Physician perspectives on the management of viral hepatitis and hepatocellular carcinoma in Myanmar

Abstract

BackgroundIn Myanmar, over five million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis has been a recent focus with the development of a National Strategic Plan on Hepatitis and plans to subsidize HCV treatment.MethodsDuring a two-day national liver disease symposium covering HCV, HBV, hepatocellular (HCC), and end-stage liver disease (ESLD), physician surveys were administered using the automated response system (ARS) to assess physician knowledge, perceptions of barriers to screening and treatment, and proposed solutions. Multivariate logistic regression was used to estimate odds ratio (OR) relating demography and practice factors with higher provider knowledge and improvement.ResultsOne hundred two physicians attending from various specialty areas (31.0% specializing in gastroenterology/hepatology and/or infectious disease) were of mixed gender (46.8% male), were younger than or equal to 40 years old (51.1% 20 to 40 years), had less experience (61.6% with ≤10 years of medical practice), were from the metropolitan area of Yangon (72.1%), and saw <10 liver disease patients per week (74.3%). The majority of physicians were not comfortable with treating or managing patients with liver disease. The post-test scores demonstrated an improvement in liver disease knowledge (9.0% ± 27.0) compared to the baseline pre-test scores; no variables were associated with significant improvement in hepatitis knowledge. Physicians identified the cost of diagnostic blood tests and treatment as the most significant barrier to treatment. Top solutions proposed were universal screening policies (46%), removal of financial barriers for treatment (29%), patient education (14%) and provider education (11%).ConclusionsPhysician knowledge improved after this symposium, and many other needs were revealed by the physician input on barriers to care and their solutions. These survey results are important in guiding the next steps to improve liver disease management and future medical education efforts in Myanmar.

Treatment rates and factors associated with direct‐acting antiviral therapy for insured patients with hepatitis C‐related hepatocellular carcinoma – A real‐world nationwide study

“…Additionally, only 58.5% of patients with positive HCV RNA at HCC diagnosis received DAA treatment in this study, further highlighting the severely suboptimal treatment rate even among patients with confirmed viraemic HCV‐related HCC 18,19 . As such, the low treatment rate demonstrates the need for continual education among practitioners and the public about the need to screen for HCV as well as the availability of potentially curative treatment with relatively mild side effects 20–26 . In this light, according to the U.S. Preventive Task Force, all U.S. adults should be screened for HCV at least once in their lifetime 27 .…”

“…18,19 As such, the low treatment rate demonstrates the need for continual education among practitioners and the public about the need to screen for HCV as well as the availability of potentially curative treatment with relatively mild side effects. [20][21][22][23][24][25][26] In this light, according to the U.S. Preventive Task Force, all U.S. adults should be screened for HCV at least once in their lifetime. 27 Furthermore, surveillance for HCC needs to be encouraged among those with cirrhosis to preclude the diagnosis of advanced HCC.…”

Training the healthcare workforce to support task-shifting and viral hepatitis elimination: a global review of English language online trainings and in-person workshops for management of hepatitis B and C infection

“…For example, the Clinton Health Access Initiative (CHAI), collaborated with both the Nigerian and Rwandan ministries of health to develop national training for primary healthcare providers [ 47 ], and also provides technical assistance to Cambodia, India, Indonesia, Myanmar, and Vietnam, with more than 5,900 healthcare workers trained across these 7 countries [ 48 ]. Similarly, Stanford University collaborated with both the Myanmar Ministry of Health and Sports and the Mongolia Ministry of Health and Sports to support development of a two-day viral hepatitis training symposiums in each country [ 26 , 49 ].…”

Estimating causes of community death of adults in Myanmar from a nationwide population sample: Application of verbal autopsy

“…Myanmar has high levels of alcohol consumption in males, starting at young ages [ 32 ], and a high prevalence of Hepatitis B and C [ 33 ]. Strengthening policies to reduce alcohol use and removing barriers to the treatment of Hepatitis B and C [ 34 ], would appear to be important public health priority actions for government to reduce excess mortality due to this disease, particularly in men of economically productive age.…”