Background Chronic hepatitis B virus(HBV) remains a major cause of hepatocellular carcinoma(HCC) in Australia, despite the availability of effective, subsidised antiviral therapy. We aimed to describe the clinical characteristics, HBV care cascade and outcomes among people with HBV-related HCC in Victoria, Australia. Methods We conducted a multicentre cohort study of all incident HCC cases across eight tertiary health networks in Victoria, Australia. Cases were identified retrospectively(1 January 2018 to 31 October 2021) and prospectively(1 November 2021 to 31 October 2022). The primary outcome was the proportion of incident HCC attributable to HBV. Secondary outcomes included uptake of guideline-based antiviral therapy and surveillance and overall survival from HCC diagnosis. Multivariable logistic regression was used to identify factors associated with treatment and surveillance uptake. Results Among 1203 incident HCC cases, 219(18.2%) were HBV-related. Most patients were male (89%) and of Asian ethnicity(60%). While 61% were aged 56–75 years, 25% were 36–55 years. Cirrhosis was present in 141(64%), although 57(26%) were newly diagnosed with cirrhosis at HCC presentation. 121(60%) patients were eligible for antiviral therapy. Linkage to specialist care was associated with treatment uptake(adjusted OR 8.4, 95% CI 4.3–16.1; p<0.001). Surveillance enrolment at diagnosis was higher among HBV-related HCC compared with non-HBV HCC(48% vs 40%). Conclusion HBV remains a substantial contributor to HCC in Australia. Gaps in antiviral treatment and cirrhosis recognition persist, highlighting missed opportunities for prevention and early detection. Interventions to improve linkage to care and delivery of guideline-based HBV management are urgently needed.

Globally, 254 million people are chronically infected with the hepatitis B virus and over 200,000 people in Australia are living with chronic hepatitis B. Over 70

BACKGROUND:Chronic hepatitis B virus (HBV) remains a major cause of hepatocellular carcinoma (HCC) in Australia, despite the availability of effective, subsidized antiviral therapy. We aimed to describe the clinical characteristics, HBV care cascade, and outcomes among people with HBV-related HCC in Victoria, Australia. METHODS:We conducted a multicenter cohort study of all incident HCC cases across eight tertiary health networks in Victoria, Australia. Cases were identified retrospectively (January 1, 2018 to December 31, 2019) and prospectively (January 1, 2020 to October 17, 2022). The primary outcome was the proportion of incident HCC attributable to HBV. Secondary outcomes included uptake of guideline-based antiviral therapy and surveillance and overall survival from HCC diagnosis. Multivariable logistic regression was used to identify factors associated with treatment and surveillance uptake. RESULTS:Among 1203 incident HCC cases, 219 (18.2%) were HBV related. Most patients were male (89%) and of Asian ethnicity (60%). While 61% were aged 56-75 years, 25% were 36-55 years. Cirrhosis was present in 141 (64%), although 57 (26%) were newly diagnosed with cirrhosis at HCC presentation. The 121 (60%) patients were eligible for antiviral therapy. Linkage to specialist care was associated with treatment uptake (adjusted OR 8.4, 95% CI 4.3-16.1; p < 0.001). Surveillance enrolment at diagnosis was higher among HBV-related HCC compared with non-HBV HCC (48% vs. 40%). CONCLUSION:HBV remains a substantial contributor to HCC in Australia. Gaps in antiviral treatment and cirrhosis recognition persist, highlighting missed opportunities for prevention and early detection. Interventions to improve linkage to care and delivery of guideline-based HBV management are urgently needed.

To achieve hepatitis B virus (HBV) elimination in Australia, a shift from hospital to community-based care is needed. This study aimed to describe the prevalence of chronic HBV and uptake of the cascade of care in primary care patients. This prospective cohort study was conducted in 76 urban and regional primary care clinics across Victoria, Australia between 1/7/2020 and 30/6/2023. Anonymised socio-demographic, clinical and laboratory data from general practice (GP) clinics' electronic medical records (EMR) were extracted. Descriptive analysis of the cohort of clinic clients with HBV was performed. A total of 346,927 individuals attended appointments across the study period. Of these, 25,212 had records indicating HBV-related testing. 491 (0.14%) individuals had evidence of current HBV infection defined as HBV surface antigen (HBsAg) positive and/or HBV DNA positive. 469 attended the clinics during the study period, among whom 239 (51%) were female. In the GP EMR, only 59 (13%) had evidence of at least one HBV DNA test and at least one ALT test ordered. Fourteen patients (3%) had record of being reviewed for HBV management by the clinic nurse or GP and 78 (17%) reviewed by a viral hepatitis specialist. Ninety-two (20%) were on treatment for HBV. Of people receiving treatment, 23 (25%) had a record of linkage to specialist care. Our data show that significant gaps in the cascade of care remain for people with chronic HBV in primary care settings, with a low proportion of patients having evidence of participating in all stages of the HBV cascade of care.

OBJECTIVE:Australia is not on track to achieve national hepatitis B elimination care targets. Many low hepatitis B prevalence Australian regions have disproportionately lower care uptake rates than higher-prevalence regions. This study aimed to determine enablers to providing care in a low hepatitis B prevalence region of Australia. METHODS:Semi-structured interviews were conducted with healthcare workers in the Barwon South West region of Victoria, Australia, to identify their perspectives on hepatitis B care and service delivery. RESULTS:Between August and November 2023, 20 participants were interviewed including nine general practitioners, four nurses, three specialists, three interpreters, and one refugee worker. Hepatitis B was understood as a rare, complex condition. The increasing pressure on general practitioners to manage specialist health conditions affected their willingness to manage hepatitis B. Enablers included specialist nurses providing case management and developing systematic links between specialist clinic staff and general practitioners. A localised community of practice would build general practitioner confidence. CONCLUSIONS:Low-prevalence regions have unique hepatitis B care challenges. Disease prevalence needs to be considered when implementing decentralised models of care, with infrequent exposure challenging general practitioner confidence and skill maintenance. IMPLICATIONS FOR PUBLIC HEALTH:The model for community-based hepatitis B care should be guided by prevalence and regional population characteristics and supported by enabling infrastructure.

