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Martyn E, O'Regan S, Harris P, Leonard M, Veitch M, Sultan B, Matthews PC, Ghosh I, Story A, Surey J. Hepatitis B virus (HBV) screening, linkage and retention-in-care in inclusion health populations: Evaluation of an outreach screening programme in London. J Infect 2024; 88:167-172. [PMID: 38159579 PMCID: PMC7615690 DOI: 10.1016/j.jinf.2023.12.012] [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: 09/06/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES We evaluated a hepatitis B virus (HBV) screening programme, delivered by a specialist pan-London multidisciplinary outreach team, to understand population characteristics and care cascade among people who experience extreme social exclusion (Inclusion Health (IH) groups). METHODS Point-of-care HBV screening was performed in temporary accommodation for people experiencing homelessness (PEH) and people seeking asylum (initial accommodation centres, IACs) via a mobile unit staffed by peers with lived experience, nurses, and doctors. We analysed demographics and HBV characteristics of adults screened between May 2020 and January 2022. We ascertained linkage-to-care (LTC), retention-in-care (RIC) and loss-to-follow-up (LTFU). People LTFU were contacted by peers to re-engage in care. RESULTS 2473 people were screened: 809 in IACs, 1664 in other temporary accommodation. Overall hepatitis B surface antigen (HBsAg) prevalence was 1.7% (43/2473), highest in IACs (3.5%, 28/809). LTC within 3 months was 56% (24/43) and RIC, 87% (26/30). LTC was higher when referred to a local IH-specialist hepatitis service, compared to other services (77%, 17/22 vs 33%, 7/21; p = 0.006). LTFU was 30% (13/43), reduced to 21% (9/43) after intervention by peers. CONCLUSION Our findings support outreach screening among IH populations and peer-supported linkage to IH-specialist hepatitis services. We recommend increased HBV testing and HBV-specific IH specialist services.
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Affiliation(s)
- Emily Martyn
- London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK; The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK.
| | - Sive O'Regan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Mark Leonard
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Martha Veitch
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Binta Sultan
- Mortimer Market Centre, Central and North London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK; Institute of Global Health, University College London, Gower St, London WC1E 6BT, UK
| | - Philippa C Matthews
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK; Mortimer Market Centre, Central and North London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK; Division of Infection and Immunity, University College London, Gower St, London WC1E 6BT, UK; Department of Infectious Diseases, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK; Mortimer Market Centre, Central and North London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK; Collaborative Centre for Inclusion Health, University College London, Gower St, London WC1E 6BT, UK
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK; Institute of Global Health, University College London, Gower St, London WC1E 6BT, UK; Universidad Autonoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid 28049, Spain
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Campbell C, Wang T, Gillespie I, Barnes E, Matthews PC. Analysis of primary care electronic health record data of people living with hepatitis B virus: infection and hepatocellular carcinoma risk associated with socio-economic deprivation. Public Health 2024; 226:215-227. [PMID: 38091810 PMCID: PMC7615551 DOI: 10.1016/j.puhe.2023.10.036] [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: 04/24/2023] [Revised: 08/28/2023] [Accepted: 10/18/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES We set out to characterise chronic hepatitis B (CHB) in the primary care population in England and investigate risk factors for progression to hepatocellular carcinoma (HCC). STUDY DESIGN Retrospective cohort study. METHODS We identified 8039 individuals with CHB in individuals aged ≥18 years between 1999 and 2019 in the English primary care database QResearch. HCC risk factors were investigated using Cox proportional hazards modelling. RESULTS Most of those with a record of CHB were males (60%) of non-White ethnicity (>70%), and a high proportion were in the most deprived Townsend deprivation quintile (44%). Among 7029 individuals with longitudinal data, 161 HCC cases occurred. Increased HCC hazards were significantly associated with male sex (adjusted hazards ratio [aHR] 3.17, 95% confidence interval [95% CI] 1.92-5.23), in the fifth deprivation quintile as compared to the third quintile (aHR 1.69, 95% CI 1.01-2.84), with older age (for age groups 56-65 and ≥66 years, compared to 26-35 years, aHRs 2.82 [95% CI 1.45-5.46] and 3.76 [95% CI 1.79-7.9], respectively), Caribbean ethnicity (aHR 3.32, 95% CI 1.43-7.71, compared to White ethnicity), ascites (aHR 3.15, 95% CI 1.30-7.67), cirrhosis (aHR 6.55, 95% CI 4.57-9.38) and peptic ulcer disease (aHR 2.26, 95% CI 1.45-3.51). CONCLUSIONS Targeting interventions and HCC surveillance at vulnerable groups is essential to improve CHB outcomes and to support progress towards international goals for the elimination of hepatitis infection as a public health threat.
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Affiliation(s)
- C Campbell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - T Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - E Barnes
- NIHR Oxford Biomedical Research Centre, Oxford, UK; Department of Hepatology, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - P C Matthews
- NIHR Oxford Biomedical Research Centre, Oxford, UK; The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK; Division of Infection and Immunity, University College London, Gower Street, London WC1E 6BT, UK; Department of Infectious Diseases, University College London Hospital, Euston Road, London NW1 2BU, UK.
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Geretti AM, Austin H, Villa G, Smith C, Sabin C, Tsang R, Sherlock J, Ferreira F, Byford R, Meza-Torres B, Whyte M, de Lusignan S. Hepatitis B virus infection in general practice across England: An analysis of the Royal College of General Practitioners Research and Surveillance Centre real-world database. J Infect 2023; 86:476-485. [PMID: 36906152 DOI: 10.1016/j.jinf.2023.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES We analyzed hepatitis B surface antigen (HBsAg) screening and seropositivity within a network of 419 general practices representative of all regions of England. METHODS Information was extracted using pseudonymized registration data. Predictors of HBsAg seropositivity were explored in models that considered age, gender, ethnicity, time at the current practice, practice location and associated deprivation index, and presence of nationally endorsed screen indicators including pregnancy, men who have sex with men (MSM), history of injecting drug use (IDU), close HBV contact or imprisonment, and diagnosis of blood-borne or sexually transmitted infections. RESULTS Among 6,975,119 individuals, 192,639 (2.8 %) had a screening record, including 3.6-38.6 % of those with a screen indicator, and 8065 (0.12 %) had a seropositive record. The odds of seropositivity were highest in London, in the most deprived neighborhoods, among minority ethnic groups, and in people with screen indicators. Seroprevalence exceeded 1 % in people from high-prevalence countries, MSM, close HBV contacts, and people with a history of IDU or a recorded diagnosis of HIV, HCV, or syphilis. Overall, 1989/8065 (24.7 %) had a recorded referral to specialist hepatitis care. CONCLUSIONS In England, HBV infection is associated with poverty. There are unrealized opportunities to promote access to diagnosis and care for those affected.
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Affiliation(s)
- Anna Maria Geretti
- Department of Infectious Diseases, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
| | - Harrison Austin
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Giovanni Villa
- Department of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Colette Smith
- Institute for Global Health, University College London (UCL), London, United Kingdom
| | - Caroline Sabin
- Institute for Global Health, University College London (UCL), London, United Kingdom; NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL, a partnership with UKSHA, London, United Kingdom
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bernardo Meza-Torres
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Martin Whyte
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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