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Downs LO, Kabagambe K, Williams S, Waddilove E, Delphin M, Lumley SF, Ndungutse R, Kimono B, Newton R, Ko J, Martyn E, Carter J, Kemper A, Monteiro F, O'Regan S, Surey J, Sultan B, Story A, MacDonald D, Tu T, Seeley J, Dusheiko G, Maponga T, Andersson MI, Spearman CW, Tucker JD, Cohen C, Wang S, Adda D, Freeland C, Halford R, Jack K, Ghosh I, Elsharkawy AM, Matthews PC, Flanagan S. Peer support for people living with hepatitis B virus-A foundation for treatment expansion. J Viral Hepat 2024; 31:490-499. [PMID: 38798022 DOI: 10.1111/jvh.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/04/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
Chronic hepatitis B infection (CHB) affects 300 million people worldwide and is being targeted by the United Nations 2030 Sustainable Development Goals (SDGs) and the World Health Organisation (WHO), working towards elimination of hepatitis B virus (HBV) as a public health threat. In this piece, we explore the evidence and potential impact of peer support to enhance and promote interventions for people living with CHB. Peer support workers (PSWs) are those with lived experience of an infection, condition or situation who work to provide support for others, aiming to improve education, prevention, treatment and other clinical interventions and to reduce the physical, psychological and social impacts of disease. Peer support has been shown to be a valuable tool for improving health outcomes for people living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), but to date has not been widely available for communities affected by HBV. HBV disproportionately affects vulnerable and marginalised populations, who could benefit from PSWs to help them navigate complicated systems and provide advocacy, tackle stigma, improve education and representation, and optimise access to treatment and continuity of care. The scale up of peer support must provide structured and supportive career pathways for PSWs, account for social and cultural needs of different communities, adapt to differing healthcare systems and provide flexibility in approaches to care. Investment in peer support for people living with CHB could increase diagnosis, improve retention in care, and support design and roll out of interventions that can contribute to global elimination goals.
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Affiliation(s)
- Louise O Downs
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kenneth Kabagambe
- The National Organization for People Living with Hepatitis B (NOPLHB), Kampala, Uganda
| | | | | | | | - Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Robert Newton
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
| | - Joy Ko
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Emily Martyn
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
| | - Jessica Carter
- The Institute for Infection and Immunity, St George's University of London, London, UK
| | - Agnieszka Kemper
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Fernando Monteiro
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Sive O'Regan
- Find and Treat, University College London Hospitals, London, UK
| | - Julian Surey
- Find and Treat, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Binta Sultan
- Department of Infectious Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals, London, UK
| | - Douglas MacDonald
- Department of Hepatology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- HepBCommunity.org, Sydney, New South Wales, Australia
- Hepatitis B Voices Australia, Melbourne, Victoria, Australia
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Geoffrey Dusheiko
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tongai Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Cape Town, South Africa
| | - Monique I Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Su Wang
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Cooperman Barnabas Medical Center, Florham Park, New Jersey, USA
| | - Danjuma Adda
- World Hepatitis Alliance, London, UK
- CFID/CCT Taraba, Tarabba, Nigeria
| | | | - Rachel Halford
- World Hepatitis Alliance, London, UK
- The Hepatitis C Trust, London, UK
| | - Kathryn Jack
- Hepatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Indrajit Ghosh
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Find and Treat, University College London Hospitals, London, UK
| | - Ahmed M Elsharkawy
- Liver Unit and National Institute for Health Research Biomedical Research Centre at the University Hospitals Birmingham, University of Birmingham, Birmingham, UK
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
| | - Stuart Flanagan
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
