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Enhanced Response to Chronic Hepatitis B

In an exciting venture, the Public Health Unit (PHU) is working with Central and Eastern Sydney PHN (CESPHN) and the Sydney Local Health District (SLHD) Gastroenterology and Liver Service to enhance the care of people in SLHD living with chronic Hepatitis B virus (HBV). For new notifications received from August 2022 onwards, the PHU will be contacting clinicians three months post-notification with a brief questionnaire to assess case status and treatment, and to offer assistance with assessment of family and household contacts. The overarching goals of the project are to assess and facilitate access to enhanced care, and to improve the identification and risk assessment of contacts, including where vaccination is indicated.

Benefits of enhanced care include assistance in developing an HBV management plan (if requested) and referral for antiviral treatment (for non S100 prescribers); in language education to patients and family, i.e. about the disease, treatments and avoiding transmission, as well as screening and vaccination of contacts; and/or facilitating assessment for and access to free fibroscans when necessary.

Ultimately, we hope to reduce progression to cirrhosis and hepatocellular carcinoma, prevent onwards transmission of the virus, and thereby work towards elimination of HBV as a public health threat.  

GPs have a crucial role in identifying people living with hepatitis B and providing lifelong care, and only 73% of people living with CHB in Australia are estimated to have been diagnosed. See a reminder of who to test here.

Why?

HBV is a leading cause of liver cancer in Australia. Those living with HBV require regular monitoring and treatment to prevent associated morbidity and mortality. In CESPHN, 26.09% of people living with chronic HBV are receiving care and 12.66% are receiving antiviral treatment (Medicare and ABS data analysed by the Doherty Institute).  This is below national targets of 50% receiving care and 20% receiving treatment. 

Chronic HBV is often a result of transmission vertically at birth or during early childhood, and in Australia is particularly prevalent in migrant communities. Assessment of household and family contacts may thus identify previously undiagnosed cases and facilitate earlier linkage to care.

What?

Each year SLHD PHU receives roughly 300 new HBV notifications (both new and chronic infections). This project will follow-up new notifications of chronic HBV received from non-gastroenterologist clinicians from August 2022 onwards. Treating practitioners will be asked to complete a brief questionnaire three months after the notification. This has been designed to be as short as possible so as not to take time away from busy clinicians! Rather it will offer assistance with management (through the Gastroenterology and Liver service) and follow-up of contacts (by the PHU).

The project will allow collection of important data on access to standard care (according to the Gastroenterological Society of Australia recommendations) and help facilitate monitoring and treatment of cases. It will also enhance assessment of potentially undiagnosed contacts, who in turn will benefit from linkage to care and treatment, including vaccination.

The project process is summarised below and, in the flowchart:

  1. New notification of chronic HBV in an SLHD resident received by the PHU, from a non-gastroenterologist clinician.
  2. Notifying clinician is sent an introductory letter via Healthlink Connect, mail or fax to acknowledge the notification and establish if they will be providing continuing care. If not, they are requested to reply with details of another appropriate practitioner (if known) or to provide consent for the patient to be contacted directly.
  3. A further introductory letter is sent to the practitioner providing continuing care (if different to the notifying clinician).
  4. Three months after notification, the treating practitioner is sent a brief questionnaire to:
    • Identify phase of infection
    • Establish treatment plan
    • Link with Gastroenterology and Liver Service if practitioner agrees
    • Assist with assessment of family and household contacts, if requested
    • NB: if there is no response to the questionnaire within 6 weeks, the PHU will follow-up with a phone call.
  5. If requested by the treating practitioner, the PHU will contact the case to identify family and household contacts. If these contacts reside within SLHD, they will be further assessed and followed-up by the PHU to ensure appropriate investigation and linkage to care.
  6. If agreed to by the treating practitioner, the Gastroenterology and Liver Service will follow-up with a phone call to discuss ongoing management of the case.

We are confident that this project is an exciting opportunity to significantly improve health outcomes within our district. The SLHD PHU or Gastroenterology and Liver Service are happy to answer any questions you may have.

Your time and assistance are greatly appreciated!

For more information contact Phoebe Chomley at sexualhealth@cesphn.com.au

For Hepatitis B clinical advice/support for patients residing

in SLHD contact CNCs Catherine Stevens 0423293470 (M-W)

or Janice Pritchard-Jones (Th) 0434360357.