Chronic hepatitis B care in regional Australia: implications for clinical practice and public health policy

BACKGROUND

Australia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets.

AIMS

This retrospective study examined people living with chronic hepatitis B (CHB) in regional North Queensland, Australia, and determined whether their care adhered to current national CHB management guidelines. The analysis aimed to identify gaps in care that might be addressed to improve future outcomes.

METHODS

All individuals referred to the gastroenterology clinic at the Townsville University Hospital in regional North Queensland, Australia, for CHB care between January 2015 and December 2020 were identified. Their linkage to care, engagement in care and receipt of guideline-recommended CHB care were determined.

RESULTS

Of 255 individuals, 245 (96%) were linked to care; 108 (42%) remained engaged in care and 86 (38%) were receiving guideline-recommended care in 2021. There were 91/255 (36%) who identified as Indigenous Australians. Indigenous status was the only independent predictor of not being linked to care (odds ratio (OR): 0.13 (95% confidence interval (CI): 0.03-0.60), P = 0.01), not being engaged in care (OR: 0.19 (95% CI: 0.10-0.36), P < 0.0001), not receiving guideline-recommended CHB care (OR: 0.16 (95% CI: 0.08-0.31), P < 0.0001) or not being engaged in a hepatocellular carcinoma surveillance programme (OR: 0.08 (95% CI: 0.02-0.27), P < 0.0001).

CONCLUSION

Current approaches are failing to deliver optimal CHB care to Indigenous Australians in regional North Queensland. Targeted strategies to ensure that Indigenous Australians in the region receive equitable care are urgently needed.

'People Like Us Would Have No Clue If the Information Is Online': Exploring Understanding and Sources of Hepatitis B Information Among Vietnamese Australians

Socio-cultural and behavioural factors are often not adequately considered in designing health promotion programs for culturally and linguistically diverse communities in Australia. Given that people of Vietnamese background are disproportionately impacted by hepatitis B, the aim of this research was to better understand these factors to inform hepatitis B health promotion messages for the Vietnamese community. Twenty participants (four living with hepatitis B) were interviewed by a Vietnamese-speaking researcher. The interview sessions explored beliefs about health, the body and liver; knowledge and attitudes about hepatitis B vaccines, testing, clinical management and stigma; and sources of health information and value given to information on social media. Participants had a range of understandings of health and hepatitis B which informed their responses to health education and intervention. Participants appeared to have limited knowledge and misconceptions about transmission, prevention, treatment, and management of hepatitis B. Stigma surrounding hepatitis B was apparent, with over half the participants reporting that they distanced themselves from people living with hepatitis B. Participants preferred online information resources for younger people and traditional media in the Vietnamese language for older people. By understanding what Vietnamese people know about hepatitis B and how they access health information, these findings can be used to inform health promotion campaigns using print, media, and radio to ensure wide reach. Knowledge of community specific information is key to reducing the burden of hepatitis B among culturally and linguistically diverse communities and ensuring they are able to access healthcare services for testing, monitoring, and care.

Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States

BACKGROUND

People with chronic hepatitis B (CHB) commonly experience social and self-stigma. This study sought to understand the impacts of CHB-related stigma and a functional cure on stigma.

METHODS

Adults with CHB with a wide range of age and education were recruited from 5 countries and participated in 90-minute qualitative, semi-structured interviews to explore concepts related to CHB-associated stigma and its impact. Participants answered open-ended concept-elicitation questions regarding their experience of social and self-stigma, and the potential impact of reduced CHB-related stigma.

RESULTS

Sixty-three participants aged 25 to 71 years (15 from the United States and 12 each from China, Germany, Italy, and Japan) reported emotional, lifestyle, and social impacts of living with CHB, including prejudice, marginalization, and negative relationship and work experiences. Self-stigma led to low self-esteem, concealment of CHB status, and social withdrawal. Most participants stated a functional cure for hepatitis B would reduce self-stigma.

CONCLUSIONS

CHB-related social and self-stigma are widely prevalent and affect many aspects of life. A functional cure for hepatitis B may reduce social and self-stigma and substantially improve the health-related quality of life of people with CHB. Incorporating stigma into guidelines along with infectivity considerations may broaden the patient groups who should receive treatment.

