1
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Kalo E, Baig A, Read S, Ahlenstiel G. Time to broaden the screening strategy for chronic hepatitis B virus infection beyond the emergency department. JHEP Rep 2024; 6:101040. [PMID: 38515552 PMCID: PMC10956043 DOI: 10.1016/j.jhepr.2024.101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Eric Kalo
- Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, Blacktown, NSW 2148, Australia
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW 2148, Australia
| | - Asma Baig
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW 2148, Australia
| | - Scott Read
- Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, Blacktown, NSW 2148, Australia
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW 2148, Australia
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW 2145, Australia
| | - Golo Ahlenstiel
- Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, Blacktown, NSW 2148, Australia
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW 2148, Australia
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW 2145, Australia
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2
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Shah SHBU, Valerio H, Hajarizadeh B, Matthews G, Alavi M, Dore GJ. Cascade of care among people with hepatitis B in New South Wales, Australia. J Viral Hepat 2023; 30:926-938. [PMID: 37553801 PMCID: PMC10946799 DOI: 10.1111/jvh.13881] [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: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
Hepatitis B virus (HBV) care cascade characterisation is important for monitoring HBV elimination progress. This study evaluated care cascade and factors associated with HBV DNA testing and treatment in New South Wales, Australia. HBV care cascade were determined through linkage of HBV notifications (1993-2017) to Medicare and pharmaceutical benefits schemes (2010-2018). Timely HBV DNA testing was within 4 weeks of HBV notification. Multivariate Cox proportional hazards regression evaluated factors associated with HBV DNA testing and treatment. Among 15,202 people with HBV notification, 10,479 (69%) were tested for HBV DNA. A total of 3179 (21%) initiated HBV treatment. HBV DNA testing was more likely among age ≥45 years (adjusted hazard ratio [aHR] 1.07, 95% CI: 1.02, 1.12), hepatocellular carcinoma (HCC) (aHR 1.23, 95% CI: 1.01, 1.50), coinfection (aHR 1.61, 95% CI: 1.23, 2.09), later notification (2014-2017) (aHR 1.21, 95% CI: 1.16, 1.26) and less likely among females (aHR 0.95, 95% CI: 0.91, 0.99), history of alcohol use disorder (AUD) (aHR 0.77, 95% CI: 0.66, 0.89), HCV coinfection (aHR .62, 95% CI: 0.55, 0.70) and Indigenous peoples (aHR 0.84, 95% CI: 0.71, 0.98). HBV treatment was associated with age ≥45 years (aHR 1.35, 95% CI: 1.24, 1.48), decompensated cirrhosis (aHR 2.07, 95% CI: 1.62, 2.65), HCC (aHR 2.96, 95% CI: 2.35, 3.74), HIV coinfection (aHR 4.27, 95% CI: 3.43, 5.31) and later notification (2014-2017) (aHR 1.37, 95% CI: 1.26, 1.47). HBV treatment was less likely among females (aHR 0.68, 95% CI: 0.63, 0.73) and Indigenous peoples (aHR 0.58, 95% CI: 0.42, 0.80). HBV DNA testing and treatment coverage have increased, but remain sub-optimal among some key populations.
