Nicole Allard

Treatment indication for chronic hepatitis B (CHB) varies across clinical guidelines. This study evaluated treatment eligibility and uptake in a large Australian cohort of people with CHB. The REACH‐B study recruited people with CHB managed through a national network of healthcare services. Participants were categorised into three groups: (1) receiving antiviral therapy; (2) untreated despite eligibility; (3) untreated and ineligible. Treatment eligibility was determined using Australian Pharmaceutical Benefits Scheme (PBS) criteria, and by international clinical guidelines. Among 3648 participants (56% male; median age 48 years; 49% born in North‐East or South‐East Asia; 27% First Nations Australians), 14% were HBeAg positive and 7% had cirrhosis. Overall, 47% ( n = 1666) were on antiviral therapy, 45% ( n = 1573) were untreated and ineligible and 7% ( n = 251) were untreated despite eligibility based on Australian PBS criteria. In adjusted analysis, the likelihood of remaining untreated despite eligibility was higher among women (aOR 1.59, 95% CI 1.34, 1.88) and younger participants (age 41–60 vs. > 60 years: aOR 1.51, 95% CI 1.01–2.28; ≤ 40 vs. > 60 years: aOR 2.65, 95% CI 1.60, 4.40). The proportion untreated despite eligibility increased to 13% when applying 2024 World Health Organisation guidelines and ranged 2%–44% based on other guidelines, highlighting the variability across the guidelines. In conclusion, among REACH‐B participants, most eligible individuals receive treatment. Lower treatment uptake among women and younger people despite eligibility partly reflects lower threshold for elevated ALT in women, and clinician determination of non‐CHB related ALT elevation. As treatment guidelines evolve and eligibility criteria broaden, monitoring treatment patterns is important.

Hepatitis B is a vaccine-preventable and treatable condition, yet many people remain undiagnosed or untreated. Population-wide testing is now recommended to ensure all adults know their hepatitis B status, and recent prescribing reforms aim to improve access to antiviral treatment.

Current uptake of chronic hepatitis B (CHB) treatment and care in Australia is well below target levels, leading to an ongoing burden of preventable liver disease and cancer. Understanding individual‐level trajectories of care engagement and variation by sociodemographic factors is essential to guide efforts to improve access to and retention in care. This study analysed records of hepatitis B viral load (VL) testing and antiviral treatment provided through Australia's national health insurance system, which were linked to migration, death, and sociodemographic data from various government datasets. Treatment and VL testing by population group were assessed, and uptake was calculated using modelled estimates of the number living with CHB. VL testing frequency and treatment adherence based on scripts dispensed were also assessed. Of the estimated 219,800 people living with CHB in Australia in 2023, 118,334 (53.8%) received either VL testing or treatment during 2014–2023. Estimated uptake of VL testing and treatment uptake were lower among Aboriginal and Torres Strait Islander people and also varied by region of birth. Of the 81,360 who received any VL testing, only 17,352 (21.3%) received it regularly, while 31,715 (39.0%) had evidence of prior monitoring but no VL testing since 2019. The majority of those who initiated treatment continued therapy and received supply sufficient for adherence. This study shows that substantial gaps exist in CHB care in Australia, particularly in continued monitoring among those not on treatment. Disparities in uptake are evident by priority population. Re‐engaging those lost to follow‐up should be prioritised.

Introduction: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, the sixth most common cause of cancer death in Australia. With shifting aetiologies and a growing at‐risk population, consistent routine surveillance recommendations are key to early detection of HCC and improved survival. We developed new evidence‐based HCC surveillance guidelines for people at high risk in Australia due to liver disease and/or other risk factors. These guidelines were developed by a working group of experts in liver cancer control and included evidence reviews, synthesis and adaptation of existing guidelines for the Australian context, and predictive modelling.Main recommendations: This article summarises the recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine HCC surveillance in the form of six‐monthly ultrasound scans, with or without α‐fetoprotein testing. People with liver cirrhosis and a non‐HCC‐related life expectancy of greater than six months are recommended to receive routine HCC surveillance. People with chronic hepatitis B virus infection who do not have liver cirrhosis are recommended to receive routine HCC surveillance if they have a family history of HCC, are Aboriginal or Torres Strait Islander peoples, or have an Asian, Pacific, or sub‐Saharan African background, with varying start ages recommended for each group. People with stage 3 non‐cirrhotic liver fibrosis (F3) may be recommended to receive routine HCC surveillance based on individual risk assessment, or otherwise monitored for progression to cirrhosis. The final guidelines were approved by the National Health and Medical Research Council (NHMRC) in April 2023.Changes in management as a result of the guideline: The updated guidelines formalise recommendations for people with cirrhosis, identify other patient groups who are recommended for surveillance, and highlight gaps in evidence where the benefit of surveillance is unclear. These guidelines were accompanied by the Roadmap to liver cancer control, a coordinated ten‐year plan for advancing liver cancer prevention and early detection in Australia. The full guidelines can be accessed at https://cancer.org.au/clinical‐guidelines/liver‐cancer/hepatocellular‐carcinoma.

Background: Active follow-up of chronic hepatitis C notifications to promote linkage to care is a promising strategy to support elimination. Aim: This pilot study in Victoria, Australia, explored if the Department of Health could follow-up on hepatitis C cases through their diagnosing clinicians, to assess and support linkage to care and complete data missing from the notification. Methods: For notifications received between 1 September 2021 and 31 March 2022 of unspecified hepatitis C cases (i.e. acquired > 24 months ago or of unknown duration), contact with diagnosing clinicians was attempted. Data were collected on risk exposures, clinical and demographic characteristics and follow-up care (i.e. HCV RNA test; referral or ascertainment of previous negative testing or treatment history). Reasons for unsuccessful doctor contact and gaps in care provision were investigated. Advice to clinicians on care and resources for clinical support were given on demand. Results: Of 513 cases where information was sought, this was able to be obtained for 356 (69.4%). Reasons for unsuccessful contact included incomplete contact details or difficulties getting in touch across three attempts, particularly for hospital diagnoses. Among the 356 cases, 307 (86.2%) had received follow-up care. Patient-management resources were requested by 100 of 286 contacted diagnosing clinicians. Conclusions: Most doctors successfully contacted had provided follow-up care. Missing contact information and the time taken to reach clinicians significantly impeded the feasibility of the intervention. Enhancing system automation, such as integration of laboratory results, could improve completeness of notifications and support further linkage to care where needed.

As the understanding of post-acute COVID-19 is evolving, regularly updated or ‘living guidelines’ will be crucial for those affected to be provided with best care within the health system.

Background: Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. Methods: Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. Results: Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. Conclusions: The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.

In 2016, hepatitis C direct-acting antivirals (DAAs) became available in Australia. A group of general practitioners (GPs) were surveyed twice to assess hepatitis C knowledge and management; 191/1000 (19.1%) responded at baseline, 164/938 (17.5%) at follow up. Participants’ mean Knowledge score increased: baseline 5.75 (95% CI 5.61–5.91), follow up 6.09 (95% CI 5.95–6.22; P <0.01). At follow up, 36/163 (22%) had prescribed DAAs compared with 23/187 (12%) at baseline (χ2(1) = 5.95, P = 0.02); however, 67/150 (45%) were unsure of treatment eligibility for people who inject drugs. Additional support for GPs is warranted to ensure optimal hepatitis C management in primary care.