Modelling jurisdictional disparities in the cascade of care for chronic hepatitis B in Australia: impact of treatment uptake on mortality

OBJECTIVE

Investigate the cascade of care for chronic hepatitis B (CHB) and estimate impacts of increasing treatment uptake on attributable burden, according to jurisdiction.

METHODS

A mathematical model of CHB in Australia was utilised, combined with notifiable disease and Medicare data. We estimated the proportion with CHB who were diagnosed, engaged in care and receiving treatment in each state/territory, and projected future mortality.

RESULTS

The highest uptake of all measures was in New South Wales, however, the largest increase over time occurred in Northern Territory. No jurisdiction is due to meet 2022 targets of treatment uptake or mortality reduction. Previously declining mortality is predicted to plateau or increase in all jurisdictions except Northern Territory. The largest gap in the cascade of care was most commonly diagnosed individuals not engaged in care; however, in Victoria and Tasmania it was lack of diagnosis.

CONCLUSIONS

Measures of the cascade of care varied substantially between jurisdictions; while all require improvements to reduce mortality, the specific gaps vary, as do potential impacts.

IMPLICATIONS FOR PUBLIC HEALTH

Improving the cascade of care for CHB will require jurisdictionally tailored approaches. If improvements are not made, more deaths will occur due to CHB in most states and territories.

Trust in healthcare providers among Chinese immigrants living with hepatitis B virus in Australia: A qualitative study

Despite the importance of trust in healthcare settings, there remains a paucity of evidence on the role it plays in patient-provider relationships and healthcare outcomes among people living with hepatitis B virus (HBV). International evidence suggests that Chinese immigrants living with HBV experience inequitable access, outcomes and treatment quality in chronic hepatitis B (CHB) health care. This study explores individual trust in healthcare providers and its impact on health-seeking behaviours and health outcomes among Chinese people living with HBV in Australia. A total of 16 participants were recruited from the Chinese community in Sydney and Melbourne and participated in semi-structured interviews. The data were analysed within a conceptual model of trust that contains five dimensions: fidelity, competence, honesty, confidentiality and global trust. The data shows how trust in physicians was formed and influenced by factors including patient-provider interactions, historically relevant experiences, health and illness beliefs and systemic barriers. While the research confirms prior findings on the impact of trust and mistrust, showing an association between low trust and treatment nonadherence, it also generates fresh insights by examining what leads to mistrust and the role of trust in shaping participants' healthcare outcomes. Findings suggest that by treating patients with respect and dignity, improving interpersonal skills and cultural competency, having open discussion on complementary and alternative medicine (CAM) treatment and protecting private information, physicians can increase patients' trust. The findings will contribute to efforts to address HBV as a health priority and increase patients' trust in healthcare providers among Chinese immigrants living with HBV.

The role of explanatory models of chronic hepatitis B on illness experience: a qualitative study of Vietnamese participants in Australia

ABSTRACTObjective: This study utilises Kleinman's theory of explanatory models of health and illness to explore the experience of chronic hepatitis B (CHB) among Vietnamese people living in Australia. It examines how these explanatory models are formed and shaped by the broader community, and the extent to which this influences understandings and responses to CHB.Design: This study is based on semi-structured interviews with 22 Vietnamese people with CHB in Melbourne, Australia. The individual interviews ranged from 30 minutes to 1.5 hours in length, and were electronically recorded, translated where necessary and transcribed verbatim. Transcripts were thematically coded using NVivo 10, with coding themes guided by categories identified in Kleinman's explanatory models framework.Results: Fundamental to most participants' narratives was the profound impact of cultural, social and economic environments on their understandings and responses to CHB. Regardless of socio-demographic background, most participants juxtaposed biomedical elements of CHB with their own existing humoral-based health belief system. In the context of a chronic asymptomatic condition that, for the most part, does not require pharmaceutical treatment, a humoral-based health belief system provided a familiar conceptual framework from which participants could immediately respond and take control of their infection. This was observed through changes in diet and lifestyle, and the use of traditional herbal medicine in an attempt to 'cure' or halt the progression of their infection.Conclusions: By speaking to people living with CHB directly, it became clear that there is a disjuncture between what is commonly assumed by the biomedical model of CHB and what is understood by individuals with the infection. The public health burden of CHB will continue unless the healthcare system, including public health policies, deliver a hepatitis B model of care that is responsive to the needs and expectations of priority populations.

