Using a chronic hepatitis B Registry to support population-level liver cancer prevention in Sydney, Australia
Authors Robotin MC, Masgoret X, Porwal M, Goldsbury D, Khoo C, George J
Received 13 July 2017
Accepted for publication 31 October 2017
Published 21 December 2017 Volume 2018:10 Pages 41—49
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Vera Ehrenstein
Monica C Robotin,1–3 Ximena Masgoret,1 Mamta Porwal,4 David Goldsbury,5 Chee Khoo,6,7 Jacob George,2,3
1School of Medicine, The University of Notre Dame Australia, Darlinghurst, 2Faculty of Medicine, University of Sydney, Camperdown, 3Storr Liver Center, Westmead Institute for Medical Research, Westmead Hospital, Westmead, 4Australian School of Graduate Management, University of New South Wales, Kensington, 5Cancer Council NSW, Woolloomooloo, 6Royal Australasian College of General Practitioners, Sydney, 7University of Western Sydney, Macarthur, NSW, Australia
Background: Approximately 1% of Australians have chronic hepatitis B (CHB), which disproportionately affects people born in hepatitis B-endemic countries. Currently, approximately half of the people affected remain undiagnosed and antiviral treatment uptake is suboptimal (~5%). This increases the likelihood of developing end-stage disease complications, particularly hepatocellular cancer (HCC), and largely accounts for the significant increases in HCC incidence and mortality in Australia over the last decades. As our previous economic modeling suggested that CHB screening and treatment is cost-effective, we tested the feasibility of a primary care-based model of CHB diagnosis and management to prevent HCC.
Materials and methods: From 2009 to 2016, the B Positive program trialed a CHB screening and management program in an area of high disease prevalence in Sydney, Australia. Trained local primary care providers (general practitioners) screened and managed their CHB patients using a purpose-built CHB Registry and a risk stratification algorithm, which allocated patients to ongoing primary care-based management or specialist referral.
Results: The program enrolled and followed up >1,500 people (25% of the target population). Their median age was 48 years, with most participants being born in China (50%) or Vietnam (32%). The risk stratification algorithm allocated most Registry participants (n=847 or 79%) to primary care-based management, reducing unnecessary specialist referrals. The level of antiviral treatment uptake in Registry patients was 18%, which was the optimal level in this population group.
Conclusion: This pilot program demonstrated that primary care-based hepatitis B diagnosis and management is acceptable to patients and their care providers and significantly increases compliance with treatment guidelines. This would suggest that scaling up access to hepatitis B treatment is achievable and can provide a means to operationalize a population-level approach to CHB management and liver cancer prevention.
Keywords: hepatitis B Registry, primary care, cancer prevention, antiviral treatment, risk stratification
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