Data linkage and computerised algorithmic coding to enhance individual clinical care for Aboriginal people living with chronic hepatitis B in the Northern Territory of Australia – Is it feasible?

Hosking, Kelly; Stewart, Geoffrey A.; Mobsby, Mikaela; Skov, Steven; Zhao, Yuejen; Su, Jiunn-Yih; Tong, Steven Y C; Nihill, Peter; Davis, Joshua S.; Connors, Christine; Davies, Jane

doi:10.1371/journal.pone.0232207

Cited by 9 publications

(8 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The “one stop liver shop” has been shown to improve the cascade of care in these communities, but there remains a significant number of individuals who are not yet diagnosed [ 29 ]. Data linkage and coding has attempted to improve identification of cases; however, many individuals do not have hepatitis B testing results [ 30 ]. A targeted strategy is likely needed for those who are pregnant to ensure hepatitis B is diagnosed and care is received.…”

Section: Discussionmentioning

confidence: 99%

Preventing early childhood transmission of hepatitis B in remote Aboriginal communities in northern Australia

Sullivan

Davies

Binks

et al. 2022

Int J Equity Health

Self Cite

View full text Add to dashboard Cite

Background Chronic hepatitis B is a public health concern in Aboriginal communities in the Northern Territory of Australia with prevalence almost four times the non-Aboriginal population. Infection is suspected to mainly occur in early life, however, the mode of transmission and vaccine effectiveness is not known in this population. WHO has set a target for hepatitis B elimination by 2030; elimination in this disproportionately affected population in Australia will require understanding of the modes of transmission and vaccine effectiveness. Methods We conducted the study at four very remote Aboriginal communities. We approached mothers who had chronic hepatitis B and had given birth between 1988 and 2013 for consent. We obtained hepatitis B serology, immunisation and birth details from the medical record. If both mother and child had hepatitis B viral DNA detected, we performed viral whole genome sequencing. Results We approached 45 women for consent, of whom 23 agreed to participate. We included 20 mothers and 38 of their children. Of the 20 included mothers, 5 (25%) had children who were hepatitis B immune by exposure and 3 (15%) had children with evidence of chronic hepatitis B infection at the time of assessment. Hepatitis B immunoglobulin (HBIg) had been given at birth in 29/38 (76.3, 95% CI 59.8–88.6) children, and 26 children (68.4, 95% CI 51.3–82.5) were fully vaccinated. Of the 3 children who had chronic hepatitis B, all had received HBIg at birth and two were fully vaccinated. Of the 5 who were immune by exposure, 4 had received HBIg at birth and one was fully vaccinated. Whole genome sequencing revealed one episode of definite mother to child transmission. There was also one definite case of horizontal transmission. Conclusions Chronic hepatitis B in this context is a sensitive issue, with a high proportion of women refusing consent. Although uncommon, there is ongoing transmission of hepatitis B to Aboriginal children in remote northern Australia despite vaccination, and this is likely occurring by both vertical and horizontal routes. Prevention will require ongoing investment to overcome the many barriers experienced by this population in accessing care.

show abstract

Section: Discussionmentioning

confidence: 99%

Preventing early childhood transmission of hepatitis B in remote Aboriginal communities in northern Australia

Sullivan

Davies

Binks

et al. 2022

Int J Equity Health

Self Cite

View full text Add to dashboard Cite

show abstract

“… 21 These studies, in combination with the present data, suggest that the current HBV vaccine is sufficient to protect against chronic infection (and possibly symptomatic acute infection, as demonstrated in a study of Alaska Native people 28 ), but not against acute infection in populations with a serotype mismatch, although a study of vaccinated Indigenous individuals living in Western Australia found a small number of people who developed CHB. 37 A recent data linkage study found that 94.1% of people born after 1990 in five NT Indigenous communities received a full vaccination course, 38 further suggesting that implementation issues are unlikely to explain the decrease in vaccine efficacy observed.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis B in the Northern Territory: insights into the changing epidemiology of an ancient condition

