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. 2023 Dec;30(12):926-938.
doi: 10.1111/jvh.13881. Epub 2023 Aug 8.

Cascade of care among people with hepatitis B in New South Wales, Australia

Syed Hassan Bin Usman Shah  1 , Heather Valerio  1 , Behzad Hajarizadeh  1 , Gail Matthews  1 , Maryam Alavi  1 , Gregory J Dore  1
Affiliations

Cascade of care among people with hepatitis B in New South Wales, Australia

Syed Hassan Bin Usman Shah et al. J Viral Hepat. 2023 Dec.

Abstract

Hepatitis B virus (HBV) care cascade characterisation is important for monitoring HBV elimination progress. This study evaluated care cascade and factors associated with HBV DNA testing and treatment in New South Wales, Australia. HBV care cascade were determined through linkage of HBV notifications (1993-2017) to Medicare and pharmaceutical benefits schemes (2010-2018). Timely HBV DNA testing was within 4 weeks of HBV notification. Multivariate Cox proportional hazards regression evaluated factors associated with HBV DNA testing and treatment. Among 15,202 people with HBV notification, 10,479 (69%) were tested for HBV DNA. A total of 3179 (21%) initiated HBV treatment. HBV DNA testing was more likely among age ≥45 years (adjusted hazard ratio [aHR] 1.07, 95% CI: 1.02, 1.12), hepatocellular carcinoma (HCC) (aHR 1.23, 95% CI: 1.01, 1.50), coinfection (aHR 1.61, 95% CI: 1.23, 2.09), later notification (2014-2017) (aHR 1.21, 95% CI: 1.16, 1.26) and less likely among females (aHR 0.95, 95% CI: 0.91, 0.99), history of alcohol use disorder (AUD) (aHR 0.77, 95% CI: 0.66, 0.89), HCV coinfection (aHR .62, 95% CI: 0.55, 0.70) and Indigenous peoples (aHR 0.84, 95% CI: 0.71, 0.98). HBV treatment was associated with age ≥45 years (aHR 1.35, 95% CI: 1.24, 1.48), decompensated cirrhosis (aHR 2.07, 95% CI: 1.62, 2.65), HCC (aHR 2.96, 95% CI: 2.35, 3.74), HIV coinfection (aHR 4.27, 95% CI: 3.43, 5.31) and later notification (2014-2017) (aHR 1.37, 95% CI: 1.26, 1.47). HBV treatment was less likely among females (aHR 0.68, 95% CI: 0.63, 0.73) and Indigenous peoples (aHR 0.58, 95% CI: 0.42, 0.80). HBV DNA testing and treatment coverage have increased, but remain sub-optimal among some key populations.

Keywords: HBV DNA testing; care cascade; data linkage; hepatitis B virus; treatment uptake.

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Conflict of interest statement

Gregory J Dore has received research support from Gilead Sciences, Merck and AbbVie. Gail Matthews has received research support from Gilead Sciences and AbbVie. Other authors have no commercial relationships that might pose a conflict of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Hepatitis B virus (HBV) care cascade among people with an HBV notification (2010–2017) in New South Wales, Australia.
FIGURE 2
FIGURE 2
Cumulative probability of (A) hepatitis B virus (HBV) DNA testing and (B) HBV treatment initiation over 3 years among people with an HBV notification in New South Wales, by time period of HBV notification (2010–2013 versus 2014–2017).
FIGURE 3
FIGURE 3
The number (A) and proportion (B) of hepatitis B virus (HBV) treatment initiations by prescriber type and treatment year in New South Wales, Australia.
See this image and copyright information in PMC

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