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Affiliation(s)
| | - Heather Valerio
- Viral Hepatitis Clinical Research Program (VHCRP)The Kirby Institute, UNSWSydneyAustralia
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program (VHCRP)The Kirby Institute, UNSWSydneyAustralia
| | - Gail Matthews
- Viral Hepatitis Clinical Research Program (VHCRP)The Kirby Institute, UNSWSydneyAustralia
| | - Maryam Alavi
- Viral Hepatitis Clinical Research Program (VHCRP)The Kirby Institute, UNSWSydneyAustralia
| | - Gregory J. Dore
- Viral Hepatitis Clinical Research Program (VHCRP)The Kirby Institute, UNSWSydneyAustralia
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3
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Tu T, Ajoyan H, George J. Novel Assays to Solve the Clinical and Scientific Challenges of Chronic Hepatitis B. Clin Liver Dis 2023; 27:837-855. [PMID: 37778773 DOI: 10.1016/j.cld.2023.05.002] [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
Chronic infection with Hepatitis B is a common, incurable, and deadly infection. Despite inexpensive laboratory tests for diagnosis and management that have been established for decades, the worldwide rate of diagnosis is only ∼10%, and ∼5% of people are under treatment. Novel assays have been developed to improve linkage to care by providing more flexible approaches to determine a patient's health status. Other assays have been established to better investigate intrahepatic host-virus interactions to support clinical trials for cure research. This review outlines the clinical and scientific challenges still to be solved and the upcoming methods used to address them.
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Affiliation(s)
- 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.
| | - Harout Ajoyan
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
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4
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Ajuwon BI, Richardson A, Roper K, Lidbury BA. Clinical Validity of a Machine Learning Decision Support System for Early Detection of Hepatitis B Virus: A Binational External Validation Study. Viruses 2023; 15:1735. [PMID: 37632077 PMCID: PMC10458613 DOI: 10.3390/v15081735] [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] [Received: 07/17/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
HepB LiveTest is a machine learning decision support system developed for the early detection of hepatitis B virus (HBV). However, there is a lack of evidence on its generalisability. In this study, we aimed to externally assess the clinical validity and portability of HepB LiveTest in predicting HBV infection among independent patient cohorts from Nigeria and Australia. The performance of HepB LiveTest was evaluated by constructing receiver operating characteristic curves and estimating the area under the curve. Delong's method was used to estimate the 95% confidence interval (CI) of the area under the receiver-operating characteristic curve (AUROC). Compared to the Australian cohort, patients in the derivation cohort of HepB LiveTest and the hospital-based Nigerian cohort were younger (mean age, 45.5 years vs. 38.8 years vs. 40.8 years, respectively; p < 0.001) and had a higher incidence of HBV infection (1.9% vs. 69.4% vs. 57.3%). In the hospital-based Nigerian cohort, HepB LiveTest performed optimally with an AUROC of 0.94 (95% CI, 0.91-0.97). The model provided tailored predictions that ensured most cases of HBV infection did not go undetected. However, its discriminatory measure dropped to 0.60 (95% CI, 0.56-0.64) in the Australian cohort. These findings indicate that HepB LiveTest exhibits adequate cross-site transportability and clinical validity in the hospital-based Nigerian patient cohort but shows limited performance in the Australian cohort. Whilst HepB LiveTest holds promise for reducing HBV prevalence in underserved populations, caution is warranted when implementing the model in older populations, particularly in regions with low incidence of HBV infection.
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Affiliation(s)
- Busayo I. Ajuwon
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, Canberra, ACT 2601, Australia; (K.R.); (B.A.L.)
- Department of Biosciences and Biotechnology, Faculty of Pure and Applied Sciences, Kwara State University, Malete 241103, Nigeria
| | - Alice Richardson
- Statistical Support Network, The Australian National University, Acton, Canberra, ACT 2601, Australia;
| | - Katrina Roper
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, Canberra, ACT 2601, Australia; (K.R.); (B.A.L.)
| | - Brett A. Lidbury
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, Canberra, ACT 2601, Australia; (K.R.); (B.A.L.)