Hepatitis B and Liver Cancer: Community Awareness, Knowledge and Beliefs of Middle Eastern Migrants in Sydney, Australia

Chronic hepatitis B (CHB) is a significant global health challenge given an increasing morbidity and inadequate public health response, Migrant populations are primarily affected by CHB in industrialised countries, and while more than 7% of Australians with CHB were born in Africa or the Middle East, little is known of their awareness or knowledge of viral hepatitis and its impact. This qualitative study, using semi-structured interviews with Assyrian and Arabic community leaders and focus groups (FG) with 66 community members sought to identify hepatitis and liver cancer knowledge and awareness among local Arabic and Assyrian-speaking communities in Western Sydney. Interviews were thematically analysed, with findings framing the topics for the FGs which were analysed using a framework analysis. Themes identified across both methods included limited awareness or knowledge of viral hepatitis or liver cancer, stigma associated with both conditions, variable levels of health literacy and trust in medical practitioners, and fear that receiving “bad news” would deter people from seeking care. Preferred sources of health information were family doctors, family members, the internet and the ethnic media. The study gave valuable information for the design of an educational program and provided useful information for the planning of culturally appropriate hepatitis screening and treatment services for these communities.

Pharmacist intervention to improve patients' knowledge and attitude towards hepatitis B infection

OBJECTIVE

Lack of knowledge/awareness of people living with hepatitis B (PLH) often leads to misinformation and stigmatisation. This study aimed to assess the contribution of the clinical pharmacist (CP)-led education on knowledge of PLH about their disease.

METHODS

This prospective, cross-sectional study was carried out between 1 October 2017 and 1 April 2018, at infectious disease and gastroenterology outpatient clinics in a university hospital. All PLH were interviewed face-to-face by a CP and a questionnaire about hepatitis B virus (HBV) knowledge was applied both at the beginning of the study (first interview) and 3 months later (second interview). Correct information was provided verbally to the patients by the CP concerning their incorrect answers during the first interview. A 10% increase in the number of correct answers was targeted for the second interview.

RESULTS

A total of 147 PLH with a mean age of 43.05 ± 13.25 years were included in the study (55.8% female). In the first interview, the mean (±standard deviation) number of correct answers was 35.53 ± 9.15 out of 51 questions. In the second interview, correct answers were 48.67 ± 2.74 with an increase of 25.8% (P < .001). In the first interview, the number of correct answers was higher for the following groups: 20-39 age group, people with monthly income of >1081 $ and university graduates. The number of correct answers to all questions but one was elevated (P < .001) in the second interview. Answers to the question "there is a carrier state in chronic hepatitis B (CHB)" did not change (P = .125).

CONCLUSION

Significant improvement was observed in the correct answer rate after CP's contribution, therefore as a team member, CP has an important role in improving patients' knowledge and attitude towards HBV infection.

Comparing Australian health worker and student attitudes and concerns about providing care to people living with hepatitis B

ISSUE ADDRESSED

Hepatitis B (HBV) is a major public health issue with over 250 million people chronically infected worldwide. In Australia, prevalence is higher among migrant communities and these groups may be reticent to attend health care services due to concerns about experiencing stigma and discrimination. The way health workers perceive their clients, particularly those of migrant backgrounds, may influence the way they treat these clients and the quality of care provided. This study investigated and compared the attitudes and concerns health workers and health students have towards working with clients living with HBV.

METHODS

Health workers (n = 551) and students (n = 199) completed an online survey which investigated attitudes towards people living with HBV, comfort with providing care for these clients and concerns they have about working with them.

RESULTS

Health students expressed less comfort (U = 47 611, z = -2.73, P = .006) and reported more concerns about working with people with HBV than qualified health workers (U = 61611.50, z = 2.64, P = .008). Students' concerns were centred around their own ability to provide care rather than issues related to clients. There were no differences in overall attitudes towards people living with HBV between health workers and students.

CONCLUSION

To address concerns that health workers and students may have in working with people living with HBV, particularly those from migrant communities, and to ensure that health workers feel comfortable and confident, HBV workforce development should be included in undergraduate and postgraduate training programmes as well as in continuing professional education. SO WHAT?: This will assist the health workforce to develop competency in the treatment of people living with HBV, with the ultimate aim of providing best quality, non-judgemental care to all people living with HBV.

