Journal of Viral Hepatitis最新文献

Point-of-care testing for hepatitis C virus (HCV) offers multiple benefits to key populations and healthcare providers, but it has not achieved widespread implementation. This analysis investigates the impact of the health system on the sustainability of point-of-care HCV testing in Australia. Between September 2023 and January 2024, in-depth, semi-structured interviews were conducted with people involved in HCV policymaking in Australia. Data were coded using WHO's Health System Building Blocks framework (i.e., Health Workforce, Health System Financing, Medical Technologies, Leadership and Governance). Thematic analysis examined how the health system supports and hinders the long-term sustainability of HCV point-of-care testing. There were 29 participants working in seven Australian jurisdictions or nationally: 13 from departments of health, six from community-led organisations, five from local health services, and five from pathology. The analysis demonstrates the interrelations between Building Blocks, but governance was consistently foregrounded across each theme. For Health Workforce, the community approach to models of care in Australia bolstered support for HCV testing outside of traditional healthcare settings. For Health System Financing, sustainability was threatened by a lack of long-term funding mechanisms for point-of-care testing. For Leadership and Governance, state and national HCV elimination targets were seen as important to drive point-of-care testing at the local level, especially when they were reflected in services' key performance indicators. Integration into existing health system structures, sustainable funding mechanisms, and strengthened governance frameworks are needed to sustain HCV point-of-care testing in Australia. Study findings are critical to inform a long-term testing strategy in Australia and internationally.

An estimated 254 million people live with hepatitis B worldwide, with only 13% of people diagnosed and 3% receiving antiviral treatment. Without timely treatment, people with hepatitis B risk developing liver damage and liver cancer. In countries like Australia, where most people with hepatitis B are born in countries with higher prevalence, it is important that the knowledge and perceptions of hepatitis B in immigrant populations are explored to improve engagement in care. This review sought to systematically identify and synthesise qualitative research findings describing the knowledge and perceptions of hepatitis B in immigrant communities. An Ovid database search for English language publications for the years 2000–2024 was performed. 34 studies were selected for review. These were analysed using thematic synthesis and categorised using an modified version of the socio-ecological model. Ten analytic themes were identified: (1) knowledge of hepatitis B and misconceptions about transmission, (2) knowledge and familiarity with hepatitis B varies between communities, (3) culturally informed perceptions of health and illness, (4) alternative aetiologies of hepatitis B infection, (5) barriers and facilitators to engagement in healthcare, (6) sources of information, (7) stigma and family dynamics, (8) gender differences, (9) fear and anxieties of engaging with the healthcare system, (10) fear of health outcomes related to hepatitis B. These themes can be used to frame the development of culturally appropriate health promotion materials and interventions to improve knowledge and engagement in care among people living with hepatitis B.

Hepatitis B virus (HBV) infection is a global health challenge, with the World Health Organization (WHO) targeting its elimination by 2030. Jordan lacks sufficient data on HBV epidemiology, including prevalence, incidence and clearance. This study addresses these gaps through a retrospective analysis of HBV testing data from 40,268 individuals collected at Biolab Diagnostic Laboratories (2010–2024). Using cross-sectional and cohort study designs, the study examined hepatitis B surface antigen (HBsAg) prevalence, temporal trends, incidence, clearance rates and associated risk factors. Statistical methods included regression analyses, Kaplan–Meier estimations and Poisson models. HBsAg prevalence was 3.8% (95% CI: 3.6%–4.0%), with a nationally weighted prevalence of 5.3% (95% CI: 4.4%–6.4%). Prevalence was around 1% in individuals under 20 years, increasing to 8.5% (95% CI: 7.7%–10.0%) in the 50–59 age group. Over the past 15 years, prevalence declined by 7% annually [adjusted odds ratio (aOR): 0.93; 95% CI: 0.92–0.94]. HBsAg positivity was significantly associated with age, male sex and governorate. Cumulative HBsAg incidence was 0.26% (95% CI: 0.11%–0.64%) after 5 years of follow-up, with an incidence rate of 0.63 per 1000 person-years (95% CI: 0.26–1.51). Cumulative HBsAg clearance was 7.45% (95% CI: 4.07%–13.43%) at the 6-month follow-up mark, with a clearance rate of 17.68 per 100 person-years (95% CI: 9.51–32.86). Among HBsAg-positive individuals with > 6 months of follow-up, cumulative HBsAg clearance reached 46.12% (95% CI: 24.50%–74.34%) after 13 years of follow-up, with a clearance rate of 5.27 per 100 person-years (95% CI: 3.32–8.36). HBV epidemiology in Jordan shows declining prevalence and incidence, likely driven by expanding HBV vaccination coverage. To meet the WHO's 2030 elimination targets, Jordan must prioritise scaling up birth-dose vaccination, improving case detection and ensuring timely treatment.