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5
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Hamilton EM, Rassam W, Yan Y, Singh A, Ng SYA, Zhang J, Lv J, Islam N, Malouf R, Yang L, Millwood IY, Chen Z. Correlates of chronic hepatitis B virus infection in the general adult population of China: Systematic review and meta-analysis. J Viral Hepat 2023; 30:470-488. [PMID: 36751939 DOI: 10.1111/jvh.13816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023]
Abstract
Chronic infection with hepatitis B virus (HBV) is a significant public health issue in China. Understanding factors associated with chronic HBV is important to enable targeted screening and education and to improve early diagnosis and prevention of disease progression. This systematic review and meta-analysis aimed to identify and describe correlates of chronic HBV among Chinese adults. Searches were conducted in MEDLINE, EMBASE and grey literature up to 25 June 2020. Eligible papers included observational studies in adults of the general population in China that reported factors associated with chronic HBV, measured by Hepatitis B surface antigen (HBsAg). Meta-analysis was performed using fixed-effect models of HBsAg prevalence among factors, and of adjusted odds ratios (ORs) for chronic HBV associated with each factor. Overall 39 articles were included, covering 22 factors, including a range of sociodemographic, behavioural and medical factors. In meta-analysis of eligible studies, a range of factors were significantly associated with higher HBsAg prevalence, including middle age, male sex, being married, rural residence, lower education, smoking, having a HBsAg positive household contact, family history of HBV, history of surgery or blood transfusion. The adjusted ORs varied, from 1.11 (95% CI 1.05-1.18) for smoking to 5.13 (95% CI 4.99-5.26) for having a HBsAg positive household contact. In Chinese adults, a range of factors are associated with chronic HBV infection, which may help inform targeted screening in the general population.
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Affiliation(s)
- Elizabeth Mova Hamilton
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Wadie Rassam
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Yan Yan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Avjit Singh
- Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Sarah Yoon Ai Ng
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jiabi Zhang
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Nazrul Islam
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Reem Malouf
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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6
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Lemoh C, Xiao Y, Tran L, Yussf N, Moro P, Dutertre S, Wallace J. An Intersectional Approach to Hepatitis B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4879. [PMID: 36981797 PMCID: PMC10049575 DOI: 10.3390/ijerph20064879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Hepatitis B is a chronic condition, primarily associated with hepatitis B viral infection in early life. The failure of prevention and appropriate management can lead to subsequent liver cirrhosis and cancer. Hepatitis B most commonly affects people born in Asia and Sub-Saharan Africa and their global diasporas. The physical, psychological, and social impacts of hepatitis B are strongly influenced by sex and gender. Inequities in access to timely, sensitive diagnosis and effective management arise from interactions between structural inequalities related to race, ethnicity, Indigenous/settler status, class, and geography. The biomedical response to hepatitis B has led to advances in prevention, diagnosis, and treatment, but many affected communities have explanatory health belief models that differ from that of biomedicine. We argue that an intersectional approach, led by affected people and communities, can integrate biomedicine with the lived experience and social context that give purpose to and shape all personal, communal, clinical, and public health responses to hepatitis B. This approach has the potential to enable a consciously equitable, effective response to the biopsychosocial complexities of hepatitis B, improve the health and wellbeing of people living with hepatitis B, and reduce hepatitis B-associated mortality.
