Abstract
Around 200,000 people live with chronic hepatitis B in England. Despite national guidance on identification and management of cases and their close contacts, testing rates of close contacts is as low as 43% in high prevalence areas of London. Our study aimed to determine whether a nurse-led enhanced management and contact tracing of chronically infected individuals improved testing uptake, vaccination and onward referral of close contacts. The study was conducted across Greater Manchester and East of England regions between October 2015 and July 2017. All HBV chronically infected individuals registered with a GP and their close contacts were eligible for recruitment. The proportion of contacts who were tested, vaccinated and referred where appropriate were compared before and after the nurse-led intervention. Baseline and outcome information was collected using questionnaires. The intervention improved case referral rates by an additional 14% (from 86% (88/102 cases) to 99.7%; 648/650 cases). The proportion of contacts tested increased from 34% to 72%-94% with 18 new cases of HBV diagnosed. Amongst close contacts tested, vaccination rates of at least three doses increased from 77% (43/56) to 93% (452/491) during the study. Our study has shown that nurse-led enhanced management greatly improves identification, testing and vaccination of close contacts. The identification of new acute and chronic cases is likely to make the intervention cost effective and local health commissioners should consider providing a nurse-led service as part of hepatitis B care pathways.
Highlights
Hepatitis B is a vaccine-preventable disease caused by the bloodborne hepatitis B virus (HBV)
The outcome for baseline cases and their contacts were described retrospectively at the time of recruitment. Because these individuals were prospectively being managed by the intervention nurses, they were counted in the intervention group, in addition to any individuals who were first notified between 1 October 2015 and 1 July 2017
All adults registered with a GP identified as chronic HBV infection (CHB) cases during the study period and their close contacts were eligible for recruitment into the study as summarized in Box 1
Summary
Hepatitis B is a vaccine-preventable disease caused by the bloodborne hepatitis B virus (HBV) It can cause a liver infection leading to both acute and chronic disease, cirrhosis and liver cancer.[1] Approximately 257 million people suffer from chronic HBV infection (CHB) worldwide and around 600,000 die annually because of associated liver disease.[2,3] In the UK, approximately 0.3% of the population have CHB,[4] mostly among ethnic minority groups and in large cities 5-7 where migrants, who acquired the infection as children in their birth country, mainly contribute to the burden.[8]. Without intervention, up to 90% of infected infants will develop CHB.[9] Around 25% of chronically infected individuals will develop liver cirrhosis or liver cancer.[10] Effective prevention strategies are of paramount importance These include birth vaccination of babies born of mothers with CHB and identifying and testing contacts of individuals infected with HBV, with subsequent vaccination or referral
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