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. 2025 Dec 3.
doi: 10.1111/jgh.70151. Online ahead of print.

Evaluation of Factors Influencing Specialist Referral Among Individuals Tested Positive for HBsAg in Health Check Programs in Hong Kong

Henry Lik Yuen Chan  1   2 , Judy Man Lee Lee  3 , Christie Fung Yin Cheng  3 , Aggie Fung Sheung Chan  3 , Dorothy Man Ching Tung  3 , Grace Lai Hung Wong  2 , Patrick Chun Yip Tsoi  4 , Tsz Kei Pun  5 , Terry Cheuk Fung Yip  2   6
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Evaluation of Factors Influencing Specialist Referral Among Individuals Tested Positive for HBsAg in Health Check Programs in Hong Kong

Henry Lik Yuen Chan et al. J Gastroenterol Hepatol. .

Abstract

Background and aims: Linkage of hepatitis B virus (HBV)-infected individuals to medical care is a major hurdle in the HBV elimination care cascade. This study aimed to investigate the rate and factors influencing specialist referral of HBV cases identified in health check programs.

Methods: This was a retrospective study among consecutive individuals undergoing health check programs with hepatitis B surface antigen (HBsAg) tested in a hospital from 2014 to 2023. Clinical data were captured from the hospital electronic database. Letter of referral after health check was recorded.

Results: A total of 28 940 individuals underwent health check with HBsAg tested. Six hundred and seventy-three HBsAg-positive individuals were eligible for analysis. Overall, 322 (47.8%) individuals received referral to hepatology specialist. There was a trend of increasing referral with time over the 10 years; trend slope (95% confidence interval): 5.0% (3.5%-6.4%) per year; p < 0.001. HBV DNA was tested in 207 (30.8%) individuals. On multivariable analysis, with reference to individuals with no HBV DNA tested, HBV DNA ≥ 2000 IU/mL was the strongest independent factor associated with referral (adjusted odds ratio 21.42; 95% confidence interval 8.79-52.24; p < 0.001). Detectable HBV DNA < 2000 IU/mL had a modest association with referral (adjusted odds ratio 1.84; 95% confidence interval 1.08-3.11; p = 0.024).

Conclusions: Elevated HBV DNA is an important factor associated with specialist referral among HBsAg-positive individuals identified at health check programs. These findings suggest that implementing reflex HBV DNA testing could be a key strategy to improve specialist referral and facilitate linkage to care.

Keywords: hepatitis B virus; hepatitis elimination; linkage to care; screening.

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