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Affiliation(s)
- Christopher Lemoh
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Yinzong Xiao
- Burnet Institute, Melbourne, VIC 3004, Australia
| | - Lien Tran
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
- Department of Infectious Diseases, The University of Melbourne, Melbourne, VIC 3004, Australia
| | - Piergiorgio Moro
- Centre for Culture, Ethnicity and Health, North Richmond Community Health, Richmond, VIC 3121, Australia
| | - Sophie Dutertre
- Centre for Culture, Ethnicity and Health, North Richmond Community Health, Richmond, VIC 3121, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia
- Centre for Social Research in Health, University of New South Wales, Kensington, NSW 2052, Australia
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7
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Tran L, Cowie BC. Universal testing for hepatitis B must be accompanied by better linkage with care. Med J Aust 2023; 218:165-166. [PMID: 36739107 DOI: 10.5694/mja2.51848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/06/2023]
Affiliation(s)
- Lien Tran
- WHO Collaborating Centre for Viral Hepatitis, the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
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8
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Xiao Y, Hellard ME, Thompson AJ, Seaman C, Howell J, Scott N. The cost-effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030. Med J Aust 2023; 218:168-173. [PMID: 36596568 DOI: 10.5694/mja2.51825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To assess the impact on diagnosis targets, cost, and cost-effectiveness of universal hepatitis B screening in Australia. DESIGN Markov model simulation of disease and care cascade progression for people with chronic hepatitis B in Australia. SETTING Three scenarios were compared: 1. no change to current hepatitis B virus (HBV) testing practice; 2. universal screening strategy, with the aim of achieving the WHO diagnosis target by 2030 (90% of people with chronic hepatitis B diagnosed), based on opportunistic (general practitioner-initiated) screening for HBsAg; 3. universal screening strategy, and also ensuring that 50% of people with chronic hepatitis B are receiving appropriate clinical management by 2030. MAIN OUTCOME MEASURES Projected care cascade for people with chronic hepatitis B, cumulative number of HBV-related deaths, intervention costs, and health utility (quality-adjusted life-years [QALYs] gained during 2020-2030). An incremental cost-effectiveness ratio (ICER) threshold (v scenario 1) of $50 000 per QALY gained was applied. RESULTS Compared with scenario 1, 80 HBV-related deaths (interquartile range [IQR], 41-127 deaths) were averted during 2020-2030 in scenario 2, 315 HBV-related deaths (IQR, 211-454 deaths) in scenario 3. Scenario 2 cost $84 million (IQR, $41-106 million) more than scenario 1 during 2020-2030 (+8%), yielding an ICER of $104 921 (IQR, $49 587-107 952) per QALY gained. Scenario 3 cost $263 million (IQR, $214-316 million) more than scenario 1 during 2020-2030 (+24%), yielding an ICER of $47 341 (IQR, $32 643-58 200) per QALY gained. Scenario 3 remained cost-effective if the test positivity rate was higher than 0.35% or the additional costs per person tested did not exceed $4.02. CONCLUSIONS Universal screening for hepatitis B will be cost-effective only if the cost of testing is kept low and people receive appropriate clinical management.
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Affiliation(s)
| | - Margaret E Hellard
- The Burnet Institute, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Alexander J Thompson
- St Vincent's Hospital, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | | | - Jess Howell
- The Burnet Institute, Melbourne, VIC.,St Vincent's Hospital, Melbourne, VIC
| | - Nick Scott
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
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9
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Deng HMA, Romero N, Allard N, Rowe S, Yussf N, Cowie B. Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009-2017). Vaccine 2023; 41:1726-1734. [PMID: 36759283 DOI: 10.1016/j.vaccine.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains one of the leading causes of transmission worldwide. An estimated 90 % of infants who are exposed to HBV and do not receive appropriate post exposure immunoprophylaxis will go on to develop chronic hepatitis B (CHB). In Australia, universal birth dose vaccination was adopted in 2000 and universal antenatal screening for hepatitis B was introduced in the 1990 s, however up to 10 % of women may have missed screening. There is no coordinated care or data collection that systematically reports the access to interventions to prevent mother-to-child transmission (PMTCT) for women with CHB. Therefore, the incidence rate of MTCT is unknown. METHODS We conducted retrospective data linkage of perinatal records, public health notification and hospital admission data to identify women with a record of HBV infection who had given birth to a live infant(s) in Victoria between 2009 and 2017. We assessed uptake of birth dose vaccination and hepatitis B immunoglobulin (HBIG) and explored factors associated with administration of birth dose recorded as administered within 7 days. RESULTS Among 690,052 live births, 6118 births (0.90 %) were linked to 4196 women with a record of HBV infection. 89.4 % of all Victorian infants (n = 616,879), and 96.8 % of infants linked to women with a positive record of CHB (n = 5,925) received birth dose within 7 days. Infants born in private hospitals had reduced odds of receiving birth dose when compared to public hospitals births (Victorian population, aOR = 0.67, 95 %CI = 0.66, 0.69; CHB linked records aOR = 0.17, 95 %CI = 0.11, 0.25). Of the 6118 infants linked to a positive maternal record of CHB, discrepant recording of maternal CHB status between the three datasets was identified in 72.4% of records and HBIG administration was recorded for only 2.3% of births. CONCLUSION An approach that involves coordinated care and integrates data collection for women with CHB and their infants is required to support the elimination of MTCT of hepatitis B in Victoria.
