Measuring quality of hepatitis B care in a remote Australian Aboriginal community: opportunities for improvement.
Australia
/ epidemiology
Carcinoma, Hepatocellular
Health Services, Indigenous
Hepatitis B
Hepatitis B Antibodies
Hepatitis B Surface Antigens
Hepatitis B Vaccines
/ therapeutic use
Hepatitis B virus
Hepatitis B, Chronic
/ diagnosis
Humans
Liver Neoplasms
Native Hawaiian or Other Pacific Islander
Retrospective Studies
Seroepidemiologic Studies
Australia
chronic hepatitis B
indigenous health
public health
vaccination
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
02
03
2021
received:
24
12
2020
accepted:
05
05
2021
pubmed:
13
5
2021
medline:
19
8
2022
entrez:
12
5
2021
Statut:
ppublish
Résumé
Chronic hepatitis B (CHB) infection remains a significant public health issue for Indigenous Australians, in particular for remote communities. 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. 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. 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. 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.
Sections du résumé
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.
Substances chimiques
Hepatitis B Antibodies
0
Hepatitis B Surface Antigens
0
Hepatitis B Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1347-1353Subventions
Organisme : Gastroenterological Society of Australia
ID : 2018
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Royal Australasian College of Physicians.
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