Hepatitis B Virus Screening Rates Research Articles

Adherence to pretreatment hepatitis B virus (HBV) screening in patients with cancer after implementation of built-in order set.

330 Background: Patients with a history of HBV exposure are at risk of reactivation when receiving treatments that affect the immune system, such as cancer-directed therapies. ASCO guidelines recommend universal HBV screening prior to initiation of cancer-directed therapies to prevent hepatic dysfunction and delays in cancer care. However, significant variation remains in clinical practice. Improving HBV screening is of special interest at our institution, given that we serve a large proportion of Asian immigrants at high risk of prior HBV exposure. With our institution’s transition to EPIC on Apr 1, 2022, the HBV serology order set was incorporated into the pre-treatment checklist of every cancer therapy plan. We studied the rates of HBV screening before and after implementing this change. Methods: We identified patients with cancer starting systemic cancer treatment at our institution between Oct 1, 2021 – Mar 31, 2022 (pre-EPIC period), and Oct 1, 2023 – Mar 31, 2023 (post-EPIC period). Patients who received only endocrine therapy, transferred care, or lost to follow-up prior to treatment initiation were excluded. To select a random sample from each time-period of interest, patients were assigned a random number, sorted based on this random number, and then reviewed in order. All data was collected retrospectively by manual chart review. Results: We randomly selected and reviewed 69 patients from pre-EPIC period, and 75 from post-EPIC period. Their demographic, disease, and treatment characteristics are summarized in the table. HBV screening rates were 42% and 80% in the pre-and post-EPIC periods, respectively (p<0.001). Twenty-one (14.6%) patients screened positive for HBV core antibody, among whom six (5.1%) had negative surface antibodies. Conclusions: The built-in HBV serology order set significantly improved rates of hepatitis B screening prior to starting systemic cancer-directed treatment. It is a low-cost and highly effective intervention. Our next steps are to determine how a higher adherence to HBV screening guidelines impacted the management of patients with prior HBV exposure. Pre-EPIC:Oct 1, 2021 - Mar 31, 2022 (N=69) Post-EPIC: Oct 1, 2022 – Mar 31, 2023 (N=75) P values Age at diagnosis (years), mean (SD) 62.1 (1.4) 65.2 (1.6) 0.15 Female (%) 40 (58.0) 35 (46.7) 0.18 Race (%): 0.051 White 51 (73.9) 49 (65.3) Asian 8 (11.6) 20 (26.7) Other 10 (14.5) 6 (8.0) Cancer type (%): 0.39 Hematological Malignancies 19 (27.5) 16 (21.3) Solid Tumor 50 (72.7) 59 (78.7) Metastatic Disease (%) 24 (34.8) 25 (33.3) 0.95 Treatment Type (%): 0.13 CD20 mAb+/- other 3 (4.4) 9 (12.0) Chemotherapy+/-other 52 (75.4) 57 (76.0) Other 14 (20.3) 9 (12.0) mAb: monoclonal antibody.

Hepatitis B serology testing in patients with cancer initiating anticancer therapy.

375 Background: The prevalence of hepatitis B virus (HBV) in the US is ~5%. Patients receiving anticancer therapy with a history of HBV infection are at risk for viral reactivation leading to hepatitis flare, liver failure, and death. The American Society of Clinical Oncology (ASCO) updated 2020 HBV screening and management guidelines recommending all patients have HBV serologies before anticancer therapy initiation. In August 2021, only 17% of patients initiating anticancer therapy at UConn Health had HBV serology screening before treatment. We aimed to increase the HBV screening rate by at least 50%, using HBV serologies before initiation of anticancer therapy. Methods: The plan-do-study-act method was used to conduct this quality improvement (QI) project. To increase the HBV screening rate, we provided education and a two-part HBV serology ordering process improvement. Education consisted of an e-mail to cancer center providers and nurses detailing updated ASCO HBV screening and recommendations. The ordering process improvement plan included 1) multidisciplinary team created HBV serology order, which could be ordered inside or outside of anticancer treatment plan and 2) best practice advisory (BPA) alert to providers when a new anticancer treatment plan was opened. Part 2 of the ordering process improvement plan included incorporation of HBV serology order set directly into anticancer treatment plans along with other baseline laboratory orders to reduce provider time and eliminate the need for BPA. A two-part retrospective chart review was conducted, using an electronic medical record report of patients initiating anticancer treatment plans between treatment periods (pre -intervention and post-intervention). Inclusion criteria included: patients > 18 years and treated with anticancer therapy for newly diagnosed cancer. Patients were excluded if they had known or suspected HBV infection; or were within the Department of Corrections. Results: During the post-implementation phase, 125 patients initiated a new anticancer treatment plan. Of these, 30 (24%) patients were excluded: 18 received prior treatment before HBV serology implementation, 6 received previous anticancer treatment, 5 did not receive anticancer treatment, and 1 was a Department of Correction patient. Out of 95 remaining eligible patients, 84 patients (88.5%) had HBV serologies performed before treatment initiation. Conclusions: Incorporating HBV serologies into anticancer treatment plans appears to be a reliable, acceptable, and valid means to increase adherence to ASCO guidelines related to HBV screening prior to initiation of anticancer therapy. We plan to initiate a follow-up analysis to identify reasons why HBV serologies were not obtained in 12% of patients to inform further QI interventions, and to ensure appropriate management of patients with positive HBV serology results.