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Affiliation(s)
- Hui Min-Anna Deng
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia.
| | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia
| | - Stacey Rowe
- State Government Department of Health, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia
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10
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Jacob R, Prince DS, Pipicella JL, Nguyen A, Bagatella M, Alvaro F, Maley M, Foo H, Middleton P, Kayes T, DiGirolamo J, Davison SA, Levy MT. Routine screening of emergency admissions at risk of chronic hepatitis (SEARCH) identifies and links hepatitis B cases to care. Liver Int 2023; 43:60-68. [PMID: 36050826 PMCID: PMC10087472 DOI: 10.1111/liv.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Significant barriers exist with hepatitis B (HBV) case detection and effective linkage to care (LTC). The emergency department (ED) is a unique healthcare interaction where hepatitis screening and LTC could be achieved. We examined the efficacy and utility of automated ED HBV screening for Overseas Born (OB) patients. METHODS A novel-automated hepatitis screening service "SEARCH" (Screening Emergency Admissions at Risk of Chronic Hepatitis) was piloted at a metropolitan hospital. A retrospective and comparative analysis of hepatitis testing during the SEARCH pilot compared to a period of routine testing was conducted. RESULTS During the SEARCH pilot, 4778 OB patients were tested for HBV (86% of eligible patient presentations), compared with 1.9% of eligible patients during a control period of clinician-initiated testing. SEARCH detected 108 (2.3%) hepatitis B surface antigen positive patients including 20 (19%) in whom the diagnosis was new. Among 88 patients with known HBV, 57% were receiving medical care, 33% had become lost to follow-up and 10% had never received HBV care. Overall, 30/88 (34%) patients with known HBV were receiving complete guideline-based care prior to re-engagement via SEARCH. Following SEARCH, LTC was successful achieved in 48/58 (83%) unlinked patients and 19 patients were commenced on anti-viral therapy. New diagnoses of cirrhosis and hepatocellular carcinoma were made in five and one patient(s) respectively. CONCLUSIONS Automated ED screening of OB patients is effective in HBV diagnosis, re-diagnosis and LTC. Prior to SEARCH, the majority of patients were not receiving guideline-based care.
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Affiliation(s)
- Rachael Jacob
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - David S Prince
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph L Pipicella
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Angela Nguyen
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Melissa Bagatella
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Frank Alvaro
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Michael Maley
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Hong Foo
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Paul Middleton
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia.,South Western Emergency Research Institute, UNSW, Sydney, New South Wales, Australia
| | - Tahrima Kayes
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Julia DiGirolamo
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Scott A Davison
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Miriam T Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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11
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Yussf N, Wallace J, Perrier M, Romero N, Cowie B, Allard N. Women with hepatitis B: how mothers with chronic hepatitis B understand and experience the prevention of mother-to-child transmission interventions in Victoria, Australia. Aust J Prim Health 2022; 28:514-521. [PMID: 36155134 DOI: 10.1071/py22014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of hepatitis B can be prevented with targeted interventions; however, MTCT continues to occur in Australia and globally. This qualitative research investigated how mothers with chronic hepatitis B (CHB) understand and experience interventions for the prevention of MTCT of CHB (PMTCT-CHB) in Victoria, Australia. METHODS Semi-structured interviews were conducted with women with CHB. Participants were recruited through purposive and snowballing sampling. Interviews explored the women's experience of care for themselves