Best ways to improve hepatitis B diagnosis and care revealed

There are around 220,000 Australians living with hepatitis B, which can lead to life-threatening liver conditions if not properly managed. However, one-quarter of Australians with the virus don’t know they have it, and only 23% are receiving regular clinical care, according to the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine.  The Sax Institute is helping policymakers in NSW address the issue through evidence-based strategies.

The NSW Ministry of Health commissioned an Evidence Check from the Sax Institute on interventions that reduce the disease burden of hepatitis B.  This report – along with consultation with communities and key partners – has supported the development of the new NSW Hepatitis B Strategy 2023-2026.

The NSW Hepatitis B Strategy 2023-2026 supports the goal set by the World Health Organisation to eliminate hepatitis B as a public health concern by 2030. The Strategy has set targets that 90% of people with hepatitis B should be diagnosed and 100% of people living with the virus receive care by 2026. 

The Strategy aims to maintain the state’s high childhood vaccine coverage and ensure all pregnant women are screened for hepatitis B, and preventative action is taken to minimise infection to their child. It also aims to ensure people impacted by hepatitis B are informed, followed up and engaged in care, with a particular focus on culturally and linguistically diverse people.

Evidence points the way forward

The Sax Institute brought together experts from The Kirby Institute and the Peter Doherty Institute for Infection and Immunity to co-author the Evidence Check. Sixty-one studies from the past 10 years were analysed, and the report identified strategies that improved screening rates, linkage to care and vaccination for hepatitis B.

“This Evidence Check is important because it looked at interventions around hepatitis B in Australia and other countries,” says co-author Associate Professor Behzad Hajarizadeh from The Kirby Institute, who has researched hepatitis B for more than 15 years. “We can see what has worked, and what we should try next.”

“Australia now has good infant vaccination coverage, and the number of new cases of hepatitis B is coming down. But we are concerned about the people who acquired the virus many years ago.”

Hepatitis B affects the liver and is transmitted through blood and sexual contact, as well as from mother to child during birth. In Australia, most people affected by chronic hepatitis B are born overseas, with the most common regions of origin being North-East Asia and South-East Asia.

The virus often has no symptoms at first, which is one of the barriers to diagnosis and treatment, says Associate Professor Hajarizadeh. “The other barriers are low health literacy and misunderstandings about the disease among some people – for instance, the belief that it’s congenital and can’t be treated.”

People with hepatitis B should get regular blood tests to monitor their liver health and be put on anti-viral medication if need be. “We don’t have a cure, but with treatment you can lead a healthy life.”

Effective strategies revealed

Most of the studies analysed in the Evidence Check had interventions with multiple components, but several types of intervention stood out as being effective, and these have been included in the new policy strategy.

Community education was found to increase testing rates and linkage to care, particularly when it was delivered face-to-face. Interventions with on-site testing and vaccination led to higher uptakes in those areas as well.

“It makes sense that having on-site testing and vaccination are effective, because for many people it’s difficult to navigate the health system,” says Associate Professor Hajarizadeh.

While there is some good-quality evidence available, there are still basic things we don’t know about Australians living with hepatitis B, says Associate Professor Hajarizadeh. “We don’t know the exact proportion of people who are eligible for treatment, and when they transition from the monitoring to the treatment stage,” he says. The Kirby Institute has begun working on a longitudinal cohort study of Australians living with hepatitis B, which received $1.6 million in funding last year and aims to provide valuable nationally representative information.

To read the Evidence Check, click here.