An estimated 170 million people worldwide have hepatitis C, which is a significant cause of morbidity and mortality. Therefore, health professionals (HPs) are likely to care for people with hepatitis C at some stage in their careers. However, little is known about HPs' attitudes towards treating people with hepatitis C. An analytical, cross-sectional survey was conducted to explore the inter-relationship among HPs' hepatitis C knowledge and attitudes towards treating people with hepatitis C and their self-reported clinical behaviour: Self-administered questionnaires were distributed to 3675 complementary therapists, dentists, medical practitioners, nurses, pharmacists, undergraduate medical and nursing students and people with hepatitis C in Victoria, Australia. Forty-six per cent responded (n = 1510). Only HP (complementary therapists, dentists, medical practitioners, nurses and pharmacists) data is presented (n = 1347). Most HPs demonstrated adequate hepatitis C knowledge, but some displayed intolerant attitudes toward people with hepatitis C. Their self-reported compliance with infection control practices indicated that they frequently treated people with hepatitis C differently from other patients by using additional infection control precautions while treating patients with hepatitis C. In addition, fear of contagion and disapproval of injecting drug use emerged as barriers to their willingness to treat people with hepatitis C. The results suggest that focusing education strategies on changing HPs' attitudes toward people with hepatitis C, injecting drug users, and infection control guidelines rather than concentrating solely on medical information might ultimately improve patient care.

BackgroundThe implementation of a comprehensive public health response to hepatitis B in Australia is urgently required to reduce the increasing burden of hepatitis B infection on the health system and the community. A significant gap in the public health response to hepatitis B is an understanding of how people with chronic hepatitis B (CHB) respond to CHB.FindingsA qualitative study involving semi-structured interviews and focus group discussions was conducted. Interviews were held with 20 people with CHB from three states of Australia. In addition, four focus group discussions were held with a total of 40 community and health workers from culturally and linguistically diverse communities in four Australian states.People with CHB reported no formal or informal pre or post test discussion with little information about hepatitis B provided at the point of diagnosis. Knowledge deficits about hepatitis B were found among most participants. Few resources are available for people with CHB or their families to assist them in understanding the infection and promoting their health and well-being. A lack of confidence in the professional knowledge of service providers was noted throughout interviews.ConclusionsPeople with CHB need culturally and linguistically appropriate education and information, particularly at the point of diagnosis. Primary health care professionals need the knowledge, skills and motivation to provide appropriate information to people with CHB, to ensure they have the capacity to better manage their infection.

BackgroundChina has the largest absolute number of people living with hepatitis B with up to 300,000 people estimated to die each year from hepatitis B related diseases. Despite advances in immunisation, clinical management, and health policy, there is still a lack of accessible and affordable health care for people with hepatitis B. Through in-depth interviews, this study identifies the personal, social and economic impact of living with hepatitis B and considers the role of stigma and discrimination as barriers to effective clinical management of the disease.MethodsSemi-structured qualitative interviews were held with 41 people living with hepatitis B in five Chinese cities. Participants were recruited through clinical and non-government organisations providing services to people with hepatitis B, with most (n = 32) being under the age of 35 years.ResultsPeople living with hepatitis B experience the disease as a transformative intergenerational chronic infection with multiple personal and social impacts. These include education and employment choices, economic opportunities, and the development of intimate relationships. While regulations reducing access to employment and education for people with hepatitis B have been repealed, stigma and discrimination continue to marginalise people with hepatitis B.ConclusionsEffective public policy to reduce morbidity and mortality associated with hepatitis B needs to address the lived impact of hepatitis B on families, employment and educational choices, finances, and social marginalisation.

