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Narayana S, Nugent M, Woodman R, Larkin M, Ramachandran J, Muller K, Wigg A. Measuring quality of hepatitis B care in a remote Australian Aboriginal community: opportunities for improvement. Intern Med J 2022; 52:1347-1353. [PMID: 33979037 DOI: 10.1111/imj.15349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic hepatitis B (CHB) infection remains a significant public health issue for Indigenous Australians, in particular for remote communities. AIM To evaluate the spectrum of hepatitis B virus (HBV) care provided to a remote Aboriginal community. Measures studied included screening, seroprevalence, vaccination rates and efficacy, and HCC risk and surveillance adherence. METHODS A retrospective audit of HBV care received by all permanent residents currently attending a remote Aboriginal Health service. This study was endorsed by both the local Aboriginal Health service and the Aboriginal Health Council of South Australia. RESULTS A total of 208 patients attended the clinic, of whom 52% (109) were screened for HBV. Of these, 12% (13) had CHB and 20% (22) had evidence of past infection. Similarly, of the 208 attending patients, complete vaccination was documented in 48% (99). Of the 33 patients with post-vaccination serology, 24% (8) had subtherapeutic (<10 IU/mL) levels of HBsAb. Subtherapeutic HBsAb was independently associated with higher Charlson Comorbidity scores (odds ratio = 17.1; 95% confidence interval 1.2-243.3; P = 0.036). Definitive breakthrough infection was identified in 6% (2) patients. One HBsAg positive patient was identified as needing HCC surveillance, but had not undertaken HCC surveillance. CONCLUSION Opportunities to improve the quality of CHB care through increased HBV vaccination, screening and adherence to HCC surveillance were identified. High rates of subtherapeutic vaccine responses and documented breakthrough infection raises concerns about the effectiveness of current CHB vaccines in this population.
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Affiliation(s)
- Sumudu Narayana
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael Nugent
- Tullawon Health Service, Yalata, South Australia, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Michael Larkin
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
| | - Jeyamani Ramachandran
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Muller
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alan Wigg
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Hosking K, Stewart G, Mobsby M, Skov S, Zhao Y, Su JY, Tong S, Nihill P, Davis J, Connors C, Davies J. Data linkage and computerised algorithmic coding to enhance individual clinical care for Aboriginal people living with chronic hepatitis B in the Northern Territory of Australia - Is it feasible? PLoS One 2020; 15:e0232207. [PMID: 32343712 PMCID: PMC7188233 DOI: 10.1371/journal.pone.0232207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic hepatitis B (CHB) is endemic in the Aboriginal population of Australia's Northern Territory (NT). However, many people's hepatitis B virus (HBV) status remains unknown. OBJECTIVE 1. To maximise the utility of existing HBV test and vaccination data in the NT by creating a linked dataset and computerised algorithmic coding. 2. To undertake rigorous quality assurance processes to establish feasibility of using the linked dataset and computerised algorithmic coding for individual care for people living with CHB. METHODS Step 1: We used deterministic data linkage to merge information from three separate patient databases. HBV testing and vaccination data from 2008-2016 was linked and extracted for 19,314 people from 21 remote Aboriginal communities in the Top End of the NT. Step 2: A computerised algorithm was developed to allocate one of ten HBV codes to each individual. Step 3: A quality assurance process was undertaken by a clinician, using standardised processes, manually reviewing all three databases, for a subset of 5,293 Aboriginal people from five communities to check the accuracy of each allocated code. RESULTS The process of data linking individuals was highly accurate at 99.9%. The quality assurance process detected an overall error rate of 17.7% on the HBV code generated by the computerised algorithm. Errors occurred in source documentation, primarily from the historical upload of paper-based records to electronic health records. An overall HBV prevalence of 2.6% in five communities was found, which included ten cases of CHB who were previously unaware of infection and not engaged in care. CONCLUSIONS Data linkage of individuals was highly accurate. Data quality issues and poor sensitivity in the codes produced by the computerised algorithm were uncovered in the quality assurance process. By systematically, manually reviewing all available data we were able to allocate a HBV status to 91% of the study population.