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Abbott J, Aldhouse NVJ, Kitchen H, Pegram HC, Brown F, Macartney M, Villasis-Keever A, Sbarigia U, Ito T, Chan EKH, Kennedy PT. A conceptual model for chronic hepatitis B and content validity of the Hepatitis B Quality of Life (HBQOL) instrument. J Patient Rep Outcomes 2024; 8:29. [PMID: 38436804 PMCID: PMC10912061 DOI: 10.1186/s41687-023-00675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/12/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is increased emphasis on incorporating patient perspectives and patient-relevant endpoints in drug development. We developed a conceptual model of the impact of chronic hepatitis B (CHB) on patients' lives and evaluated the content validity of the Hepatitis B Quality of Life (HBQOL) instrument, a patient-reported outcome tool for use in clinical studies, as a patient-relevant endpoint to measure health-related quality of life in patients with CHB. METHODS A literature review of qualitative studies of patient experience with CHB and concept elicitation telephone interviews with patients with CHB in the United Kingdom were used to develop a conceptual model of the experience and impact of living with CHB. The content validity of the HBQOL was evaluated using cognitive debriefing techniques. RESULTS The qualitative literature review (N = 43 publications) showed that patients with CHB experience emotional/psychological impacts. During concept elicitation interviews (N = 24), fatigue was the most commonly reported symptom, and most participants were worried/anxious about virus transmission and disease progression/death. A conceptual model of patients' experiences with CHB was developed. The conceptual relevance and comprehensibility of the HBQOL were supported, though limitations, including the lack of a self-stigma item and recall period, were noted for future improvement. CONCLUSIONS The conceptual model shows that patients with CHB experience emotional/psychological impacts that affect their lifestyles, relationships, and work/schooling. The cognitive debriefing interviews support the content validity of the HBQOL as a conceptually relevant patient-reported outcome measure of health-related quality of life.
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Affiliation(s)
- Jane Abbott
- Barts and The London School of Medicine and Dentistry, London, UK
| | | | | | | | | | | | | | | | - Tetsuro Ito
- Janssen Health Economics & Market Access EMEA, High Wycombe, UK
| | | | - Patrick T Kennedy
- Barts and The London School of Medicine and Dentistry, London, UK.
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Newark Street, London, E1 2AT, UK.
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Ahmed S, Méndez RY, Naveed S, Akhter S, Mushtaque I, Malik MA, Ahmad W, Figueroa RN, Younas A. Assessment of hepatitis-related knowledge, attitudes, and practices on quality of life with the moderating role of internalized stigma among hepatitis B-positive patients in Pakistan. Health Psychol Behav Med 2023; 11:2192782. [PMID: 37008419 PMCID: PMC10064821 DOI: 10.1080/21642850.2023.2192782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Aim This study aimed to assess the Pakistani hepatitis B patients' knowledge, attitudes, and practices towards hepatitis management and the impact of self-management on the quality of life of hepatitis B patients as well as the moderating role of stigmatization. Methods A cross-sectional study design was used, and the data was collected from a total of 432 hepatitis B positive patients through a self-designed questionnaire. The studied subjects consisted of men (n = 205, 47%), women (n = 165, 38%), and transgender (n = 62, 14%). The obtained data were statistically analyzed using SPSS software version 26.0 for Windows. Results The mean age of the study participants was 48. Knowledge has a significant positive relationship with hepatitis self-management and quality of life, whereas knowledge has a negative relationship with stigmatization. Furthermore, multivariate analysis revealed that men were more knowledgeable about the disease than women and transgender people (6.14 ± 2.08 vs. 3.23 ± 1.61 vs. 1.03 ± 0.73, F = 8.2**, p = .000). On the scale of attitude and practice, significant gender differences were found. Women had more experience with hepatitis self-management than men or transgender (4.21 ± 13.0 vs. 2.17 ± 6.02 vs. 0.37 ± 0.31, F = 6.21**, p = .000). The regression analysis showed that self-management has a positive association with quality of life (B = 0.36, p = .001). The moderation analysis revealed that stigmatization negatively moderates the relationship between self-management and quality of life (B = -0.53, p = .001). Conclusion Generally, patients had good knowledge about the disease and its self-management. However, a societal and community-level awareness campaign should be organized on the quality of life and stigmatization of people with chronic illness regarding their human rights, dignity, and physical, mental, and social well-being.
