

Abstract

Objective: To estimate the level of access to diagnosis, management and treatment for people living with chronic hepatitis B (CHB) in Australia, and to identify the gaps in clinical care for people living with CHB.Methods: Analysis of publicly available population level data including infectious disease notifications, Medicare and Pharmaceutical Benefits Scheme utilisation data, census-based estimates of CHB prevalence and burden, and mathematical modelling. Results:In 2012, of the estimated 218,567 Australians living with CHB, 57% had been diagnosed, 17,367 people (8%) received recommended HBV DNA viral load testing (without treatment) and 10,987 (5%) received antiviral therapy. Conclusions:This analysis reveals substantial gaps in the cascade of care for CHB in Australia, most notably in diagnosis (with 43% undiagnosed) and in recommended yearly monitoring (87% not in care). The number receiving therapy represents only one-third of those estimated to require treatment to prevent progressive liver disease and liver cancer.Implications: These findings demonstrate that the majority of those affected are not receiving guideline-based care; highlight the need for improvements in opportunistic screening, engagement in care, and access to therapy; and provide a method to assess the impact of public health and clinical interventions in response to CHB over time.

Hepatitis B knowledge and associated factors among people with chronic hepatitis B

“…The sample is not representative of the population with CHB in Australia, considering that only a minority of this total population has been diagnosed and currently receive clinical care. 4,6 Participants in this study were recruited in clinical settings and over-represent people with CHB who were sufficiently motivated to seek clinical care for their infection. Considering these potential selection biases, it is possible that the knowledge gaps found in the current study will likely be more pronounced among the broader community of people with CHB in Australia.…”

“…3 A low diagnosis rate and poor access to clinical care among people with CHB is a major barrier to reducing hepatitis B-related morbidity and mortality. It is estimated that only 56% of people with CHB in Australia 4 and less than 40% in the United States 5 have been diagnosed, while approximately 13% 6 and 50% 5 of those who have been diagnosed receive clinical care for their infection in these two countries, respectively. The proportion of untreated people with CHB in Europe ranges between 37% and 66%.…”

Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia

“…While providing questionnaires in Chinese and Vietnamese languages reduced a selection bias toward people with good English proficiency and assisted in recruiting a more representative study population given the demographic profile of people with CHB in Australia (16), the response rate was suboptimal with the findings susceptible to a selection bias toward people more confident in communicating feelings. Participants were recruited in clinical settings and are not representative of the population with CHB in Australia, particularly considering that only a minority of this total population having been diagnosed and receiving clinical care (34, 35). While Aboriginal and Torres Strait Islanders are estimated to be 9% of the total population of people with CHB living in Australia, only one participant in this study identified as a member of these communities (34).…”

Barriers to optimal screening and vaccination of hepatitis B contacts: a survey of general practitioners in NSW, Australia

“…1 The Australian National hepatitis B strategy [2014][2015][2016][2017] 2 acknowledges the increasing public health burden of CHB and emphasises the management of CHB in the primary care setting, and the testing and vaccination of priority populations, including close contacts of known cases. Close contacts are most at risk of infection; however, a previous study demonstrated that recommended screening and vaccination of close contacts is occurring suboptimally 3 , despite the availability of a free hepatitis B vaccine for contacts in Australia.…”