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Affiliation(s)
- Kelly Hosking
- Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Geoffrey Stewart
- Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
- Centre for Disease Control, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Mikaela Mobsby
- Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Steven Skov
- Centre for Disease Control, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Yuejen Zhao
- Innovation & Research, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Jiunn-Yih Su
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Centre for Disease Control, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Steven Tong
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Peter Nihill
- Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Joshua Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Christine Connors
- Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Jane Davies
- Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Sullivan RP, Davies J, Binks P, Dhurrkay RG, Gurruwiwi GG, Bukulatjpi SM, McKinnon M, Hosking K, Littlejohn M, Jackson K, Locarnini S, Davis JS, Tong SYC. Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia. J Viral Hepat 2020; 27:407-414. [PMID: 31785060 DOI: 10.1111/jvh.13243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 01/17/2023]
Abstract
Many Indigenous Australians in northern Australia living with chronic hepatitis B are unaware of their diagnosis due to low screening rates. A venous blood point of care test (POCT) or oral fluid laboratory test could improve testing uptake in this region. The purpose of this study was to assess the field performance of venous blood POCT and laboratory performance of an oral fluid hepatitis B surface antigen (HBsAg) test in Indigenous individuals living in remote northern Australian communities. The study was conducted with four very remote communities in the tropical north of Australia's Northern Territory. Community research workers collected venous blood and oral fluid samples. We performed the venous blood POCT for HBsAg in the field. We assessed the venous blood and oral fluid specimens for the presence of HBsAg using standard laboratory assays. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the POCT and oral fluid test, using serum laboratory detection of HBsAg as the gold standard. From 215 enrolled participants, 155 POCT and 197 oral fluid tests had corresponding serum HBsAg results. The POCT had a sensitivity of 91.7% and specificity of 100%. Based on a population prevalence of 6%, the PPV was 100% and NPV was 99.5%. The oral fluid test had a sensitivity of 56.8%, specificity of 98.1%, PPV of 97.3% and NPV of 65.9%. The venous blood POCT has excellent test characteristics and could be used to identify individuals with chronic HBV infection in high prevalence communities with limited access to health care. Oral fluid performance was suboptimal.
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Affiliation(s)
- Richard P Sullivan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Casuarina, NT, Australia.,Department of Infectious Diseases, Immunology and Sexual Health, St George & Sutherland Clinical School, UNSW, Kogarah, NSW, Australia
| | - Jane Davies
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Casuarina, NT, Australia
| | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | | | | | - Melita McKinnon
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Kelly Hosking
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Top End Health Service, Primary Health Care Branch, Northern Territory Government, Darwin, NT, Australia
| | - Margaret Littlejohn
- Victorian Infectious Diseases Research Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia
| | - Kathy Jackson
- Victorian Infectious Diseases Research Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia
| | - Stephen Locarnini
- Victorian Infectious Diseases Research Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Victorian Infectious Disease Service, The Royal Melbourne Hospital, Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia
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Cheah BC, Davies J, Singh GR, Wood N, Jackson K, Littlejohn M, Davison B, Mcintyre P, Locarnini S, Davis JS, Tong SY. Sub-optimal protection against past hepatitis B virus infection where subtype mismatch exists between vaccine and circulating viral genotype in northern Australia. Vaccine 2018; 36:3533-40. [DOI: 10.1016/j.vaccine.2018.01.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/13/2022]
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Marr I, Davies J, Baird RW. Hepatitis B virus and human T-cell lymphotropic virus type 1 co-infection in the Northern Territory, Australia. Int J Infect Dis 2017; 58:90-95. [PMID: 28315754 DOI: 10.1016/j.ijid.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To establish the relationship between hepatitis B virus (HBV) and human T-cell lymphotropic virus type 1 (HTLV-1) serological markers in the Northern Territory, Australia. METHODS A retrospective serological study of patients presenting to public healthcare facilities in the Northern Territory between 2008 and 2015 was performed in order to determine the presence and relationships of serological markers of HBV and HTLV-1. RESULTS Seven hundred and forty individual patients were found to be serologically positive for HTLV-1 in the Northern Territory over the 8-year period. Hepatitis B results were available for 521 of these patients. Hepatitis B surface antigen (HBsAg) positivity was demonstrated in 15.9% (83/521) of this cohort, which was significantly different to the HTLV-1-negative group (3.7%, 125/3354) (p<0.001). Excluding individuals with isolated hepatitis B surface antibody (anti-HBs), those in the HTLV-1-positive group had a higher HBV exposure history (67.5%, 352/521) when compared to HTLV-1-negative individuals (37.8%, 1259/3354) (p<0.001). HTLV-1-positive individuals had a lower prevalence of HBV combined anti-HBs and hepatitis B core antibody (anti-HBc) positive markers compared to those who were HTLV-1-negative (56.3% (198/352) versus 73.8% (937/1269), respectively; p<0.001). CONCLUSIONS A significantly higher prevalence rate of HBV was found in HTLV-1-positive individuals from the Northern Territory. When considering the higher exposure to HBV in HTLV-1-positive individuals, the clearance of HBV appears lower than in those individuals testing HTLV-1-negative. A lower prevalence of clearance in HTVL-1-positive individuals than in HTLV-1-negative individuals, as signified by formation of HBVcAb and HBVsAb in HTVL-1 positive individual's may equate to higher prevalence of ongoing coinfection.