Addressing cultural diversity: the hepatitis B clinical specialist perspective

Objectives: Hepatitis B is a viral infection primarily affecting people from culturally diverse communities in Australia. While vaccination prevents infection, there is increasing mortality resulting from liver damage associated with chronic infection. Deficits in the national policy and clinical response to hepatitis B result in a low diagnosis rate, inadequate testing and diagnosis processes, and poor access to hepatitis B treatment services. While research identifies inadequate hepatitis B knowledge among people with the virus and primary health care workers, this project sought to identify how specialist clinicians in Australia negotiate cultural diversity, and provide often complex clinical information to people with hepatitis B. Design: A vignette was developed and presented to thirteen viral hepatitis specialist clinicians prior to an electronically recorded interview. Recruitment continued until saturation of themes was reached. Data were thematically coded into themes outlined in the interview schedule. Ethical approval for the research was provided by the La Trobe University Human Research Ethics Committee. Results: Key messages provided to patients with hepatitis B by clinical specialists were identified. These messages were not consistently provided to all patients with hepatitis B, but were determined on perceptions of patient knowledge, age and highest educational level. While the vignette stated that English was not an issue for the patient, most specialists identified the need for an interpreter. Combating stigma related to hepatitis B was seen as important by the specialists and this was done through normalising the virus. Having an awareness of different cultural understandings about hepatitis B specifically, and health and well-being generally, was noted as a communication strategy. Conclusion: Key core competencies need to be developed to deliver educational messages to people with hepatitis B within clinical encounters. The provision of adequate resources to specialist clinics will assist in addressing gaps in the clinical response to hepatitis B.

What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

Background: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations.

Methods: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed.

Results: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored.

Conclusion: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems

Barriers to the Prevention and Control of Hepatitis B and Hepatitis C in the Community of Southwestern China: A Qualitative Research

Objective viral hepatitis is a big challenge in China. However, few studies have focused on mapping the difficulties from a broader view. This study aimed to identify the barriers to the prevention and control of hepatitis B and hepatitis C in communities from the perspectives of hepatitis patients, residents, and healthcare providers. A total of 26 participants were recruited through purposive sampling. Data were collected by in-depth face-to-face interviews from September 2015 to May 2016 in two communities from Chongqing and Chengdu, China. A thematic framework was applied to analyze the qualitative data from the interviews. The critical factors of barriers to hepatitis prevention and control in the districts included poor cognition of residents regarding hepatitis B and hepatitis C, severe stigma in society, inadequate health education, and the provision of unsatisfactory medical services. Strengthening health education and improving services for treating patients with hepatitis are suggested to make further progress. A substantial gap remains between the need and currently available services for hepatitis patients and residents. Delivering quality prevention and control health services, improving health education, and reducing stigma in society are recommended to improve the prevention and control program for hepatitis B and C in communities.

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

OBJECTIVE

To examine the chronic hepatitis B (CHB) assessment and management practices of general practitioners in the Sydney and South Western Sydney Local Health Districts, areas with a high prevalence of CHB, and to obtain their views on alternative models of care.

DESIGN, SETTING AND PARTICIPANTS

We used a descriptive, cross-sectional study design to survey GPs who had seen at least one patient aged 18 years or over who had been notified as having CHB to the Public Health Unit between 1 June 2012 and 31 May 2013. There were 213 eligible GPs; the response rate was 57.7%.

MAIN OUTCOME MEASURES

The CHB assessment, management and referral practices of the GPs, and their opinions about different models of care.

RESULTS

Most GPs (78.9%) were at least reasonably confident about managing CHB. GPs were generally most comfortable with a model of care that involved initial referral to a specialist; managing CHB without specialist input or with only review by a specialised nurse practitioner were less popular.

CONCLUSION

These results suggest that barriers, including dependence on specialist input, still hinder the appropriate assessment and management of CHB patients by GPs. Well designed and targeted support programs that include specialist support are needed if there is to be a successful shift to an increased role for GPs in the model of care for managing CHB.