Current practice and recommendations for management of hepatitis B virus in people living with HIV in Asia.

The prevalence of HIV and hepatitis B virus (HBV) co-infection is higher in Asia than in Europe and North America and varies significantly between different regions within Asia. Important routes of transmission of both these infections include high-risk unprotected sexual contact, intravenous drug use, and transmission of maternal infection perinatally or in early childhood. While life expectancy among people living with HIV has been extended with effective antiretroviral therapy (ART), HBV-induced liver injury and complications have emerged as a leading cause of morbidity and mortality in people living with HIV. This article describes the prevalence of co-infection, current clinical practice, and recommendations for the management of people living with HIV-HBV co-infection in Asia. Screening for HBV should occur at the time of HIV diagnosis; however, HBV screening rates in people living with HIV in Asia vary widely by region. Similarly, people with HBV should be screened for HIV before initiation of HBV antiviral therapy. People with HIV-HBV co-infection should be assessed for liver damage and risk factors for liver disease and be monitored regularly for liver complications and HBV DNA. Medical treatment with ART is lifelong and includes tenofovir and lamivudine or emtricitabine, unless intolerant or contraindicated, as these are active against both HIV and HBV. HBV vaccination programmes are effective in reducing co-infection rates. Mother-to-child transmission can be prevented through measures such as vaccination, antenatal screening, and treatment of pregnant women who are infected.

Electronic Alert System Significantly Increases HBV Screening Rates Before Immunosuppressive Treatments.

Hepatitis B Virus (HBV) screening rates before starting immunosuppressive treatments are suboptimal. The aim of the study was to evaluate the efficacy of a new electronic alert system in increasing HBV screening rates. The electronic alert system, HBVision2, identifies patients at risk of HBV reactivation when a pre-determined International Classification of Diseases (ICD)-10 code is entered into the hospital's database or immunosuppressive treatment is prescribed. The system evaluates the prior Hepatitis B Surfage Antigen (HBsAg) and anti-Hepatitis B Core Immunglobulin G (HBc IgG) results and sends an alert code to the clinician for screening if serology is not completely available or consult a specialist in case of positive serology. The HBV screening and consultation rates of patients before (control group) and after HBVision2 were retrospectively compared. The clinical course of unscreened and/or unconsulted patients was determined, and the clinical efficacy of HBVision2 in preventing HBVr was predicted. Control group included 815 patients (52.6% male, mean age: 60 ± 12, 82.5% with oncologic malignancy) and study group included 504 patients (56% male, mean age: 60 ± 13, 91.4% with oncologic malignancy). Groups were similar with respect to gender, mean age, and HBVr risk profile of the immunosuppressive treatment protocols. Overall, both HBsAg (from 55.1% to 93.1%) and anti- HBc IgG screening rates significantly increased (from 4.3% to 79.4%) after the electronic alert system (P < .001, for both). Consultation rates of anti-HBc IgG-positive patients significantly increased from 40% to 72.7% (P = .012). HBVr developed in 2 patients (2.6%) who were not screened and/or consulted after the alert system. Alert program prevented the development of HBVr in 10 patients (1.9%) of the study group and decreased the development of HBVr by 80%. Electronic alert system significantly improved HBsAg and anti-HBc IgG screening rates before starting immunosuppressive treatment and prevented the development of HBVr to a great extent. However, screening rates are still below optimal and need to be improved.