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Affiliation(s)
- Ian Marr
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
| | - Jane Davies
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rob W Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Davies J, Bukulatjpi S, Sharma S, Caldwell L, Johnston V, Davis JS. Development of a Culturally Appropriate Bilingual Electronic App About Hepatitis B for Indigenous Australians: Towards Shared Understandings. JMIR Res Protoc 2015; 4:e70. [PMID: 26063474 PMCID: PMC4526931 DOI: 10.2196/resprot.4216] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 11/13/2022] Open
Abstract
Background Hepatitis B is endemic in Indigenous communities in Northern Australia; however, there is a lack of culturally appropriate educational tools. Health care workers and educators in this setting have voiced a desire for visual, interactive tools in local languages. Mobile phones are increasingly used and available in remote Indigenous communities. In this context, we identified the need for a tablet-based health education app about hepatitis B, developed in partnership with an Australian remote Indigenous community. Objective To develop a culturally appropriate bilingual app about hepatitis B for Indigenous Australians in Arnhem Land using a participatory action research (PAR) framework. Methods This project was a partnership between the Menzies School of Health Research, Miwatj Aboriginal Health Corporation, Royal Darwin Hospital Liver Clinic, and Dreamedia Darwin. We have previously published a qualitative study that identified major knowledge gaps about hepatitis B in this community, and suggested that a tablet-based app would be an appropriate and popular tool to improve this knowledge. The process of developing the app was based on PAR principles, particularly ongoing consultation, evaluation, and discussion with the community throughout each iterative cycle. Stages included development of the storyboard, the translation process (forward translation and backtranslation), prelaunch community review, launch and initial community evaluation, and finally, wider launch and evaluation at a viral hepatitis conference. Results We produced an app called “Hep B Story” for use with iPad, iPhone, Android tablets, and mobile phones or personal computers. The app is culturally appropriate, audiovisual, interactive, and users can choose either English or Yolŋu Matha (the most common language in East Arnhem Land) as their preferred language. The initial evaluation demonstrated a statistically significant improvement in Hep B-related knowledge for 2 of 3 questions (P=.01 and .02, respectively) and overwhelmingly positive opinion regarding acceptability and ease of use (median rating of 5, on a 5-point Likert-type scale when users were asked if they would recommend the app to others). Conclusions We describe the process of development of a bilingual hepatitis B-specific app for Indigenous Australians, using a PAR framework. The approach was found to be successful with positive evaluations.
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Affiliation(s)
- Jane Davies
- Menzies School of Health Research, Global and Tropical Health, Charles Darwin University, Darwin, Australia.