and their infants aimed at PMTCT-CHB. Interviews were conducted over the phone with a qualified interpreter where required. The consolidated criteria for reporting qualitative research framework was used with data thematically analysed. This study was co-designed with mothers with CHB through a Community Advisory Group established for this research; coordinated and supported by LiverWELL and the researchers. RESULTS Sixteen women were interviewed. Although most women understood the purpose of hepatitis B vaccination, there were significant gaps in information and education provided to mothers regarding PMTCT-CHB. These gaps included understanding of the extent of protection of vaccination, breastfeeding with CHB, post-vaccination testing for infants and lack of clarity of the woman's own hepatitis B status. There was notable fear and worry associated with hepatitis B transmission, with emotional support for mothers identified as a major gap in service delivery. Additionally, some women experienced stigma and discrimination due to their hepatitis B and refugee status. CONCLUSIONS This study explored how mothers with CHB understand and experience interventions to prevent MTCT. Our findings reveal substantial gaps in delivery of information and care in the context of PMTCT-CHB in Victoria. Our findings can support development of evidence-based interventions and systems to improve healthcare for mothers with CHB and their infants, and thereby reduce possible CHB transmission and other negative outcomes, including stigma and discrimination.
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Affiliation(s)
- Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia; and Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Vic. 3004, Australia
| | | | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia; and Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia; and Royal Melbourne Hospital, Melbourne, Vic. 3000, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia; and Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia
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Trends in decompensated cirrhosis and hepatocellular carcinoma among people with a hepatitis B notification in New South Wales. JHEP Rep 2022; 4:100552. [PMID: 36119722 PMCID: PMC9478454 DOI: 10.1016/j.jhepr.2022.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023] Open
Abstract
Background & Aims Population-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions. Methods Trends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors. Results Among 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth <1944, adjusted hazard ratio [aHR] 2.06, 95% CI 1.57–2.69), alcohol use disorder (aHR 4.82, 95% CI 3.96–5.87) and HCV co-infection (aHR 1.88, 95% CI 1.53–2.31). Predictors of HCC diagnosis included older age (birth <1944, aHR 3.94, 95% CI 2.91–5.32) and male sex (aHR 3.79, 95% CI 3.05–4.71). Conclusion In an era of improved antiviral therapies, the risk of HBV-related liver morbidity and mortality has declined. HCV co-infection and alcohol use disorder are key modifiable risk factors associated with the burden of HBV. Lay summary Rising hepatitis B-related morbidity and mortality is a major public health concern. However, the development of highly effective medicines against hepatitis B virus (HBV) has brought renewed optimism for its elimination by 2030. This study shows a steady decline in HBV-related liver morbidity and mortality in New South Wales, Australia. Moreover, late hepatitis notification has also declined, allowing individuals with HBV to have access to timely antiviral treatment. Despite this, hepatitis C co-infection and alcohol use disorder are key modifiable risk factors associated with HBV disease burden. To attain the desired benefits from highly effective antiviral treatment, managing comorbidities, including hepatitis C and high alcohol use, must improve among individuals with hepatitis B. The World Health Organization has set a 65% HBV mortality reduction target by 2030. Since the early 2000s, diagnoses of decompensated cirrhosis and HCC increased, but age-standardised incidence rates decreased. Age-standardised liver mortality rates decreased from 2.64 in 2003 to 0.97 per 1,000 person-years in 2017. Late HBV notification declined from 41% and 40% during 2001-2009 to 28% and 26% in 2010-2018, respectively. Hepatitis C co-infection and alcohol-use disorder are key modifiable risk factors associated with HBV disease burden.