S1365 Improving Screening and Vaccination Rate for Hepatitis B in Veterans Affair Primary Care Population: A Quality Improvement Study

Introduction: According to Advisory Committee on Immunization Practices (ACIP), acute infection with Hepatitis B virus (HBV) is rising among adults 40 years and older. Hepatitis B (HepB) vaccines have long demonstrated safety and efficacy for decades, however less than a third of U.S. adults reported being vaccinated against HBV in 2018. In 2022, ACIP updated its recommendation and advised vaccinating all adults aged 19-59 and those 60 years and older with risk factors; adults 60 years and older without known risk factors may also be vaccinated. Our project aims to improve HBV screening and vaccination rate among Veterans Affairs (VA) primary care clinic patient population. Methods: Data was collected from pre-intervention (October – December 2021) and post-intervention (March – May 2022); all patients seen in clinic during these months were included. Patients were considered immune against HBV from vaccination if they have positive anti-HBsAg; and susceptible to infection if hepatitis panel negative. Interventions include educating each resident group regarding update in vaccination guideline and hepatitis panel interpretation. Reminder poster regarding HBV vaccine was placed in each clinic room. In addition, reminder for checking HepB status was developed and embedded in VA electronic medical record (EMR) system, which will show up at the end of each visit. (Figure) Results: In the pre-intervention period from October to December 2021, a total of 1242 veterans were seen in primary care clinic. 532 veterans were screened for immunity in the past with 378 veterans noted to have no immunity against hepatitis B. Out of 378 non-immune veterans, only 35 patients were vaccinated against HepB. (Table) In the post-intervention period from March to May 2022, 1174 veterans were seen. 689 veterans were screened for immunity and 402 have no immunity against HBV on hepatitis panel; 123 veterans received HepB vaccine during clinic visit, which is more than 20% increase compared to prior. Conclusion: Our data suggest that HBV vaccination rate was suboptimal among veteran population. A low-cost intervention along with the help of technology could be beneficial in integrating new vaccination guideline in VA standard of care. Our project strikes to encourage clinicians to bear the responsibility and offer the vaccine to adult patients proactively, rather than wait for patients to request for it. The goal of this project is to increase awareness of new vaccination guideline and reach for full vaccination rate among veteran population. Table 1. - Data gathered from pre-intervention and post-intervention period. Pre-Intervention (October to December 2021) Post-Intervention (March to May 2022) Total veterans seen in clinic 1242 1174 Veterans that were screened for Hepatitis B 532 out of 1242 (42.8%) 689 out of 1174 (58.7%) Screened veterans found to have no immunity against Hepatitis B 378 out of 532 (71%) 402 out of 689 (58.3%) Veterans without HepB immunity that received HepB vaccine 35 out of 378 (9%) 123 out of 402 (30.6%) Figure 1.: Example of electronic reminder that was developed and embedded in VA electronic medical record system. The reminder will show up at the end of each clinic visit, which will ask physicians to check veterans' hepatitis B status and offer vaccine if appropriate.

Hepatitis B screening to reduce the risk of viral reactivation in gynecologic oncology patients receiving chemotherapy at a regional tertiary cancer center: A quality improvement initiative.

332 Background: In 2020, ASCO released a Provisional Clinical Opinion recommending universal hepatitis B virus (HBV) screening prior to systemic chemotherapy to reduce the risk of reactivation and associated morbidities. There is limited data for HBV prevalence and risk factors in gynecologic oncology. In gynecologic oncology patients at the Juravinski Cancer Centre, median baseline screening rate over 6 months was 0%. Our aim was to increase the rate of HBV screening to 70% in gynecologic oncology patients initiating chemotherapy over 6 months and compare real-world efficacy of risk factor-based vs. universal screening. Methods: We performed an interrupted time series study using the Model for Improvement methodology. Four interventions were introduced to address identified screening barriers: provider education, standardization of a testing protocol, integration with existing clinical workflow, and biweekly feedback reports. These were modified in response to outcomes and stakeholder feedback in Plan-Do-Study-Act cycles. Process and outcome measures data were collected by chart review and analyzed on statistical process control and run charts. Retrospective chart review collected demographic and disease data including Centers for Disease Control (CDC) hepatitis risk factors. Results: From Dec 1/20 to Nov 30/21, there were 381 new chemotherapy initiations in gynecology patients. The proportion of physicians screening increased significantly from 0% to 85%, and HBV monthly screening rates increased significantly from 0% to 72.2% by month 8 and were sustained for 4 months at last analysis. The integrated clinic screening protocol and feedback report interventions were each associated with increased screening rates. Of 330 unique patients initiating chemotherapy, 175 were screened (53%). Although ≥95% lacked data for 4 CDC hepatitis risk factors, 60.9% had ≥1 risk factor, and 11.2% had ≥2. HBV surface antigen (HBSAg) was non-reactive in all screened patients, but anti-HBV core (HBc) antibody was reactive in 5 (2.9%), indicative of prior infection. Real world risk factor-based screening in those with ≥1 CDC risk factor would have only identified 3/5 seropositive patients. In the screened population, risk-factor based screening had sensitivity 60%, specificity 38.8%, PPV 2.8%, NPV 97.1%. There were no HBV reactivations. Conclusions: Implementation of 4 interventions to increase HBV screening in gynecologic oncology patients receiving chemotherapy significantly improved screening rates, achieving our target at 8 months with sustained improvement. Risk-factor based screening lacks sensitivity compared to universal screening which may impact management. Lessons learned from this initiative may be applicable to other interventions to reduce infectious morbidity in oncologic populations.