Development of an in-House TaqMan Real-Time PCR-Based Method to Detect Residual Host Cell DNA in HBV Vaccine

Biological therapeutic products such as recombinant hepatitis B virus (HBV) vaccine, produced by microbial fermentation in complex media, should be evaluated for host cell DNA contamination in purification steps. Eliminating these contaminations increases the efficacy of the vaccine and decreases its side effects. The objective of the present study is to trace the residual host cell DNA (HCD) in recombinant HBV vaccine by developing a TaqMan Real-Time PCR method which is more sensitive, specific, and reproducible than traditional methods such as Picogreen analysis and Threshold DNA assay. Primers and a probe were designed for the most highly conserved regions of Pichia pastoris genome. To determine the specificity of the assay, in addition to performing a BLAST for the primers and the probe in NCBI nucleotide database, 20 different human genomes and 8 bacterial and viral genomes were used. Moreover, serial dilutions of plasmids, from 10(2) to 10(7) copies/μL (from 0.00064 to 6.4 pg/μL), were prepared to find the sensitivity and the limit of detection (LOD) of the assay. Using 28 different genome samples, the specificity of the assay was determined to be 100 %. In addition, the sensitivity and LOD of the method was 0.39 × 10(-5) pg/μL. Moreover, the reproducibility of the assay based on intra- and inter-assay was 1.03 and 1.06 %, respectively. Considering the suitable specificity and sensitivity, ease of use, relatively low cost, and rapidity of the assay, it can be a reproducible and sensitive method to examine recombinant vaccines for P. pastoris residual DNA.

Feasibility, acceptability and safety of a nurse led hepatitis B clinic based in the community

AIM

The aim of this study was to investigate if a community based hepatitis B (HBV) nurse clinic is a feasible, acceptable and safe strategy to improve access to best practice chronic hepatitis B care (CHB) in Sydney Local Health District.

METHODS

The weekly clinic commenced in an Inner West Sydney Health Centre in November 2012. The CNC responsibilities included patient assessment, management, education, triage, the development of care plans for GPs and GP support. Nursing practice was guided by recommendations from internationally and nationally endorsed CHB Guidelines. Information on patient demographics, clinical findings, triage decisions and sources of referral were collected and used to assess the feasibility, acceptability and safety of the nurse clinic. Patients were also invited to complete a self-administered survey. The survey included questions on attitudes towards the clinic and opinions on barriers to accessing treatment and care. Data was collated and analysed in both Excel and SPPS.

RESULTS

In the first 18 months of the clinic 66 people attended, 56 (80%) had CHB, 51 (77%) were born in an Asian country. An equal number of males and females attended. 11 (17%) required further management at a hospital based liver clinic and were referred. 5 (8%) have commenced anti-viral treatment. 24 (36%) met the criteria for six monthly HCC screening and were commenced on HCC surveillance. Twenty-two GPs referred patients. 11 (17%) patients returned the survey and they reported a high level of satisfaction with the clinic and willingness to engage in future CHB care.

CONCLUSIONS

This study of a community based CHB nurse clinic shows it is a feasible, acceptable, and safe initiative. The nurse improved access to best practice care and supported patients to effectively manage their CHB. We have confirmed a nurse can have a central role in triage, case management and GP support. Given the high CHB prevalence in our LHD a higher number of GP referrals were expected. Further research on how to increase engagement with GPs and people living with CHB is needed. We plan to expand our model with the CHB nurse conducting assessments and education in GP practices.

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

OBJECTIVE

To assess hepatitis B knowledge among people with chronic hepatitis B (CHB) in Australia.

METHODS

People with CHB in three Australian jurisdictions completed a self-administered questionaire, including 24 hepatitis B knowledge questions across four domains: transmission; natural history; epidemiology and prevention; and clinical management.

RESULTS

Ninety-three people completed the survey. Mean age was 45 years, 43% were women and 93% were born overseas (75% from Asia). Mean total knowledge score was 55 out of 100 with 17 participants (18%) scoring ≥75 (defined as a high knowledge). Clinical management scored the lowest (median: 25) and natural history scored the highest (median: 80). In adjusted linear regression, tertiary education (vs. secondary and under) was associated with higher knowledge score (β: 11.95; 95%CI: 2.45, 21.44; p=0.01). In adjusted logistic regression, very good English proficiency (vs. limited/no proficiency) was associated with high knowledge (OR: 7.65; 95%CI: 1.94, 30.19; p<0.01). Participants reporting hepatitis B-related anxiety demonstrated a significantly higher knowledge score compared to those reporting no such anxiety (β: 15.11; 95%CI: 4.40, 25.81; p<0.01).

