Educational Intervention Improves HBV Care, More Needed for Underserved Populations With HCV

Infectious Disease Advisor
30 Nov, 2019 ,

A patient-centered educational intervention for hepatitis B virus (HBV) infection can improve overall HBV care in underserved safety-net populations, according to study.

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Between July 2017 and July 2018, adults with chronic HBV were recruited at a single safety-net liver clinic to evaluate the effects of an in-person, language-concordant HBV educational intervention on appropriate HBV care, including clinic follow-up, laboratory monitoring, hepatocellular carcinoma (HCC) surveillance, and HBV treatment. Patients who participated in the educational intervention (n=102; 54.9% men; mean age, 52.0±13.8 years; 83.3% Asian) were compared in a 1:1 ratio with age- and sex-matched controls receiving usual care for HBV at the same clinic.

The educational intervention improved all measures of HBV care. Appropriate clinic follow-up increased from 25.5% to 81.4% of patients (P <.001), HBV laboratory monitoring from 62.8% to 77.5% (P =.02), and HBV treatment from 71.5% to 98.5% (P <.001). Compared with the control group, rates for appropriate clinic follow-up, laboratory monitoring, and HCC surveillance were all significantly higher among participants who received educational intervention (all P <.001).

In multivariate-adjusted analysis, individuals who received patient-centered HBV education were 7-fold more likely to adhere to follow-up protocol (odds ratio [OR], 7.02; 95% CI, 3.64-13.56; P <.001) compared with usual care, and significantly more likely have appropriate laboratory monitoring (OR, 4.94; 95% CI, 2.64-9.25; P <.001) and HCC surveillance (OR, 4.47; 95% CI, 2.21-9.46; P <.001).1

Based on these findings, the researchers suggested that formal in-person education may benefit other underserved groups.1 In the United States, one such example is the population of adult children of members of the baby boomers generation, many of whom have undiagnosed infection with hepatitis C virus (HCV). Children of these women represent a potential 30,000 to 50,000 cases of vertical transmission of HCV.2 As public health campaigns largely overlook this population, many are unaware of their HCV infection risk.

Researchers have therefore aimed to elucidate barriers that may exist in these adults obtaining HCV screening, and these study results were presented in another study at The Liver Meeting.2 Women born from 1945 to 1965 with active/prior HCV (N=264) treated at the University of Pennsylvania’s hepatology clinic were approached by the research team for consent to contact their children (aged ≥18 years) and/or refer the researchers to their children. These individuals were offered free HCV antibody/RNA testing.2

Overall, 37.9% (n=100) of mothers consented and 86 adult children were contacted. Of these individuals, 60 consented and 30 completed HCV screening either subsequently or through past results. Mothers commonly cited doubts about HCV infection occurring before pregnancy or of their children having HCV, and assumptions that their children had already been screened as reasons for not consenting. For their adult children, doubts of asymptomatic infection, inconvenience of testing, and assumptions of prior screening were cited as common reasons for not consenting.2

“Poor grasp of risks of HCV and reservations about testing are barriers to screening adult children of HCV+ baby boomer moms,” wrote the investigators.2 As such, more efforts are needed to educate this population of adults who may be infected but unaware.