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Schwarzenberg SJ, King WC, Ling SC, Murray KF, Mogul D, Rosenthal P, Rodriguez-Baez N, Teckman J, Schwarz KB. Change in Health-Related Quality of Life in Youth with Chronic Hepatitis B Living in North America: A 5-Year Cohort Study. J Pediatr Gastroenterol Nutr 2023; 77:713-719. [PMID: 37756340 DOI: 10.1097/mpg.0000000000003957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Greater hepatitis-related symptomology is associated with lower health-related quality-of-life (HRQoL) among untreated youth with chronic hepatitis B (CHB). How HRQoL changes over time in this population is unknown. METHODS Children from 7 hepatology centers in North America positive for hepatitis B surface antigen, not taking anti-viral therapy, were enrolled in the Hepatitis B Research Network. A validated self-report HRQoL measure, the Child Health Questionnaire Child Report (CHQ-CF87), was completed annually by participants 10-17 years, with demographic variables, liver disease symptoms, and laboratory tests. Linear mixed-effects models were used to evaluate the 10 CHQ-CF87 subscale scores over 5 years among participants who completed the CHQ-CF87 at least twice. RESULTS Participants (N = 174) completed the CHQ-CF87 a median of 4 times. Median age was 12 years (interquartile range: 10-14) at baseline; 60% were female, 79% Asian, and 47% adopted. The CHQ-CF87 subscale scores were high at baseline (median range: 75.4-100) and did not differ by time point, except for the Family Activities subscale (mean [95% CI]: 82.3 [79.8-84.8] at baseline; 90.8 [86.1-94.6] week 240). Most subscale scores lacked sufficient individual-level variability in change over time to evaluate predictors. Being White versus Asian predicted a more favorable change in Behavior (6.5 [95% CI: 2.0-11.0]). Older age predicted less favorable change in Mental Health (-0.8 [95% CI: -1.36 to -0.23] per year). Changes in liver enzymes and hepatitis B antigens, DNA, or symptom count were not related to changes in these subscale scores. CONCLUSION HRQoL was generally good and consistent across 5 years in youth with CHB.
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Affiliation(s)
| | - Wendy C King
- the Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Simon C Ling
- the Department of Paediatrics, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen F Murray
- the Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Philip Rosenthal
- the Department of Pediatrics, University of California at San Francisco, San Francisco, CA
| | | | - Jeffrey Teckman
- the Department of Pediatrics, Saint Louis University, Saint Louis, MO
| | - Kathleen B Schwarz
- the Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD
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Evon DM, Lin HHS, Khalili M, Wahed AS, Yim C, Fontana RJ, Hoofnagle JH. Symptoms of Liver Disease During Tenofovir Therapy With or Without Peginterferon: Results from the Hepatitis B Research Network Immune Active Trial. Dig Dis Sci 2023; 68:4499-4510. [PMID: 37804353 PMCID: PMC11149619 DOI: 10.1007/s10620-023-08108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/05/2023] [Indexed: 10/09/2023]
Abstract
AIMS Evaluate patient-reported liver symptoms during treatment for chronic hepatitis B viral (HBV) infection and associations between changes in symptoms and levels of alanine aminotransferase (ALT) and viral markers. METHODS Data from 200 participants in the Hepatitis B Research Network Immune Active Trial who completed symptom assessments were analyzed. Patients were treated with tenofovir, with or without peginterferon (TDF + PegIFN vs. TDF alone) for 192 weeks. Participants completed a Symptom Checklist at baseline and every 4-12 weeks. A total symptom score was created, ranging from 0 (none) to 40 (severe). The SF-36 was completed every 48 weeks. Associations of symptom scores with ALT and viral markers were evaluated at baseline and end of treatment. RESULTS Participants were 65% male, 83% Asian, with a mean age of 42. Baseline symptoms were mild (median = 2, range 0-25) and associated with baseline ALT, HBV DNA levels and HBeAg + status. Patients on TDF alone experienced a more rapid and greater improvement in symptoms, but by week 192, symptom improvement was similar in both groups (54% vs 36%). Symptom improvements correlated with ALT and HBV DNA, most markedly among those with symptoms at baseline. Most patients (4 out of 6) who achieved HBsAg loss experienced symptom improvements. Overall, SF-36 scores did not change with treatment. CONCLUSIONS Reduction in ALT and HBV DNA levels with therapy are associated with significant improvement in liver symptoms such as fatigue and pain over the liver, especially among those with higher ALT, HBV DNA, symptoms and HBeAg + status prior to treatment.