BackgroundUniversal access to the hepatitis C direct acting antiviral (DAAs) regimens presents a unique opportunity to eliminate hepatitis C in Australia. Large numbers of Australians have already been cured using these treatments, however, the numbers presenting for treatment have begun to plateau. This study explored how people experienced and understood being cured of hepatitis C, with the aim of informing interventions to increase uptake of DAA treatment among people with hepatitis C.MethodsThis qualitative study used semi-structured interviews to explore the experiences of people with hepatitis C taking DAAs accessing both hospital and community clinics. Interviews were conducted 12 weeks after treatment completion. Participants were asked to reflect on their experience of living with hepatitis C, their reasons for seeking treatment, and their experience of, DAA treatments. Participants were also asked to reflect on the meaning of being cured, and how they shared this experience with their peers. Interviews were transcribed verbatim and key themes were identified using inductive thematic analysis.ResultsTwenty participants were interviewed. While participants described a range of physical health benefits of achieving a hepatitis C cure it was an improved sense of psychological wellbeing that had the most significant impact on participants’ lives. The majority described their relief about no longer living with the burden of an uncertain future due to anxiety about developing liver disease or cancer, as well as fear of infecting others. Participants who had a past history of injecting drug use, described being cured as a way to break the connection with their past. Participants who were current injectors raised concerns about re-infection.ConclusionFeeling “normal” and not infectious allows people to live with reduced psychological distress, in addition to the physical benefits of no longer being at risk of developing serious liver disease. Future engagement strategies targeting people who are not accessing hepatitis health care need to promote the lived experience of being cured and the substantial psychological, and physical health benefits, offered by achieving a cure. Interventions aimed at people who are currently injecting also need to highlight the availability of re-treatment in conjunction with primary prevention strategies.

Participation in HIV cure-related clinical trials that involve antiretroviral treatment (ART) interruption may pose substantial individual risks for people living with HIV (PLHIV) without any therapeutic benefit. As such, it is important that the views of PLHIV are considered in the design of HIV cure research trials. Examining the lived experience of PLHIV provides unique and valuable perspectives on the risks and benefits of HIV cure research. In this study, we interviewed 20 PLHIV in Australia about their knowledge and attitudes toward clinical HIV cure research and explored their views regarding participation in HIV cure clinical trials, including those that involve ART interruption. Data were analysed thematically, using both inductive and deductive coding techniques, to identity themes related to perceptions of HIV cure research and PLHIV’s assessment of the possible risks and benefits of trial participation. Study findings revealed interviewees were willing to consider participation in HIV cure research for social reasons, most notably the opportunity to help others. Concerns raised about ART interruption related to the social and emotional impact of viral rebound, including fear of onward HIV transmission and anxiety about losing control. These findings reveal the ways in which PLHIV perspectives deepen our understanding of HIV cure research, moving beyond a purely clinical assessment of risks and benefits in order to consider the social context.

Abstract:Objective: To assess hepatitis B knowledge among people with chronic hepatitis B (CHB) in Australia.Methods: People with CHB in three Australian jurisdictions completed a self-administered questionaire, including 24 hepatitis B knowledge questions across four domains: transmission; natural history; epidemiology and prevention; and clinical management.Results: Ninety-three people completed the survey. Mean age was 45 years, 43% were women and 93% were born overseas (75% from Asia). Mean total knowledge score was 55 out of 100 with 17 participants (18%) scoring ≥75 (defined as a high knowledge). Clinical management scored the lowest (median: 25) and natural history scored the highest (median: 80). In adjusted linear regression, tertiary education (vs. secondary and under) was associated with higher knowledge score (β: 11.95; 95%CI: 2.45, 21.44; p=0.01). In adjusted logistic regression, very good English proficiency (vs. limited/no proficiency) was associated with high knowledge (OR: 7.65; 95%CI: 1. 94, 30.19; p<0.01). Participants reporting hepatitis B-related anxiety demonstrated a significantly higher knowledge score compared to those reporting no such anxiety (β: 15.11; 95%CI: 4.40, 25.81; p<0.01). Conclusions and implications:Hepatitis B-related knowledge gaps were identified among people with CHB. Interventions to improve knowledge should focus on people with low levels of academic education and limited English proficiency.

To improve the clinical management of people with CHB in Australia, the health system needs to encourage the screening of people at risk, improve access to clinical services, and the knowledge and communication skills of primary health care and community health service providers. This study supported developing a shared care model and related infrastructures including training programs, referral pathways and clinical guidelines.

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