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Davies J, Bukulatjpi S, Sharma S, Davis J, Johnston V. "Only your blood can tell the story"--a qualitative research study using semi-structured interviews to explore the hepatitis B related knowledge, perceptions and experiences of remote dwelling Indigenous Australians and their health care providers in northern Australia. BMC Public Health 2014; 14:1233. [PMID: 25430502 PMCID: PMC4289355 DOI: 10.1186/1471-2458-14-1233] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/19/2014] [Indexed: 12/03/2022] Open
Abstract
Background Hepatitis B is endemic in the Indigenous communities of the Northern Territory of Australia and significantly contributes to liver-related morbidity and mortality. It is recognised that low health literacy levels, different worldviews and English as a second language all contribute to the difficulties health workers often have in explaining biomedical health concepts, relevant to hepatitis B infection, to patients. The aim of this research project was to explore the knowledge, perceptions and experiences of remote dwelling Indigenous adults and their health care providers relating to hepatitis B infection with a view to using this as the evidence base to develop a culturally appropriate educational tool. Methods The impetus for this project came from health clinic staff at a remote community in Arnhem Land in the Northern Territory, in partnership with a visiting specialist liver clinic from the Royal Darwin Hospital. Participants were clinic patients with hepatitis B (n = 12), community members (n = 9) and key informants (n = 13); 25 were Indigenous individuals. A participatory action research project design was used with purposive sampling to identify participants. Semi-structured interviews were undertaken to explore: current understanding of hepatitis B, desire for knowledge, and perspectives on how people could acquire the information needed. All individuals were offered the use of an interpreter. The data were examined using deductive and inductive thematic analysis. Results Low levels of biomedical knowledge about Hepatitis B, negative perceptions of Hepatitis B, communication (particularly language) and culture were the major themes that emerged from the data. Accurate concepts grounded in Indigenous culture such as “only your blood can tell the story” were present but accompanied by a feeling of disempowerment due to perceived lack of “medical” understanding, and informed partnerships between caregiver and patient. Culturally appropriate discussions in a patient’s first language using visual aids were identified as vital to improving communication. Conclusions Having an educational tool in Indigenous patient’s first language is crucial in developing treatment partnerships for Indigenous patients with hepatitis B. Using a culturally appropriate worldview as the foundation for development should help to reduce disempowerment and improve health literacy.
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Affiliation(s)
- Jane Davies
- Menzies School of Health Research, Rocklands Drive, Tiwi, Darwin, NT 0811, Australia.
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Parker C, Tong SY, Dempsey K, Condon J, Sharma SK, Chen JW, Sievert W, Davis JS. Hepatocellular carcinoma in Australia's Northern Territory: high incidence and poor outcome. Med J Aust 2014; 201:470-4. [DOI: 10.5694/mja13.11117] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/24/2014] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Karen Dempsey
- Health Gains Planning Unit, Northern Territory Government, Darwin, NT
| | - John Condon
- Menzies School of Health Research, Darwin, NT
| | | | - John W C Chen
- South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, SA
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Olsen A, Wallace J, Maher L. Responding to Australia's National Hepatitis B Strategy 2010-13: gaps in knowledge and practice in relation to Indigenous Australians. Aust J Prim Health 2014; 20:134-42. [PMID: 24216010 DOI: 10.1071/py12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/27/2013] [Indexed: 11/23/2022]
Abstract
The Australian National Hepatitis B Strategy 2010-13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action; preventing HBV transmission; optimising diagnosis and screening; clinical management of people with chronic hepatitis B (CHB); and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001-May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible individuals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.
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Affiliation(s)
- Anna Olsen
- The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, Latrobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Lisa Maher
- The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia
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Graham S, Guy RJ, Cowie B, Wand HC, Donovan B, Akre SP, Ward JS. Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta-analysis. BMC Infect Dis 2013; 13:403. [PMID: 24004727 DOI: 10.1186/1471-2334-13-403] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 08/27/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Australia, higher rates of chronic hepatitis B (HBsAg) have been reported among Aboriginal and Torres Strait Islander (Indigenous) compared with non-Indigenous people. In 2000, the Australian government implemented a universal infant/adolescent hepatitis B vaccination program. We undertook a systematic review and meta-analysis to assess the disparity of HBsAg prevalence between Indigenous and non-Indigenous people, particularly since 2000. METHODS We searched Medline, Embase and public health bulletins up to March 2011. We used meta-analysis methods to estimate HBsAg prevalence by Indigenous status and time period (before and since 2000). RESULTS There were 15 HBsAg prevalence estimates (from 12 studies) among Indigenous and non-Indigenous people; adults and pregnant women (n = 9), adolescents (n = 3), prisoners (n = 2), and infants (n = 1). Of these, only one subgroup (adults/pregnant women) involved studies before and since 2000 and formed the basis of the meta-analysis. Before 2000, the pooled HBsAg prevalence estimate was 6.47% (95% CI: 4.56-8.39); 16.72% (95%CI: 7.38-26.06) among Indigenous and 0.36% (95%CI:-0.14-0.86) in non-Indigenous adults/pregnant women. Since 2000, the pooled HBsAg prevalence was 2.25% (95% CI: 1.26-3.23); 3.96% (95%CI: 3.15-4.77) among Indigenous and 0.90% (95% CI: 0.53-1.28) in non-Indigenous adults/pregnant women. CONCLUSIONS The disparity of HBsAg prevalence between Indigenous and non-Indigenous people has decreased over time; particularly since the HBV vaccination program in 2000. However HBsAg prevalence remains four times higher among Indigenous compared with non-Indigenous people. The findings highlight the need for opportunistic HBV screening of Indigenous people to identify people who would benefit from vaccination or treatment.