Qama

Allard

Cowie

et al. 2021

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

Background Aboriginal and Torres Strait Islander people are disproportionately affected by hepatitis B virus (HBV) infection. A proposed mismatch between standard vaccines and the HBV/C4 sub‐genotype prevalent in Aboriginal people in the Northern Territory (NT) may reduce vaccine effectiveness. Aims To determine HBV prevalence in the NT by Indigenous status and to explore patterns of immunity following implementation of universal vaccination, using a large longitudinal diagnostic dataset. Methods A retrospective analysis of all available HBV serology results in the NT from 1991 to 2011 was conducted, with HBV prevalence and vaccination status analysed according to adigenous status, age and sex using individuals' patterns of HBsAg, anti‐HBs and anti‐HBc serology over repeated tests. Results 100 790 individuals were tested (33.4% Indigenous) between 1991 and 2011 (26.1% of the 2011 NT population), with a total of 211 802 tests performed. In 2011, the proportion of HBV positive individuals in the NT was 3.17% (5.22% in Indigenous populations) compared to previous 2011 estimates of 1.70% (3.70% in Indigenous populations). The vaccine failure rate was lower than expected with only one presumed vaccinated person subsequently developing HBsAg positivity (0.02%). Evidence of suboptimal vaccine efficacy by breakthrough anti‐HBc positivity in vaccinated individuals was demonstrated in 3.1% of the vaccinated cohort, of which 86.4% identified as Indigenous (HR 1.17). No difference in HBeAg positivity or seroconversion was observed between Indigenous and non‐Indigenous individuals living with CHB. Conclusions The burden of CHB in Indigenous people in the NT has previously been underestimated. A higher HBV prevalence in the NT than described in previous cross‐sectional studies was found, including a higher prevalence in Indigenous people. Evidence of suboptimal vaccine efficacy was demonstrated predominantly in Indigenous individuals.

show abstract

“…This has allowed more complete interpretation of one’s serological status. This is important as complete serological assessment has been shown to be suboptimal in our region but is currently being addressed with data linkage and computerised coding [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Viral hepatitis in correctional facilities in the Northern Territory of Australia 2003–2017

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The demographic of Northern Territory prison population differs than elsewhere in Australia and the prevalence of hepatitis B and hepatitis C may therefore be somewhat different from other jurisdictions. There has been no study which has specifically described the serological results of a large proportion of prisoners in Northern Territory correctional facilities over an extended period of time. Methods This retrospective longitudinal study reviewed serological results and testing rates for hepatitis B, and hepatitis C performed in correctional facilities in the Northern Territory of Australia between July 1st, 2003 and June 30th, 2017. Results The proportion of positive records over 14 years for hepatitis B surface antigen (HBsAg) was 641/12,066 (5.3, 95% CI 4.9–5.7), for hepatitis B core antibody (anti-HBc) 4937/12,138 (40.1, 95%CI 39.8–41.6), for hepatitis B surface antibody (anti-HBs) 6966/13,303 (52.4, 95% CI 51.5–53.2), and for hepatitis C antibody 569/12,153 (4.7, 95% CI 4.3–5.1). The proportion of prisoners tested for hepatitis B and hepatitis C has decreased since 2015, while a high proportion of prisoners remain non-immune to hepatitis B. Conclusion There is a relatively high proportion of positive serological markers of hepatitis B, and a lower proportion of positive hepatitis C serology in the Northern Territory’s correctional facilities compared to overall Australian rates. As the proportion of prisoners tested for hepatitis B and C has decreased recently, and a high proportion of prisoners remain non-immune to hepatitis B, there are opportunities to increase testing and vaccination rates in this population.

show abstract

Data linkage and computerised algorithmic coding to enhance individual clinical care for Aboriginal people living with chronic hepatitis B in the Northern Territory of Australia – Is it feasible?

Cited by 9 publications

References 27 publications

Preventing early childhood transmission of hepatitis B in remote Aboriginal communities in northern Australia

Preventing early childhood transmission of hepatitis B in remote Aboriginal communities in northern Australia

Hepatitis B in the Northern Territory: insights into the changing epidemiology of an ancient condition

Viral hepatitis in correctional facilities in the Northern Territory of Australia 2003–2017

Contact Info

Product

Resources

About