Hepatitis B screening to reduce the risk of viral reactivation in gynecologic oncology patients receiving chemotherapy at a regional tertiary cancer center: A quality improvement initiative.

e18628 Background: In 2020, ASCO released a Provisional Clinical Opinion recommending universal hepatitis B virus (HBV) screening prior to systemic chemotherapy to reduce the risk of reactivation and associated morbidities. There is limited data for HBV prevalence and risk factors in gynecologic oncology. In gynecologic oncology patients at the Juravinski Cancer Centre, median baseline screening rate over 6 months was 0%. Our aim was to increase the rate of HBV screening to 70% in gynecologic oncology patients initiating chemotherapy over 6 months and compare real-world efficacy of risk factor-based vs. universal screening. Methods: We performed an interrupted time series study using the Model for Improvement methodology. Four interventions were introduced to address identified screening barriers: provider education, standardization of a testing protocol, integration with existing clinical workflow, and biweekly feedback reports. These were modified in response to outcomes and stakeholder feedback in Plan-Do-Study-Act cycles. Process and outcome measures data were collected by chart review and analyzed on statistical process control and run charts. Retrospective chart review collected demographic and disease data including Centers for Disease Control (CDC) hepatitis risk factors. Results: From Dec 1/20 to Nov 30/21, there were 381 new chemotherapy initiations in gynecology patients. The proportion of physicians screening increased significantly from 0% to 85%, and HBV monthly screening rates increased significantly from 0% to 72.2% by month 8 and were sustained for 4 months at last analysis. The integrated clinic screening protocol and feedback report interventions were each associated with increased screening rates. Of 330 unique patients initiating chemotherapy, 175 were screened (53%). Although ≥95% lacked data for 4 CDC hepatitis risk factors, 60.9% had ≥1 risk factor, and 11.2% had ≥2. HBV surface antigen (HBSAg) was non-reactive in all screened patients, but anti-HBV core (HBc) antibody was reactive in 5 (2.9%), indicative of prior infection. Real world risk factor-based screening in those with ≥1 CDC risk factor would have only identified 3/5 seropositive patients. In the screened population, risk-factor based screening had sensitivity 60%, specificity 38.8%, PPV 2.8%, NPV 97.1%. There were no HBV reactivations. Conclusions: Implementation of 4 interventions to increase HBV screening in gynecologic oncology patients receiving chemotherapy significantly improved screening rates, achieving our target at 8 months with sustained improvement. Risk-factor based screening lacks sensitivity compared to universal screening which may impact management. Lessons learned from this initiative may be applicable to other interventions to reduce infectious morbidity in oncologic populations.

Assessment of Hepatitis B Virus Screening Behaviors among Asian-Americans through the Lens of Social Cognitive Theory.

Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions. Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted. About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening. HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors.

Antenatal hepatitis B screening in Nigeria: A comparative analysis with syphilis and HIV.