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Davies J, Littlejohn M, Locarnini SA, Whiting S, Hajkowicz K, Cowie BC, Bowden DS, Tong SYC, Davis JS. Molecular epidemiology of hepatitis B in the Indigenous people of northern Australia. J Gastroenterol Hepatol 2013; 28:1234-41. [PMID: 23432545 DOI: 10.1111/jgh.12177] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The hepatitis B surface antigen was first described in the blood of an Indigenous Australian man, yet little is known about its molecular epidemiology in this population, in which it is endemic. The study aimed to determine the clinical and molecular epidemiology of hepatitis B virus (HBV) in Indigenous people from northern Australia. METHODS Following ethics approval and informed consent, blood specimens and clinical details from Indigenous adults known to be infected with HBV and who were born and raised in Indigenous communities in northern Australia were obtained. HBV genotypes were determined in isolates with sufficient HBV DNA by polymerase chain reaction by sequencing of the polymerase/surface gene. RESULTS Between June 2010 and June 2012, 65 patients were recruited from six different regions of northern Australia. Thirty-two patients (49%) were hepatitis B e-antigen-positive, and 48% were hepatitis B e-antibody-positive. No patients were found to be coinfected with hepatitis C virus or human immunodeficiency virus. Of the 49 samples with sufficient viral load for genotyping, 100% were infected with genotype C4, previously only reported from two Indigenous Australians. All isolates had wild-type polymerase gene sequences despite 14 currently or previously receiving antiviral treatment. The canonical sG145R vaccine-escape variant was detected in the surface antigen of virus from two patients. CONCLUSIONS The exclusive HBV genotype in this ancient population is genotype C4. Whole genome sequencing and clinical follow-up of this cohort are in progress, with the aim of exploring the clinical significance of these findings.
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Affiliation(s)
- Jane Davies
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
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Davies J, Jabbar Z, Gagan F, Baird RW. Blood-borne viruses in the haemodialysis-dependent population attending Top End Northern Territory facilities 2000-2009. Nephrology (Carlton) 2012; 17:501-7. [PMID: 22458921 DOI: 10.1111/j.1440-1797.2012.01603.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe the incidence and prevalence of blood-borne viruses (BBV) including: hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and human T-cell leukaemia virus type-1 (HTLV) in the haemodialysis-dependent population of the Top End of the Northern Territory (TENT). METHODS We retrospectively reviewed the serology of BBV in a longitudinal fashion in the haemodialysis-dependent population treated in the TENT of Australia from 2000 to 2009 inclusive. HBV, HCV, HIV and HTLV serology on commencement of dialysis and at exit or January 2010, whichever was earlier, as well as demographic details were collected. Patients with a change in serological status had all serology reviewed. RESULTS Four-hundred and forty patients were included in the analysis. Of these, 84.3% were Indigenous and 55.4% female, with a median age of 50 (IQR 43-59) years at the commencement of haemodialysis. Evidence of past HBV infection was documented in 42.7% and 8.9% were hepatitis B surface antigen-positive. Positive serology for HTLV was documented in 2.2%, 1.6% were hepatitis C antibody-positive and no individual was HIV-positive. Three patients had a definite change in their HBV serology over time; this equates to an absolute seroconversion risk of 0.1 per 100 person years or 0.0006 per dialysis episode. CONCLUSIONS In this cohort, there was a high rate of past and current hepatitis B infection but low rates of seroconversion while on haemodialysis.
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Affiliation(s)
- Jane Davies
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
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