Adherence to Hepatitis B Antiviral Therapy

Abstract

Hepatitis B virus (HBV) antiviral therapies potentially suppress HBV viral load to an undetectable level reducing the risk of progressive liver disease and the development of HBV-related hepatocellular carcinoma. Adherence to antiviral therapies is imperative to achieve and maintain viral suppression. To date, there has been limited research on adherence to HBV therapies. Our study aimed to explore factors influencing adherence to antiviral therapy. A total of 29 participants consented to in-depth qualitative interviews at three outpatient clinics in Sydney, New South Wales, Australia. Interviews were digitally recorded and transcribed. Transcripts were initially classified as adherent or nonadherent and thematic analysis was used to identify dominant themes. Adherent behavior was reported by 59% (n = 17) of participants. Several themes influenced adherence including routine, fear of HBV-related disease progression, clinician-patient communication, treatment knowledge, and forgetfulness. To our knowledge, this is the first qualitative study to explore adherence to HBV antiviral therapy. An interplay of several dominant themes emerged from our data including fear of chronic HBV disease progression, clinician-patient communication, treatment knowledge, routine, and forgetfulness. Study findings have the potential to change nursing clinical practice, especially the way nurses and other clinicians target key HBV treatment messages and education, while monitoring adherence.

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

“…From an initial screen of 878 titles, 30 studies providing data for 23,823 patients met our eligibility criteria and were taken through for review (Fig. ) . The majority (23 studies, 17,057 patients) were from high‐income settings, mainly the United States (seven studies), Australia (four studies), and France (three studies).…”

“…Barriers to adherence were reported by seven studies . Among patients with suboptimal adherence, the most commonly reported barriers to adherence were forgetting (three studies, 81.1%; 95% CI, 68.7%‐93.5%), limited understanding of the importance of adherence (two studies, 32.3%; 95% CI, 17.2%‐47.4%), and change to daily routine (two studies, 27.4%; 95% CI, 4.7%‐50.1%).…”

Factors Associated with Non-Adherence to HBV Antiviral Therapy

“…Indeed in our earlier qualitative study, non-adherent participants who commenced HBV treatment at a younger age (< 45 years) described a period of transition and adjustment to taking medicine daily. This group of patients described the importance of establishing a routine when treatment commenced [19].…”

“…Previous studies have not formally measured health literacy in HBV-affected populations undergoing treatment. Language discordance [14] and ineffective communication between patients and clinicians [19] have been reported to influence adherent behaviour without measuring health literacy as a potential factor contributing to misinterpretation of key health messages. Considering that more than half of the current study population reported less than adequate health literacy and that the HBV-affected population in Australia is composed primarily of migrants from non-English-speaking HBV-endemic countries [41], it is essential that health care providers are universally responsive to the individual health literacy needs of their patients.…”

“…At the time of the study, there were no validated HBV adherence-based questionnaires. Therefore, we designed our data collection tool based on data from our formative qualitative work exploring factors influencing adherent behaviour [19]. The questionnaire included demographic (8 questions), treatment-related (7questions), and disease-related (6 questions) factors and asked whether medications had been missed in the last 30 days and if ever missed, and the number of clinician (defined as doctor or registered nurse) and a patient using a validated questionnaire adapted from the University of Washington Quality of Communication (QOC) questionnaire [20].…”