Impact of a nurse‐led enhanced monitoring, management and contact tracing intervention for chronic hepatitis B in England, 2015‐2017

Abstract

Around 200,000 people live with chronic hepatitis B in England. Despite national guidance on identification and management of cases and their close contacts, testing rates of close contacts is as low as 43% in high prevalence areas of London. Our study aimed to determine whether a nurse‐led enhanced management and contact tracing of chronically infected individuals improved testing uptake, vaccination and onward referral of close contacts. The study was conducted across Greater Manchester and East of England regions between October 2015 and July 2017. All HBV chronically infected individuals registered with a GP and their close contacts were eligible for recruitment. The proportion of contacts who were tested, vaccinated and referred where appropriate were compared before and after the nurse‐led intervention. Baseline and outcome information was collected using questionnaires. The intervention improved case referral rates by an additional 14% (from 86% (88/102 cases) to 99.7%; 648/650 cases). The proportion of contacts tested increased from 34% to 72%‐94% with 18 new cases of HBV diagnosed. Amongst close contacts tested, vaccination rates of at least three doses increased from 77% (43/56) to 93% (452/491) during the study. Our study has shown that nurse‐led enhanced management greatly improves identification, testing and vaccination of close contacts. The identification of new acute and chronic cases is likely to make the intervention cost effective and local health commissioners should consider providing a nurse‐led service as part of hepatitis B care pathways.

What do primary care staff know and do about blood borne virus testing and care for migrant patients? A national survey

“…Three quarters would offer close contacts of HBV infected cases testing, and three quarters would offer close contacts hepatitis B vaccination. These proportions seem high, as many patients diagnosed with HBV and HCV are known not to be accessing secondary care – in a 2012 UK study only a third of HBV diagnosed patients were on treatment [ 45 ] and an analysis of England sentinel surveillance data showed that between 2004 and 2017 only 21% of viraemic HCV diagnosed patients had evidence of treatment [ 46 ], and baseline HBV testing of close contacts was only 34% in a 2018 UK study [ 47 ]. Our results may be due to sampling and responder bias, due to initially contacting networks who were interested in migrant health, and those who were interested being more likely to respond, as well as wishing to give socially acceptable or desirable responses.…”

Cohort Profile: The National Institute for Health Research Health Informatics Collaborative: Hepatitis B Virus (NIHR HIC HBV) research dataset

“…As the prevalence of HBV infection is low across the UK overall, there are limited data describing population characteristics and disease burden. 5 , 6 Chronic HBV (CHB) nevertheless presents a concern in certain populations, either as a result of increased prevalence and/or risk factors for the development of long-term liver disease (e.g. chronic coinfection with HIV 7 or other hepatitis viruses, 8 , 9 diabetes mellitus or metabolic syndrome, 10 , 11 alcohol abuse, 11 migrants from countries/regions with a high prevalence of HBV 12 , 13 ).…”

Cohort Profile: National Institute for Health Research Health Informatics Collaborative: Hepatitis B Virus (NIHR HIC HBV) Research Dataset

“…As the prevalence of HBV infection is low across the United Kingdom (UK) overall, there are limited data describing population characteristics and disease burden (5, 6). Chronic HBV (CHB) nevertheless presents a concern in certain populations, either as a result of increased prevalence, and/or risk factors for the development of long-term liver disease (e.g., chronic coinfection with HIV (7) or other hepatitis viruses (8, 9), diabetes mellitus or metabolic syndrome (10, 11), alcohol abuse (11), migrants from countries/regions with a high prevalence of HBV (12, 13)).…”

“…Leveraging existing clinical data is a cost-effective way to build a detailed description of HBV infection. Existing primary care datasets like Clinical Practice Research Datalink (CPRD) (6) do not capture HBV data well, as surveillance and treatment are largely managed in secondary care. During the last decade, large amounts of routinely-collected clinical data have been accumulated in electronic patient record (EPR) systems in the UK’s unified secondary care services.…”

“…Although comparable HBV datasets are more available in other countries, such as China and the US (28-30), there are scarce comprehensive data of HBV in the UK, except data reported from certain populations (31-33) or the primary care population (5, 6). We believe this secondary care cohort can start to fill evidence gaps, especially by collating laboratory and imaging data, which are not well captured in primary care.…”