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Hamilton E, Yang L, Mentzer AJ, Guo Y, Chen Y, Lv J, Fletcher R, Wright N, Lin K, Walters R, Kartsonaki C, Yang Y, Burgess S, Sansome S, Li L, Millwood IY, Chen Z. Conventional and genetic risk factors for chronic Hepatitis B virus infection in a community-based study of 0.5 million Chinese adults. Sci Rep 2022; 12:12075. [PMID: 35840665 PMCID: PMC9287541 DOI: 10.1038/s41598-022-16360-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Despite universal vaccination of newborns, the prevalence of chronic hepatitis virus B (HBV) infection and the associated disease burden remain high among adults in China. We investigated risk factors for chronic HBV infection in a community-based study of 512,726 individuals aged 30-79 years recruited from ten diverse areas during 2004-2008. Multivariable logistic regression was used to estimate odds ratios (ORs) of hepatitis B surface antigen (HBsAg) positivity recorded at baseline by sociodemographic and lifestyle factors, and medical history. In a random subset (n = 69,898) we further assessed the association of 18 single nucleotide polymorphisms (SNPs) previously shown to be associated with HBsAg positivity and development of chronic liver disease (CLD) (1600 cases). Several factors showed strong associations with HBsAg positivity, particularly younger age (< 40 vs. ≥ 60 years: OR 1.48, 95% CI 1.32-1.66), male sex (1.40, 1.34-1.46) and urban residency (1.55, 1.47-1.62). Of the 18 SNPs selected, 17 were associated with HBsAg positivity, and 14 with CLD, with SNPs near HLA-DPB1 were most strongly associated with both outcomes. In Chinese adults a range of genetic and non-genetic factors were associated with chronic HBV infection and CLD, which can inform targeted screening to help prevent disease progression.
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Affiliation(s)
- Elizabeth Hamilton
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK.
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | | | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | | | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Kuang Lin
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Robin Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yingcai Yang
- NCDs Prevention and Control Department, Shinan CDC, Qingdao, Shandong, China
| | - Sushila Burgess
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Sam Sansome
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Liming Li
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
- Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK.
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, BDI Building, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
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Lubel JS, Strasser SI, Thompson AJ, Cowie BC, MacLachlan J, Allard NL, Holmes J, Kemp WW, Majumdar A, Iser D, Howell J, Matthews GV. Australian consensus recommendations for the management of hepatitis B. Med J Aust 2022; 216:478-486. [PMID: 35249220 DOI: 10.5694/mja2.51430] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The prevalence of hepatitis B virus (HBV) infection in Australia is nearly 1%. In certain well defined groups the prevalence is far greater, yet an estimated 27% of people living with HBV infection remain undiagnosed. Appropriate screening improves detection, increases opportunity for treatment, and ultimately reduces the significant morbidity and mortality associated with the development of liver fibrosis and hepatocellular carcinoma (HCC). MAIN RECOMMENDATIONS This statement highlights important aspects of HBV infection management in Australia. There have been recent changes in nomenclature and understanding of natural history, as well as a newly defined upper limit of normal for liver tests that determine phase classification and threshold for antiviral treatment. As the main burden of hepatitis B in Australia is within migrant and Indigenous communities, early identification and management of people living with hepatitis B is essential to prevent adverse outcomes including liver cancer and cirrhosis. CHANGE IN MANAGEMENT AS A RESULT OF THIS GUIDELINE These recommendations aim to raise awareness of the current management of hepatitis B in Australia. Critically, the timely identification of individuals living with hepatitis B, and where appropriate, commencement of antiviral therapy, can prevent the development of cirrhosis, HCC and mother-to-child transmission as well as hepatitis B reactivation in immunocompromised individuals. Recognising patient and viral factors that predispose to the development of cirrhosis and HCC will enable clinicians to risk-stratify and appropriately implement surveillance strategies to prevent these complications of hepatitis B.
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Affiliation(s)
- John S Lubel
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
| | - Jennifer MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - Nicole L Allard
- University of Melbourne, Melbourne, VIC
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - Jacinta Holmes
- St Vincent's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | | | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - David Iser
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Jess Howell
- Monash University, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW
- St Vincent's Hospital Sydney, Sydney, NSW
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