CONCLUSIONS AND IMPLICATIONS

Hepatitis B-related knowledge gaps were identified among people with CHB. Interventions to improve knowledge should focus on people with low levels of academic education and limited English proficiency.

Challenges in managing patients in Australia with chronic hepatitis B: the General Practitioners' perspective

OBJECTIVE

General Practitioners (GPs) are essential to reducing the impact of chronic hepatitis B (CHB) given their clinical management role where only 56% of people with the infection in Australia have been diagnosed. This qualitative study aimed to identify the challenges GPs face in effectively responding to CHB.

METHODS

Semi-structured interviews were conducted with 26 GPs self-identifying as having a 'high caseload' of patients and/or a particular interest in CHB. Participants were recruited from five jurisdictions and came from diverse ethnicities, clinical experience and practice profile. Interview data were analysed according to the principles of grounded theory.

RESULTS

Patient and GP knowledge, a lack of community awareness, and language and cultural diversity impeded the GP response to CHB. Communication with specialists was reported as challenging with unclear referral pathways, limited feedback from specialists after referral, and poor liaison and support for managing people living with CHB. Regulations restricting GPs capacity to respond included the lack of prescribing opportunities, fear of Medicare auditing for screening the populations most at risk, and inadequate financial support given the complexity of CHB and the communities most affected by the infection.

CONCLUSIONS

General Practitioners require additional skills and resources to support the effective management of people with CHB. These include improved awareness and knowledge about the infection, adequate financial resources to support patient management, and effective referral pathways and support.

A validation of the use of names to screen for risk of chronic hepatitis B in Victoria, Australia, 2001 to 2010

The burden of chronic hepatitis B (CHB) is increasing in Australia, particularly in those born in the Asia-Pacific region, and nearly half are undiagnosed. Primary care clinicians have a key role in diagnosing CHB, however identification of patients at risk is hindered by lack of awareness and limited information on country of birth in patient records. This study evaluates the potential of a validated list of names associated with Asian country of birth as a screening tool to predict risk of CHB, by comparing it with surveillance records for all people diagnosed with CHB or salmonellosis in Victoria from 2001 to 2010, and analysed using standard screening tools. Name list match was associated with CHB notification, with over 60% of cases having one name matching the list (sensitivity), and nearly one third matching both given name and surname; less than 15% and 2% of salmonellosis notifications matched for one name and both names, respectively (false positives). These results show that more than half of notified cases of CHB would have been identified by this name list, and that it could be used in support of initiatives to improve diagnosis of patients with diseases associated with country of birth when limited information is available.

Country of birth and other factors associated with hepatitis B prevalence in a population with high levels of immigration

BACKGROUND AND AIM

While hepatitis B virus (HBV) prevalence is known to vary greatly between countries, systematically collected population-level prevalence data from some countries is limited. Antenatal HBV screening programs in countries with substantial migrant populations provide the opportunity to systematically examine HBV prevalence in order to inform local and regional HBV estimates.

METHODS

A comprehensive register of Australian mothers giving birth from January 2000 to December 2008 was linked to a register of HBV notifications. Age-standardized prevalence of chronic HBV were calculated overall and by the mother's country of birth. Multiple logistic regression was used to investigate other factors associated with HBV prevalence.

RESULTS

Five hundred twenty-three thousand six hundred sixty-five women were included and linked to 3861 HBV notifications. The age-standardized HBV prevalence was low (0.75%, 95% confidence interval 0.72-0.79). The highest HBV prevalence rates were observed in women born in Cambodia (8.60%), Taiwan (8.10%), Vietnam (7.49%), China (6.80%), and Tonga (6.51%). Among Australia-born women, those who smoked during pregnancy, were from a more disadvantaged socioeconomic background, and lived in remote areas were more likely to have HBV. There was also a trend suggesting a decrease in the prevalence of HBV over time.

CONCLUSIONS

Antenatal screening for HBV can provide systematic population estimates of HBV prevalence in migrants and also identify other high prevalence groups. Longer follow-up will be required to confirm the small decrease in HBV prevalence observed in this study.