Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Abstract

Background: In Pakistan, approximately 4.5 million people are afflicted with chronic hepatitis B (CHB). The compliance with hepatitis B virus (HBV) management guidelines is still unknown. This was the first study from Pakistan in which the knowledge and practices of treating physicians were compared with three standardized guidelines (Asia Pacific Association for the Study of the Liver (APASL) 2012/European Association for the Study of the Liver (EASL) 2012/American Association for the Study of Liver Diseases (AASLD) 2009). Methods: A crosssectional study was conducted during 2014-2015 at four tertiary care teaching hospitals of Karachi, Pakistan. The study participants were internists, gastroenterologist, senior residents who were involved in the management of CHB patients. All participants were offered to fill the study questionnaire. Results: A total of 179 physicians (103 residents, 76 consultants) participated. Mean age of participant was 35 AE 9.3 years. Approximately one-third of them followed AASLD (27.3%) and EASL (24.0%) guidelines. Entecavir, tenofovir or Peg IFN 1 2a were considered as first line therapy by 43%, 38.5% and 30.2% respectively. However, 17.9% preferred entecavir with tenofovir for rescue therapy, 25.7% and 23.5% preferred tenofovir or entecavir as both first line and rescue therapy respectively. Serum HBV DNA, alanine transaminase levels were used to monitor during oral antivirals therapy by 45.3%. hepatocellular carcinoma screening was considered for all HBV cases by 51.4% using ultrasound (55.3%) and alfa fetoprotein (52.5%) every 6 months. Overall 40.2% participants had poor knowledge about indication of liver biopsy, treatment initiation and antiviral prophylaxis. Significant association was found between grades of knowledge and gender, age group, designation and specialty (P < 0.05). Younger physicians, consultants (age 25-40 years) and those who were practicing gastroenterology/hepatology were more likely to have higher knowledge scores in compliance with the guidelines as compared to others. Conclusion: Our study highlighted the gaps in knowledge and practices in managing CHB patients according to guidelines. Efforts to improve knowledge, refresher courses and appropriate coordination between gastroenterologists and internal medicine physicians could enable management and follow-up of patients with CHB effectively.

Awareness and Knowledge of Viral Hepatitis Prevention and Transmission in Healthcare Workers

“…The lack of awareness regarding the transmission of the disease may be a reason for the increased risk of CHB in neonates. Similar results were reported by other studies conducted among healthcare workers in Pakistan (Butt and Ahmed, 2018;Khan et al, 2019;Soomar et al, 2021). Since mother-to-child transmission of chronic hepatitis B is high, it is essential to administer vaccination to the newborn at birth to prevent infection.…”

Factors associated with nonadherence to surveillance for hepatocellular carcinoma among patients with hepatic C virus cirrhosis, 2000–2015

“…Possible reasons for the significant differences in HCC surveillance among physicians of different specialties are training background, knowledge of guidelines, experience caring for patients with cirrhosis, and practice habits. [14,20,38–41] Furthermore, patients who received care in larger hospitals (i.e., medical centers and regional hospitals) demonstrated higher HCC surveillance, a finding that is consistent with that of a previous study, which reported that physicians with an academic affiliation had higher rates of HCC surveillance. [20]…”

Public awareness and influencing factors regarding hepatitis B and hepatitis C in Chongqing municipality and Chengdu City, China: a cross-sectional study with community residents

“…We measured the second section (24 items, one point each), and their scores ranged from 0 (minimum) to 24 (maximum). A test score of 14.4 (60% of the total score) and above indicated sufficient knowledge, [20][21][22] whereas scores below 14.4 implied insufficient knowledge.…”