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Affiliation(s)
- Donna M Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Hsing-Hua S Lin
- Departments of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, USA
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Mandana Khalili
- Department of Medicine, University of California at San Francisco, San Francisco, USA
| | - Abdus S Wahed
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, USA
| | - Colina Yim
- Toronto Centre for Liver Disease, University of Toronto, Toronto, Canada
| | - Robert J Fontana
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Jay H Hoofnagle
- Liver Disease Research Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health (NIH), Bethesda, USA
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Ibrahim Y, Umstead M, Wang S, Cohen C. The Impact of Living With Chronic Hepatitis B on Quality of Life: Implications for Clinical Management. J Patient Exp 2023; 10:23743735231211069. [PMID: 38026060 PMCID: PMC10644750 DOI: 10.1177/23743735231211069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Living with chronic hepatitis B (CHB) has physical, social, and emotional impacts that often negatively affect patients' quality of life. These impacts are not usually captured during routine care. This article presents information on the impact of living with CHB and the importance of integrating health-related quality-of-life assessment into CHB care. Using a global online survey, people ages ≥18 living with CHB were asked about physical, social, and worry impacts. Of 1707 respondents, most were male (67%), < 45 years of age (81%); and 52% identified as Black. Of all participants, 66% reported physical impact, 55% reported social impact, and 49% reported worry impact of living with CHB. Those from Africa and the Western Pacific were most likely to report physical impact. Younger participants (18-45) and those not on treatment were significantly more likely to report physical and social impact. People living with CHB are impacted physically, socially, and emotionally, varied by demographic factors and disease experience. These impacts should be captured and addressed as part of routine CHB care.
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Affiliation(s)
| | | | - Su Wang
- Former President of World Hepatitis Alliance, London, UK
- Center for Asian Health & Viral Hepatitis Programs, Cooperman Barnabas Medical Center, Florham Park, New Jersey, USA
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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Su F, Jacobson IM. Chronic Hepatitis B: Treat all Who Are Viremic? Clin Liver Dis 2023; 27:791-808. [PMID: 37778770 DOI: 10.1016/j.cld.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The main aim of antiviral therapy in patients with chronic hepatitis B (CHB) is to prevent disease progression and reduce the risk of hepatocellular carcinoma (HCC). In general, treatment is recommended for select patient groups viewed as being at higher risk of developing adverse outcomes from CHB. However, patients who do not meet treatment criteria under current international guidelines may still benefit from antiviral therapy to reduce CHB-related complications. Moreover, well-tolerated antiviral drugs that are highly effective at suppressing viral replication are now widely available, and withholding therapy from patients with viremia is increasingly controversial. In this article, we review traditional treatment paradigms and argue the merits of expanding treatment eligibility to patients with CHB who do not meet current treatment criteria.
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Affiliation(s)
- Feng Su
- Department of Medicine, New York University Grossman School of Medicine, 150 East 32nd Street, Suite 101, New York, NY 10016, USA; New York University Langone Transplant Institute, 317 East 34th Street, 8th Floor, New York, NY 10016, USA.
| | - Ira M Jacobson
- Department of Medicine, New York University Grossman School of Medicine, 150 East 32nd Street, Suite 101, New York, NY 10016, USA
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Wang T, Kong LN, Yao Y, Li L. Self-Efficacy, Coping Strategies and Quality of Life among Patients with Chronic Hepatitis B. West J Nurs Res 2023; 45:800-806. [PMID: 37377383 DOI: 10.1177/01939459231184714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
This study aimed to examine the relationships of self-efficacy, coping strategies, and quality of life (QoL) among patients with chronic hepatitis B and to explore whether coping strategies play a mediating role. In this cross-sectional study, 193 patients with chronic hepatitis B from two tertiary hospitals were recruited. Data were collected using a self-report questionnaire. The results indicated that physical and mental QoL were positively associated with self-efficacy and negatively associated with resignation coping. Moreover, resignation coping partially mediated the relationship between self-efficacy and physical and mental QoL. Our findings indicated that healthcare providers can enhance self-efficacy with an emphasis on reducing the use of resignation coping to better improve QoL among patients with chronic hepatitis B.
