Low eligibility for hepatitis B treatment in the Brazilian public health system

Abstract

Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.

Noncompliance with Therapeutic Guidelines for Chronic Hepatitis B Patients in Minas Gerais, Brazil

“…Several therapeutic guidelines seek to help identify patients who are more likely to benefit from antiviral therapy. In addition, they guide physicians in the selection of safe and effective antiviral drugs [ 7 , 8 , 9 , 18 , 19 , 21 ]. However, this study shows that not all Brazilian physicians in the public health system, especially those responsible for patients with HBC undergoing treatment (8.26%), know or adopt the CPTG guidelines.…”

“…Furthermore, as described in the methods section, a preview paper [ 18 ] addressed patients not yet undergoing any treatment for HBV, while this paper aimed at assessing whether the therapeutic approach applied to treated patients is consistent with the management recommendations officially established in Brazil. Both papers accessed secondary data available from records sent to the Central Laboratory of Public Health of Minas Gerais.…”

“…This is a complement analysis of a cross-sectional study based on secondary data (clinical, laboratory and therapeutic information) of CHB patients’ records sent to the Central Laboratory of Public Health of Minas Gerais, from May 2012 to September 2013 [ 18 ]. Minas Gerais is the second most populous state (with approximately 20 million inhabitants), located in the Southeast region (corresponding to 36.6% of confirmed hepatitis B cases in Brazil) [ 12 ].…”