Nigeria has adopted routine screening of pregnant women for hepatitis B virus (HBV) as part of the interventions to eliminate its vertical transmission. However, there is a dearth of evidence on the coverage of routine antenatal HBV screening as recommended in the national guidelines. This study examined the antenatal HBV screening rate and the positivity rate compared with syphilis and HIV. We conducted a descriptive analysis of the 2019 national HIV/AIDS health sector data. The study included approximately 2.8 million pregnant women who received antenatal care (ANC) in over 6000 health facilities providing prevention of mother-to-child transmission of HIV services in Nigeria. Of the ANC clients, 0.2 million (7.2%) were screened for HBV. At the zonal level, the South West had the highest HBV screening rate (19%), while the lowest rate was in the North East (2.5%). The percentage of pregnant women screened for HBV was lower than those screened for syphilis (16.3%) and HIV (90.3%). Among those screened for HBV, the positivity rate was 5%. The HBV positivity rate ranged from 8.5% in the North Central zone to 1.3% in the South East zone. The positivity rates for syphilis and HIV were 0.4% and 0.5%, respectively. Our results indicate a low antenatal HBV screening rate and a wide disparity compared with HIV and syphilis. This finding highlights the need to understand and address the barriers affecting routine antenatal HBV screening and to strengthen the integration of HBV services into the HIV program in Nigeria.

Clinical practice of hepatitis B screening in patients starting with chemotherapy: A survey among Dutch oncologists.

ObjectiveScreening for hepatitis B virus (HBV) before chemotherapy is recommended by international guidelines; still, the HBV screening rate is low, and patients remain at risk for HBV reactivation (HBVr). Because HBVr is a serious and preventable condition, we conducted a survey to evaluate the screening behaviour of oncologists in the Netherlands.MethodsWe conducted an anonymous digital survey by email to all practicing medical oncologists. The surveys were sent in two session, the first one in 2017 and the second one in 2019. Questions included HBV screening procedures, reasons for screening and experience with HBVr.ResultsAmong the 110 respondents, 29 (27%) followed a standardised protocol. Overall, 13 (12%) oncologists screened all patients, 76 (70%) only screened patients they considered as high risk and 19 (18%) did not screen anyone. Fourteen percent of the respondents experienced a HBVr in one of their patients.ConclusionThis survey suggests that universal HBV screening is not common practice and usually patients considered as at risk for HBVr are screened, while this group is not always properly identified. Introduction of a national protocol for HBV screening and adjustment of the Dutch oncology guidelines might contribute to a reduction of HBVr during chemotherapy.

Hepatitis B Virus Screening Before Cancer Chemotherapy in Taiwan: A Nationwide Population-Based Study.

Background: Reactivation of the hepatitis B virus (HBV) during cancer chemotherapy is a severe and sometimes fatal complication. In 2009, the National Health Insurance (NHI) in Taiwan recommended and reimbursed screening for HBV infection and prophylactic antiviral therapy before cancer chemotherapy. In this study, we determined the HBV screening rate in patients with cancer undergoing chemotherapy in Taiwan.Methods: We retrospectively collected data from the National Health Insurance Research Database on patients who received systemic chemotherapy for solid or hematologic cancers from January 2000 through December 2012. We defined HBV screening based on testing for serum HBsAg within 2 years of the first chemotherapy commencement. We calculated overall and annual HBV screening rates in all patients and subgroups of age, gender, cancer type, hospital level, physician's department, and implementation of NHI reimbursement for HBV screening before cancer chemotherapy.Results: We enrolled 379,639 patients. The overall HBV screening rate was 45.9%. The screening rates were higher in males, those with hematological cancer, those at non-medical centers and medical departments. The HBV screening rates before (2000–2008) and after the implementation of NHI reimbursement (2009–2012) were 38.1 and 57.5%, respectively (p < 0.0001). The most common practice pattern of HBV screening was only HBsAg (64.6%) followed by HBsAg/HBsAb (22.1%), and HBsAg/HBcAb/HBsAb (0.7%) (p < 0.0001). The annual HBV screening rate increased from 31.5 to 66.3% (p < 0.0001). The screening rates of solid and hematological cancers significantly increased by year; however, the trend was greater in solid cancer than in hematological cancer (35.9 and 26.2%, p < 0.0001).Conclusions: The HBV screening rate before cancer chemotherapy was fair but increased over time. These figures improved after implementing a government-based strategy; however, a mandatory hospital-based strategy might improve awareness of HBV screening and starting prophylactic antiviral therapy before cancer chemotherapy.