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Affiliation(s)
- Tian Wang
- Resident Physician, Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling-Na Kong
- Associate Professor, School of Nursing, Chongqing Medical University, Chongqing, China
| | - Yu Yao
- Lecturer, School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Lin Li
- Attending Physician, Department of Liver Disease, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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YENDEWA GA, SELLU EJ, KPAKA RA, JAMES PB, YENDEWA SA, CUMMINGS PE, BABAWO LM, MASSAQUOI SP, GHAZAWI M, OCAMA P, LAKOH S, BABAWO LS, SALATA RA. Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale. J Viral Hepat 2023; 30:621-629. [PMID: 37084170 PMCID: PMC10330123 DOI: 10.1111/jvh.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included four additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant, and construct validity. Exploratory factor analysis produced a three-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (six items), negative self-image (two items), and disclosure concerns (two items). Overall, 72.8% of respondents reported perceived HBV-related stigma (mean score 29.11 ± 4.14) and a similar proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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Affiliation(s)
- George A. YENDEWA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edmond J. SELLU
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Rashid A. KPAKA
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Peter B. JAMES
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | | | - Lawrence M. BABAWO
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Ponsiano OCAMA
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sulaiman LAKOH
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Lawrence S. BABAWO
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Robert A. SALATA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Haslund-Gourley BS, Wigdahl B, Comunale MA. IgG N-glycan Signatures as Potential Diagnostic and Prognostic Biomarkers. Diagnostics (Basel) 2023; 13:1016. [PMID: 36980324 PMCID: PMC10047871 DOI: 10.3390/diagnostics13061016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/30/2023] Open
Abstract
IgG N-glycans are an emerging source of disease-specific biomarkers. Over the last decade, the continued development of glycomic databases and the evolution of glyco-analytic methods have resulted in increased throughput, resolution, and sensitivity. IgG N-glycans promote adaptive immune responses through antibody-dependent cellular cytotoxicity (ADCC) and complement activation to combat infection or cancer and promote autoimmunity. In addition to the functional assays, researchers are examining the ability of protein-specific glycosylation to serve as biomarkers of disease. This literature review demonstrates that IgG N-glycans can discriminate between healthy controls, autoimmune disease, infectious disease, and cancer with high sensitivity. The literature also indicates that the IgG glycosylation patterns vary across disease state, thereby supporting their role as specific biomarkers. In addition, IgG N-glycans can be collected longitudinally from patients to track treatment responses or predict disease reoccurrence. This review focuses on IgG N-glycan profiles applied as diagnostics, cohort discriminators, and prognostics. Recent successes, remaining challenges, and upcoming approaches are critically discussed.
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Affiliation(s)
- Benjamin S. Haslund-Gourley
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
- Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Brian Wigdahl
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
- Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Mary Ann Comunale
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
- Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA 19129, USA
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YENDEWA GA, SELLU EJ, KPAKA RA, JAMES PB, YENDEWA SA, CUMMINGS PE, BABAWO LM, MASSAQUOI SP, GHAZAWI M, OCAMA P, LAKOH S, BABAWO LS, SALATA RA. Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286086. [PMID: 36824916 PMCID: PMC9949200 DOI: 10.1101/2023.02.17.23286086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥ 18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included 4 additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant and construct validity. Exploratory factor analysis produced a 3-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (6 items), negative self-image (2 items), and disclosure concerns (2 items). Overall, 72.8% of respondents reported perceived HBV stigma (mean score 29.11 ± 4.14) and a similar a proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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Affiliation(s)
- George A. YENDEWA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edmond J. SELLU
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Rashid A. KPAKA
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Peter B. JAMES
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | | | - Lawrence M. BABAWO
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Ponsiano OCAMA
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sulaiman LAKOH
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Lawrence S. BABAWO
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Robert A. SALATA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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12
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Martyn E, Eisen S, Longley N, Harris P, Surey J, Norman J, Brown M, Sultan B, Maponga TG, Iwuji C, Flanagan S, Ghosh I, Story A, Matthews PC. The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda. eLife 2023; 12:e81070. [PMID: 36757862 PMCID: PMC9910830 DOI: 10.7554/elife.81070] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatitis B virus (HBV) infection represents a significant global health threat, accounting for 300 million chronic infections and up to 1 million deaths each year. HBV disproportionately affects people who are under-served by health systems due to social exclusion, and can further amplify inequities through its impact on physical and mental health, relationship with stigma and discrimination, and economic costs. The 'inclusion health' agenda focuses on excluded and vulnerable populations, who often experience barriers to accessing healthcare, and are under-represented by research, resources, interventions, advocacy, and policy. In this article, we assimilate evidence to establish HBV on the inclusion health agenda, and consider how this view can inform provision of better approaches to diagnosis, treatment, and prevention. We suggest approaches to redress the unmet need for HBV interventions among excluded populations as an imperative to progress the global goal for the elimination of viral hepatitis as a public health threat.