The coexistence of chronic hepatitis B (CHB) and metabolic dysfunction–associated liver disease (MASLD) gained recognition, but the diagnostic performance of non-invasive markers regarding it remains underexplored. This study aimed to evaluate the utility of the FIB-4 index for fibrosis prediction in CHB patients and investigate its performance in the distinct subgroup of CHB-MASLD. A prospective study from 2021 to 2022 included 109 CHB and 64 CHB-MASLD patients. All underwent liver stiffness measurement via elastography and FIB-4 calculation. MASLD criteria were defined, creating CHB-alone and CHB-MASLD groups. FIB-4 values were compared to the liver stiffness measurements. Statistical analyses included t-tests, ROC curves, and correlation assessments. No significant age, gender, or ethnicity differences were observed between the CHB and CHB-MASLD groups. CHB-MASLD patients exhibited higher BMI, dysglycemia, and dyslipidemia. HBeAg negativity and nucleoside/tide treatment rates were comparable. FIB-4 and APRI scores were elevated in CHB-MASLD. ROC analysis revealed an AUC of 0.86 for FIB-4 in the CHB group, with an optimal cutoff of 1.95. Subgroup analysis by BMI showed consistent FIB-4 performance. In the CHB-MASLD group, the ROC curve showed an AUC of 0.61 (p = 0.12), indicating non-significance. Our study affirms FIB-4's robust performance in predicting fibrosis in CHB patients across varied BMI profiles. Yet, challenges surface when applying FIB-4 to those with concurrent CHB and MASLD. These limitations stress the urgency of refined fibrosis prediction tools, essential for navigating the complex interplay of viral and metabolic factors in the CHB–MASLD population.

Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) treatment in Australia since their inclusion on the Pharmaceutical Benefits Scheme (PBS) in 2016. Treatment has shifted from genotype-specific to pan-genotypic regimens, with glecaprevir/pibrentasvir and sofosbuvir/velpatasvir now recommended in clinical guidelines. This study examined trends in DAA dispensing in light of evolving treatment regimens. A retrospective analysis of publicly available PBS data was conducted, assessing monthly DAA dispensings from March 2016 to December 2024. Dispensings were summarised by count and proportion, PBS item code, schedule (general, private, or public hospital) and number of repeats as a proxy for treatment duration. Dispensing volumes of DAAs increased following PBS-listing in March 2016, with the highest number of dispensings observed between 2016 and 2017 (average of 11,378 prescriptions dispensed per month). Dispensing rates subsequently declined, with an average of 1583 prescriptions dispensed per month from 2020 to 2024. Since introduction to market in August 2017, sofosbuvir with velpatasvir (pan-genotypic regimen) has maintained an average market share of 55%. Glecaprevir/pibrentasvir (pan-genotypic regimen) has maintained an average market share of 34% since its introduction in August 2018. Sofosbuvir/velpatasvir/voxilaprevir, listed on the PBS in April 2019, and used for salvage therapy, has had a smaller average market share of 4% since listing. Pan-genotypic regimens now account for nearly all DAA use in Australia. Declining dispensing rates may reflect reduced new infections and treatment fatigue. Increasing retreatment rates underscore the need for ongoing monitoring and real-world evaluations. Future head-to-head comparisons may support optimal regimen selection.