Abstract
BackgroundAboriginal and Torres Strait Islander Australians are disproportionately affected by Chronic Hepatitis B (CHB) with a prevalence of 6.08% in the Northern Territory (NT) and liver cancer rates 6 times higher than non-Indigenous Australians. Without appropriate care, overall 25% of those living with CHB will die from either liver failure or liver cancer, outcomes that can be minimised with regular follow up, antiviral treatment and hepatocellular carcinoma (HCC) screening. This care including antiviral treatment is publicly funded in the Australian setting however the care cascade still shows inequities in access to treatment for Aboriginal Australians. We describe the impact of a mobile care delivery model, “One Stop Liver Shop”, on the cascade of care for people living with CHB in a remote Australian setting.MethodsA retrospective analysis was performed for CHB care received between 2013 and 2018 in one very remote Northern Territory community, where the “One Stop Liver Shop” was iteratively developed with the community. Patients with positive Hepatitis B virus surface antigen (HBsAg) were identified through electronic medical records. Proportions of patients who are up-to-date with monitoring investigations and HCC screening were evaluated and compared to national guidelines and targets.ResultsEighty-three HBsAg positive patients were evaluated. Eighty-eight percent were engaged in care, 16% of whom were receiving antiviral treatment. Liver function tests (LFT) were up to date in 71% of patients in 2013 and 88% in 2018. Viral load (VL) monitoring was up to date for 61 (73%) of patients. There were 44 patients in whom HCC screening was indicated. Of these, 38 (86.4%) were up to date with 6 monthly alpha-fetoprotein (AFP), 35 (79.5%) were up to date with 6 monthly liver ultrasound scan (USS), and 34 (77.3%) were up-to-date for both.ConclusionsA “One Stop Liver Shop” developed with and including Aboriginal Health Practitioners bridges gaps in the availability of services to those living with CHB in a very remote community and improves the cascade of care.
Highlights
The Northern Territory (NT) has the highest prevalence of chronic hepatitis B infection (CHB) in Australia at 1.90%, compared to the national average of 0.95% [1]
A “One Stop Liver Shop” developed with and including Aboriginal Health Practitioners bridges gaps in the availability of services to those living with Chronic Hepatitis B (CHB) in a very remote community and improves the cascade of care
Over the last 7 years, we have iteratively developed the “One Stop Liver Shop” in conjunction with one specific very remote community [10] clinic
Summary
The Northern Territory (NT) has the highest prevalence of chronic hepatitis B infection (CHB) in Australia at 1.90%, compared to the national average of 0.95% [1]. Australia and New Zealand have signed up to the WHO target of elimination of CHB as a public health problem by 2030 [9] Achievement of this target will only be feasible through continued vaccination of non-immune adults and children, along with identification and provision of appropriate clinical care for those currently living with CHB (majority of whom were born prior to availability of HBV vaccination) so as to remove risk of ongoing transmission and minimise morbidity. Overall 25% of those living with CHB will die from either liver failure or liver cancer, outcomes that can be minimised with regular follow up, antiviral treatment and hepatocellular carcinoma (HCC) screening This care including antiviral treatment is publicly funded in the Australian setting the care cascade still shows inequities in access to treatment for Aboriginal Australians. We describe the impact of a mobile care delivery model, “One Stop Liver Shop”, on the cascade of care for people living with CHB in a remote Australian setting
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