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Affiliation(s)
- Emily Martyn
- The Francis Crick InstituteLondonUnited Kingdom
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Sarah Eisen
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Nicky Longley
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Institute of Global Health, University College LondonLondonUnited Kingdom
- Universidad Autonoma de Madrid, Ciudad Universitaria de CantoblancoMadridSpain
| | - James Norman
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Michael Brown
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Binta Sultan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Tongai G Maponga
- Stellenbosch University, Faculty of Medicine and Health SciencesTygerbergSouth Africa
| | - Collins Iwuji
- Department of Global Health, Brighton and Sussex Medical School, University of SussexBrightonUnited Kingdom
- Africa Health Research InstituteDurban, KwaZulu-NatalSouth Africa
| | - Stuart Flanagan
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Collaborative Centre for Inclusion Health, University College LondonLondonUnited Kingdom
| | - Philippa C Matthews
- The Francis Crick InstituteLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
- Division of Infection and Immunity, University College LondonLondonUnited Kingdom
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13
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Yan J, Wu C, He C, Lin Y, He S, Du Y, Cao B, Lang H. The social support, psychological resilience and quality of life of nurses in infectious disease departments in China: A mediated model. J Nurs Manag 2022; 30:4503-4513. [PMID: 36325798 PMCID: PMC9878052 DOI: 10.1111/jonm.13889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIM This paper aimed to investigate the relationship between social support and quality of life for nurses in infectious disease departments in China, as well as the function of psychological resilience in mediating this relationship. BACKGROUND Nurses in infectious disease departments play a critical role in the prevention and control of infectious diseases and in public health care services in general, and their quality of life can affect the quality of clinical nursing work they do. However, there are few studies on the relationship between nurses' social support networks and their quality of life. METHODS A cross-sectional study was conducted using a sample of 866 clinical nurses from the infectious disease departments of 10 general hospitals in China. Data were collected using a questionnaire survey from January to May 2021. The mediating influence of psychological resilience on social support and quality of life was investigated using structural equation modelling. RESULTS The score of quality of life was (36.36 ± 7.64). Quality of life was positively correlated with social support and psychological resilience (r1 = 0.521, r2 = 0.583; p < .01), and psychological resilience was positively correlated with social support (r = 0.426; p < .01) as well. The mediating effect of psychological resilience between social support and quality of life was 0.233, accounting for 37% of the total effect. CONCLUSION The quality of life of nurses working in infectious disease departments is in the middle level. Psychological resilience is a mediating variable between social support and quality of life. IMPLICATIONS FOR NURSING MANAGEMENT Managers can improve the quality of life of nurses by both increasing social support and strengthening psychological resilience. Managers should pay attention to the degree of social support provided to nurses and take proactive measures to build psychological resilience so that nurses can effectively manage stress and negative emotions from work and life in order improve their quality of life.
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Affiliation(s)
- Jiaran Yan
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Chao Wu
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Chunyan He
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Yawei Lin
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Shizhe He
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Yanling Du
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Baohua Cao
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
| | - Hongjuan Lang
- Nursing DepartmentFourth Military Medical UniversityXi'an ShaanxiChina
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