Lack of awareness of Hepatitis B screening and vaccination in high-risk groups

Background/aim Hepatitis B virus (HBV) vaccination rates are insufficient in high-risk patients worldwide. This study aimed to investigate the screening, immunization, and vaccination rates in three high-risk groups for HBV infection: allogeneic hematopoietic stem cell transplantation (AHSCT), renal transplantation (RT), and chronic hepatitis C (CHC) groups. Materials and methods The serological data of consecutive patients between 2014 and 2019 were reviewed using the hospital database. Results The HBV screening rates were 100.0%, 90.4%, and 82.4% in the AHSCT, CHC, and RT groups, respectively (p = 0.003). The immunization rates against HBV through either previous exposure or vaccination were 79.5%, 71.7%, and 46.5% in the AHSCT, RT, and CHC groups, respectively (p < 0.001). The HBV vaccination rate was significantly low in the CHC group (71.5%, 69.0%, 34.6% in the AHSCT, RT, and CHC groups, respectively, p < 0.001). If patients lost their immunity due to immunosuppressive therapy were accounted, the vaccination rates increased to 95.2% in the AHSCT group and 72.9% in the RT group. The rate of annual screening for HBV status was 97.9% in the AHSCT group, but it was only 23.9% in the RT group. Conclusion HBV screening and vaccination rates were significantly lower in the RT and CHC groups than in the AHSCT group.

Hepatitis B Virus Screening and Real Life Data in Patients with Solid Tumor Receiving Chemotherapy.

Reactivation of the hepatitis B virus (HBV) either during or after chemotherapy may cause serious and sometimes fatal hepatitis. All patients undergoing chemotherapy should therefore be screened in terms of HBV before chemotherapy. The purpose of this research was to identify HBV screening rates in patients with solid cancer undergoing parenteral chemotherapy and to determine the outcomes of patients undergoing HBV screening. Data for patients undergoing parenteral chemotherapy for solid cancer from January 1, 2012 to December 30, 2018 were retrieved from our electronic health record patient files in this retrospective study. Screening was defined as hepatitis B surface antigen (HBsAg) and/or hepatitis B core antibody (HBcAb) tests carried out within six months prior the first chemotherapy session. Four thousand fifty-eight (63%) of the 6440 patients who underwent parenteral chemotherapy were screened for HBsAg and/or HBcAb. The proportions of patients screened for HBsAg and HBcAb improved from 38.8% (2012) to 76.3% (2018), and from 0.2% (2012) to 43% (2018), respectively (P<0.001). The HBsAg and HBcAb positivity rates were 2.9% and 36.5%, respectively. Antiviral prophylaxis was started in 11.8% of HBsAg-negative/HBcAb-positive patients and 40.5% of HBsAg-positive patients. HBV reactivation did not occur in patients receiving antiviral prophylaxis, but was identified in 7.2% of HBsAg-positive patients and 0.6% of HBsAg-negative/HBcAb-positive patients without antiviral prophylaxis. Although HBV screening rates before chemotherapy are increasing among solid cancer patients, the rate of initiation of antiviral prophylaxis is still low. It is therefore important to raise awareness regarding HBV reactivation during/after chemotherapy.

Risk of hepatitis B reactivation in patients receiving anti-tumor necrosis factor-α therapy.

The purpose of this study was to determine hepatitis B virus (HBV) screening rates in patients receiving anti-tumor necrosis factor (TNF)-α therapy and the frequency of HBV reactivation in patients with resolved hepatitis B virus infection (hepatitis B surface antigen [HBsAg] negative, hepatitis B core antibody [Anti-HBc] positive). Data from 1834 patients who underwent anti-TNF-α therapy in the Rheumatology, Gastroenterology and Dermatology Departments of our hospital between 2010 and 2020 were retrospectively analyzed. Within 6months before the initial anti-TNF-α therapy, performing a HBsAg and/or anti-HBc test is defined as HBV screening. HBV reactivation is defined as the presence of detectable serum HBV DNA or HBsAg seroconversion from negative to positive. The overall HBV screening rate was 82.3% before starting anti-TNF-α therapy. There was an increasing trend in HBV screening rates during the years analyzed (64% in 2010, 87.4% in 2019) (P<.001). Before anti-TNF-α therapy was initiated, 272 patients were HBsAg negative and anti-HBc positive. Among these patients, HBV reactivation did not occur in 31 patients who received antiviral prophylaxis, whereas HBV reactivation occurred in only 1 (0.4%) of the 241 patients who did not receive antiviral prophylaxis. Hepatitis B virus screening rates prior to starting anti-TNF-α therapy were relatively high, and its trend was increased by year. HBV reactivation because of anti-TNF-α use rarely occurred in patients with resolved HBV infection. Further studies are needed on whether routine anti-HBc screening and/or HBV DNA follow-up are necessary in these patients aside from HBsAg.

