The Liver Meeting: Boston, Massachusetts Nov 10-14, 2023.



Stockdale, Alexander ORCID: 0000-0002-5828-3328, Holt, Bethany, Bhadoria, Ajeet, Ikeda, Daniel, Duong, David, Pollack, Todd, Ndow, Gibril, Nguyen, Vy, Ong, Janus, Pham, Thuy
et al (show 3 more authors) (2023) The Liver Meeting: Boston, Massachusetts Nov 10-14, 2023. In: The Liver Meeting, 2023-11-10 - 2023-11-14, United States.

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Abstract

Background: Globally, less than 10% of 296 million with chronic hepatitis B virus (HBV) infection had been diagnosed and only 2% treated. Increasing access to HBV care and treatment requires simplified service delivery models. A global systematic review and meta-analysis was conductedidentify range of service delivery models for HBV testing, care, and treatment, and compare outcomes achieved across the HBV care continuum. Methods: We searched PubMed, Embase, and Scopus for studies published in last 10 years that evaluated service delivery models and care cascade for HBV. Models were categorised as hospital-based, primary care/co-managed, integrated with HIV/NCD/ harm reduction sites, or for other special populations. Key outcomes across the HBV care cascade (linkage to care, treatment uptake, viral load suppression, adherence and retention to care) were pooled using random-effects meta-analysis and nested elements confidence intervals calculated using parametric bootstrapping. Results: Our search identified 3989 reports; 69 met the eligibility criteria. 17 (25%) were from LMICs. Most were observational (41 or 61%) or non-randomized interventional designs (24 or 35%), with very few RCTs (3 or 4%). In total, 9 (13%) described hospital/specialist-based models (Hosp), 22 (32%) were primary care/co-managed or screening only (Prim), and the remainder related to integrated models (e.g., harm reduction, PLHIV) or tailored for special populations (e.g., migrants, pregnancy). Only 4% of studies reported outcomes across the complete cascade of care; 33% on early outcomes (testing and linkage) and 6% across late cascade outcomes (treatment and retention). Among those reporting late cascade outcomes, antiviral treatment initiation among eligible patients was 37%, viral suppression 9%, and retention in care 16%. There were higher rates of treatment eligibility assessment following diagnosis for Hosp vs Prim care (74% [95% CI 66–81] vs 55.5% [41.7–68.6]), and for treatment initiation (69.3% [54.1–81.2] vs 57.3% [39.3–73.5]. Retention in care was similar (~42%) between models, but greater in those on antiviral therapy (70.3% [58.7–79.7]) than those only monitored (37.5% [21.0–57.6]). Adherence to treatment and DNA suppression rates were rarely reported. Conclusion: We identified a wide range of hospital and primary care-based service delivery models for HBV care and treatment in high and low income settings. Few reported data across the full cascade of care, especially for assessing treatment response. Linkage to care, uptake of treatment and retention in care was sub-optimal, and especially for reported primary-care based models. Interventions to improve adherence and retention in care are urgent across all models. Future studies should capture data across the cascade of care and utilize standardised definitions for linkage, eligibility assessment and retention.

Item Type: Conference or Workshop Item (Unspecified)
Uncontrolled Keywords: Liver, Massachusetts, Boston
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 14 Dec 2023 11:04
Last Modified: 18 Mar 2024 03:35
DOI: 10.1097/hep.0000000000000580
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3177392