Hepatitis B status in migrants and refugees: increasing health burden in Western Australia

Subramaniam, Kavitha; Flexman, James; Tarquinio, Lorenzo; Thambiran, Aesen; Hopkins, Sandra; Cheng, W. T. K.

doi:10.1111/j.1445-5994.2011.02711.x

Cited by 6 publications

(9 citation statements)

References 25 publications

(27 reference statements)

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“…Aberra et al (2017) 12 Aberra et al (2017) 12 Aberra et al (2017) 12 Aberra et al (2017) 12 Al-Naamani et al (2013) 15 Coppola et al (2017) 51 Cotler et al (2009) 52 Cuomo et al (2016) 55 De Vroey et al (2013) 59 Deltenre et al (2012) 60 Ding et al (2013) 63 Fallatah et al (2010) 71 Fung et al (2011) 76 Fung et al (2011) 76 Milosevic et al (2013) 118 Pérez-Molina et al (2011) 129 Spradling et al (2013) 142 Stefos et al (2009) 143 Stroffolini et al (2012) 146 Subramaniam et al (2012) 147 Tedder et al (2013) 152 Vella et al (2012) 158 Widjaja et al (2007) 160 Yuen et al (2009) 169…”

Section: Weight (%) Proportion (95% Ci)mentioning

confidence: 99%

Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

Tan

Bhadoria

Cui³

et al. 2021

The Lancet Gastroenterology & Hepatology

116

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Summary Background In 2016, of the estimated 257 million people living with chronic hepatitis B virus (HBV) infection worldwide, only a small proportion was diagnosed and treated. The insufficiency of information on the proportion of people infected with HBV who are eligible for treatment limits the interpretation of global treatment coverage. We aimed to estimate the proportion of people with chronic HBV infection who were eligible for antiviral treatment worldwide, based on the WHO 2015 guidelines. Methods In this systematic review and meta-analysis, we searched Medline, EMBASE, and the Cochrane databases from Jan 1, 2007, to Jan 31, 2018, for studies describing HBsAg-positive people in the population or health-care facilities. We extracted information from published studies using a standardised form to estimate the frequency of cirrhosis, abnormal alanine aminotransferase (ALT), HBV DNA exceeding 2000 IU/mL or 20 000 IU/mL, presence of HBeAg, and eligibility for treatment as per WHO and other guidelines as reported in the studies. We pooled proportions through meta-analysis with random effects. The study was registered with PROSPERO, CRD42020132345. Findings Of the 13 497 studies, 162 were eligible and included in our analysis. These studies included 145 789 participants. The pooled estimate of the proportion of cirrhosis was 9% (95% CI 8–10), ranging from 6% (4–8) in community settings to 10% (9–11) in clinic settings. Examining the proportion of participants who had characteristics used to determine eligibility in the WHO guidelines, 1750 (10·1%) of 17 394 had HBV DNA exceeding 20 000 IU/mL, and 20 425 (30·8%) of 66 235 had ALT above the upper limit of normal. 32 studies reported eligibility for treatment according to WHO or any other guidelines, with a pooled estimate of eligibility at 19% (95% CI 18–20), ranging from 12% (6–18) for studies in community settings to 25% (19–30) in clinic settings. Interpretation Many studies described people with HBV infection, but few reported information in a way that allowed assessment of eligibility for treatment. Although about one in ten of the 257 million people with HBV infection (26 million) might be in urgent need of treatment because of cirrhosis, a larger proportion (12–25%) is eligible for treatment in accordance with different guidelines. Future studies describing people with HBV infection should report on treatment eligibility, according to broadly agreed definitions. Funding WHO and US Centers for Disease Control and Prevention.

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Section: Weight (%) Proportion (95% Ci)mentioning

confidence: 99%

Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

Tan

Bhadoria

Cui³

et al. 2021

The Lancet Gastroenterology & Hepatology

116

View full text Add to dashboard Cite

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“…Asian migrants had a high prevalence of chronic hepatitis B (CHB) than their African counterparts (54.3% vs 36.7%; n = 478); they were at risk of cirrhosis unless treated and increased cost over ten years [ 45 ]. Women born in Afghanistan, Bhutan, Iraq, and Myanmar, had poor maternal health, poor pregnancy care attendance, and late booking of visits [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges

Khatri

Assefa

2022

BMC Public Health

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Background About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia. Methods We conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model. Results A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations. Conclusions People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment.

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“…high rate of HBV infection, which contributes to the relatively steady prevalence of HBV. 5,54 Reprioritizing health spending to widen the scope for a rapid antiviral treatment to reach populations such as people with CALD backgrounds at high risk of getting infected with HBV is an effective investment strategy for the health system for elimination of HBV. 55 The two major HBV antiviral treatments, such as the use of entecavir and tenofovir, are now off-patent, and generic medications make wider availability more economically feasible.…”

Section: Discussionmentioning

confidence: 99%

“…4 For example, in Western Australia, an increasing trend of HBV-associated referrals was reported and most of them were patients born in Asia (57%) and Africa (35%). 5 Reekie et al 6 reported high prevalence rates of HBV in Australian migrant women born in Cambodia (8.6%), Taiwan (8.1%), Vietnam (7.5%), China (6.8%) and Tonga (6.5%). The high rates of HBV in migrants increase the risk of transmission to other migrants and the local community in the receiving country and shape the epidemiology of HBV in a country.…”

Section: Introductionmentioning

confidence: 99%

Targeted antiviral treatment of hepatitis B virus in culturally and linguistically diverse populations to achieve elimination targets in Australia

Taye

Valery

Clark

2022

Journal of Viral Hepatitis

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The majority of Australia's hepatitis B virus (HBV) burden is borne by culturally and linguistically diverse (CALD) populations, and antiviral treatment is the mainstay of intervention. Using modelling, we estimated the impact of targeted antiviral treatment scale‐up and changes in migration on HBV‐related mortality and HBV elimination in CALD populations in Australia. We fitted a deterministic mathematical model based on the natural history of HBV and the Australian migration effect in four CALD population groups according to country of birth. We used three antiviral treatment scale‐up scenarios: baseline (9.3% coverage); intermediate (coverage of 80% of patients eligible for antiviral therapy by 2030); and optimistic (coverage of 20% of all patients living with HBV by 2022). Our model predicted that if the baseline treatment is followed between 2015 and 2030, the number of chronic HBV cases and HBV‐related mortality will increase. Following the optimistic scale‐up, the number of new HBV cases could be reduced by 78%, 73%, 74% and 83% in people born in Asia‐Pacific, Europe, Africa and the Middle East, and Americas, respectively, between 2015 and 2030. An optimistic treatment scale‐up could result in a 19.2%–24.5% reduction in HBV‐related mortality and a 15%–25% reduction in HCC‐related mortality in CALD populations between 2015 and 2030. In conclusion, our findings highlight that targeted antiviral treatment for CALD populations provides significant health system benefits by reducing HBV‐related complications from cirrhosis and HCC. Expanded antiviral treatment programmes focusing on high‐prevalence CALD populations may be an effective strategy to reduce HBV‐related morbidity and mortality.

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Hepatitis B status in migrants and refugees: increasing health burden in Western Australia

Abstract: This study highlights the increasing burden of CHB in Western Australia, from people born in endemic countries, in particular, the direct costs of treatment. It will help to develop strategies that can be tailored to Western Australia with appropriate allocation of resources.

Cited by 6 publications

References 25 publications

Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges

Targeted antiviral treatment of hepatitis B virus in culturally and linguistically diverse populations to achieve elimination targets in Australia

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