Hepatitis B Screening Prior to Chemotherapy in the Middle East: A Retrospective Cohort Study

Background: Hepatitis B virus (HBV) reactivation can be asymptomatic or manifest as fatal fulminant hepatitis. Most international guidelines recommend screening patients prior to immunosuppressive therapy.&#x0D; Aims: To determine HBV screening rates and modalities in patients receiving chemotherapy at the American University of Beirut Medical Center.&#x0D; Methods: A retrospective cohort review of electronic health records of adult patients who received chemotherapeutic agents, between June 2015 and June 2016. Patients clinical characteristics were documented. Adequate screening was defined as performing all: HBsAg, HBs Abs, and anti HBc Abs(total).&#x0D; Results: A total of 1547 patients were initially assessed. 45.6% were males with a mean age of 56. 382(30%) had hematologic malignancies, of whom 111 underwent HSCT. Of those included, 303(24%) patients were screened by at least one test for HBV and 42(3.3%) for HBsAg, anti HBc Abs and HBs Abs.&#x0D; Patients who were appropriately screened were significantly younger(p=0.008) and more likely to have hematologic malignancies (n=35, 83.3%, p&lt;0.0001). Among patients with hematologic malignancies, appropriately screened patients (n=35) were younger (p=0.042) and had a history of HSCT(n=19, 54.3%, p=0.001).&#x0D; Conclusion: Rates of screening for HBV prior to chemotherapy at our medical center are low, and not always complete or adequate. There is an urgent need to implement a better screening policy.

High hepatitis B virus screening rate among patients receiving systemic anticancer treatment in Japan.

Patients with hepatitis B virus (HBV) infection have a risk of reactivation after chemotherapy. All patients undergoing chemotherapy should be screened for HBV infection. No large-scale studies have been conducted to examine HBV screening practice in Japan. We analyzed health insurance claims equivalent data linked with a nationwide hospital-based cancer registry. Patients diagnosed with cancer in 2014, who were aged 20years and older and those who underwent systemic anticancer treatment in 2014-15 were included. We assessed the HBV screening rates by the HBsAg or anti-HBc tests, HBV-DNA tests, and entecavir prescriptions. Multiple logistic regression models were used to identify factors related to the receipt of screening. Of 177,597 patients (mean [SD] age, 65.6 [12.2] years), 82.6% and 12.9% patients had a solid tumor and hematologic malignancy, respectively. Among them, 88.1%, 6.3%, and 5.5% received cytotoxic chemotherapy, targeted therapy, and anti-CD20 antibodies, respectively. Overall, 70.6% of patients were screened. The positive predictor of HBV screening was receiving anti-CD20 antibodies [odds ratio (OR); 2.23, 95% confidence interval (CI) 2.06-2.41, p < 0.001] and negative predictors were age ≥ 85 (OR 0.76, 95% CI 0.71-0.81), age 75-84 (OR 0.77, 95% CI 0.75-0.79) and targeted therapy (OR 0.69, 95% CI 0.67-0.72). Among the screened patients, 13.2% were tested for HBV-DNA, and 1.49% were prescribed entecavir. The HBV screening rate in Japan is higher than in other countries. Further improvement of the HBV screening rate is needed to prevent reactivation and avoidable deaths of patients with HBV infection.

Construction and Evaluation of the &amp;lt;i&amp;gt;E-clinic&amp;lt;/i&amp;gt; Service System in Baoan District, Shenzhen, China

Objective To construct the regional elimination of mother-to-child transmission (EMTCT) clinic (E-clinic) service system and evaluate its effect. Methods Since November 2018, the E-clinic service system has been established in the obstetric clinic of 18 maternal and child health (MCH) providers in Baoan District, Shenzhen, China, forming a regional service system. In E-clinics obstetricians take care of pregnant women with hepatitis B virus (HBV) infection for complete perinatal services and infectious disease management. Before and after the implementation of the E-clinic service system, the changes of HBV screening rate among pregnant women, HBV infected mothers DNA detection rate, mothers with high viral load (> 2 × 106 IU/mL) antiviral therapy (ART) rate and HBV MTCT rate were analyzed. Results From July 2018 to March 2020, there were 162,036 registered pregnant women and 7,358 HBV infected mothers in Baoan District, Shenzhen, including 1,179 mothers with high viral load. The HBV screening rate among pregnant women, HBV infected mothers follow up rate, HBV infected mothers DNA detection rate and ART rate were 97.6% (124,311/127,379), 99.0% (5,742/5,801), 82.8% (4,805/5,801) and 70% (687/982) respectively, which were higher than 95.9% (33,247/34,657), 93.1% (1,449/1,557), 49.3% (767/ 1,557) and 21.3% (42/197) before the implementation of the E-clinic service system. The differences were statistically significant (P 0.05). Conclusions The E-clinic service system of Baoan District in Shenzhen integrates antenatal care (ANC) and ART, improves the management of HBV infection during pregnancy, further reduces the HBV MTCT, and provides experience for other regions to manage infectious diseases during pregnancy.

Hepatitis B Virus Screening and Reactivation in a National VA Cohort of Patients with Inflammatory Bowel Disease Treated with Tumor Necrosis Factor Antagonists.

Practice guidelines recommend screening for hepatitis B virus (HBV) infection prior to initiating treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor (anti-TNF) therapy. However, the adherence to these screening guidelines and the clinical outcomes of HBV reactivation following anti-TNF use are not well known. This is a retrospective cohort study using the Veterans Health Administration datasets for IBD patients with filled prescriptions for anti-TNFs from 2003 to 2011. Laboratory testing was used to define HBV screening status in the 12months preceding anti-TNF initiation. Logistic regression models were used to identify predictors of HBV screening. Cases of potential HBV reactivation were identified using ICD-9 codes for HBV infection or acute liver failure or by medications used for HBV infection treatment, and manually reviewed for verification. We identified 3357 IBD patients with filled prescriptions for anti-TNF medications. The HBV testing prior to anti-TNF initiation was 8.1% in 2003 and increased to 43.2% by 2011, with an overall rate of 23.7%. In multivariate analysis, African-American race, facilities with a higher volume of IBD patients, and facilities with an academic affiliation were associated with a higher probability of HBV screening. We did not identify a single case of confirmed clinically relevant HBV reactivation after anti-TNF initiation during 7210 patient-years of medication use. HBV screening rates prior to anti-TNF initiation are low among IBD patients, but have increased over time. Despite low rates of screening, clinically significant HBV reactivation after anti-TNF initiation in this US cohort was nonexistent.

Hepatitis B virus in patients with chronic hepatitis C treated with direct antiviral agents.

cases of hepatitis B virus (HBV) reactivation have been reported in patients with hepatitis C virus (HCV) treated with direct antiviral agents (DAA). the main objectives of the present study are: a) to determine the prevalence of HBV/HCV coinfection in HCV patients treated with DAAs in the Autonomous Community of Madrid (CM) and also to determine the incidence and clinical relevance of HBV reactivation; and b) to determine the HBV screening rates in HCV patients in our region. For that purpose, 1,337 HCV patients were consecutively treated with DAAs in two hospitals located in South CM between January 2015 and June 2017. nine of the 1,337 (0.67%) participants were HBsAg positive and 356 (26.6%) had previous HBV infection markers. Two of the four (50%) HBsAg positive patients with untreated HBV developed a virological reactivation, but not a biochemical reaction. Of the 356 patients with previous HBV infection markers, all had normal transaminases at the end of treatment and during follow-up. The HBV screening rate amounted to 92.9% of the cohort. the prevalence of HBV (HBsAg positive) infection in patients with chronic hepatitis C in the southern area of the CM is low. HBV reactivation in HBsAg positive patients treated with DAAs is common, although without clinical relevance. In our region, there is a high rate of HBV screening in patients with HCV that are likely treated with DAAs.

Assessing the Impact of Electronic Health Record Interventions on Hepatitis B Screening and Vaccination.

Hepatitis B virus (HBV) infection is a major health disparity between Asian Americans, Native Hawaiians, and Pacific Islanders compared with other racial/ethnic groups in the U.S. Our aims were to determine the effectiveness of an electronic health record (EHR) data-driven clinical intervention to improve HBV screening and vaccination rates at a community health center primarily serving Asian American patients. Using a community-engaged approach, we conducted a study to compare the differences in screening and vaccination rates for 6,429 patient encounters before and after implementation of the EHR intervention. A multivariable logistic regression analysis was conducted to estimate the effect of the intervention. Analyses indicated that patients who visited the clinic after implementing the EHR intervention were more likely to be screened (OR=1.8, p&lt;.001) and vaccinated (OR=2.8, p&lt;.001) for hepatitis B. Electronic health record interventions implemented using a community-engaged approach may improve delivery of appropriate care to patients at risk for hepatitis B in a community health setting.