An estimated 254 million people live with hepatitis B worldwide, with only 13% of people diagnosed and 3% receiving antiviral treatment. Without timely treatment, people with hepatitis B risk developing liver damage and liver cancer. In countries like Australia, where most people with hepatitis B are born in countries with higher prevalence, it is important that the knowledge and perceptions of hepatitis B in immigrant populations are explored to improve engagement in care. This review sought to systematically identify and synthesise qualitative research findings describing the knowledge and perceptions of hepatitis B in immigrant communities. An Ovid database search for English language publications for the years 2000-2024 was performed. 34 studies were selected for review. These were analysed using thematic synthesis and categorised using an modified version of the socio-ecological model. Ten analytic themes were identified: (1) knowledge of hepatitis B and misconceptions about transmission, (2) knowledge and familiarity with hepatitis B varies between communities, (3) culturally informed perceptions of health and illness, (4) alternative aetiologies of hepatitis B infection, (5) barriers and facilitators to engagement in healthcare, (6) sources of information, (7) stigma and family dynamics, (8) gender differences, (9) fear and anxieties of engaging with the healthcare system, (10) fear of health outcomes related to hepatitis B. These themes can be used to frame the development of culturally appropriate health promotion materials and interventions to improve knowledge and engagement in care among people living with hepatitis B.

Background & aims This systematic literature review of qualitative findings aims to identify the perceived barriers and enablers for hepatocellular carcinoma (HCC) surveillance from patient and clinician perspectives. Methods A systematic search of databases using key term combinations with the following inclusion criteria: 1) qualitative and quantitative (survey) studies exploring barriers and enablers of HCC surveillance, and 2) qualitative and quantitative (survey) studies exploring barriers and enablers of enagagement in clinical care for patients with cirrhosis and/or viral hepatitis. Results The search returned 445 citations: 371 did not meet the study criteria and were excluded. 74 studies proceeded to full-text review, leading to 21 included studies (15 studies from searching with a further six studies from citation review) progressing to data extraction by two independent reviewers. Results from studies exploring patients’ perspectives reinforce that barriers are experienced by patients across different health settings, cultures, and regions. Logistical barriers including costs and transportation, and knowledge/awareness barriers were commonly identified. Studies that included clinician perspectives highlighted the need for healthcare provider education and system-level interventions to optimize HCC surveillance uptake in clinical practice. Conclusion These findings highlight the critical need for interventions that enable engagement in HCC surveillance in health services.

Peer workers with lived-living experience of illicit drug use and/or bloodborne viruses are critical in linking community with health services and programs. Despite the increasing demand for, and recognition of, the value and contributions of peer workers, the risk of workplace stigma and discrimination due to their lived-living experience remains a persistent issue. This scoping review aims to map available literature about workplace stigma and discrimination against peer workers with lived-living experience of drug use or bloodborne virus. The methods used in this scoping review were guided by the Joanna Briggs Institute methodology. A Population-Context-Concept format was used to develop search strategies conducted across four databases to assess articles for eligibility. Community representatives from Australian national and state-based peer-led Drug User Organisations provided input and expertise into all components of this review. Data was extracted and analysed from 61 articles that met the inclusion criteria. Findings were mapped against five levels the Socioecological Model of Health framework, and presented as key risk factors that either increase vulnerability to or sustain stigma and discrimination in the workplace, or protective factors that promote resilience and positive workplace experiences for peer workers. This review highlights that workplace stigma and discrimination towards peer workers takes many forms, including increased emotional labour, negative attitudes or behaviours towards peer workers from non-peer staff, disparities in working conditions between peer workers and non-peer staff, and law enforcement activities that impact peer work. Workplace stigma and discrimination experienced by peer workers can be addressed through adequate planning and the development of organisations and systems that address and acknowledge the existence of stigma and work to create safe work environments for peer workers. This includes organisational policies and training which recognises the unique emotional burdens experienced by peer work and addresses unequal employment conditions between peer- and non-peer staff, and broader societal changes around how drug use is policed.

AbstractAlmost 300 million people are living with chronic hepatitis B infection worldwide and most remain undiagnosed and at risk for liver cancer. In 2015 the World Health Organization (WHO) developed guidelines for the prevention, care, and treatment of persons with chronic hepatitis B and in early 2023 began to work on updating these guidelines. In March 2023, a self-administered, anonymous online survey was launched, aiming to identify patient preferences related to the clinical management of hepatitis B including current management, treatment, and care experiences, preferences regarding engagement with providers, and preferences related to simplifying hepatitis B care access. A sample of 560 individuals living with hepatitis B (self-identified as HBsAg positive) from 76 countries completed the survey. Key findings demonstrated that less than half (49%, N = 268) of participants regularly visited a doctor to check the health of their liver (every 6–12 months), with 37% of participants prescribed antiviral medication by a specialist (82%, N = 167) or general practitioner (13%, N = 26). Participants reported not being actively involved in care decision making with their providers (42%, N = 217), with an overwhelming majority wanting to participate in hepatitis B management and treatment choices (85%, N = 435). Participants provided qualitative and quantitative details using open-ended responses within the survey about challenges with medication affordability and receiving care from a knowledgeable provider. Overall findings demonstrated key gaps in care, management, and treatment access related to hepatitis B: identifying these gaps can be used to identify areas for improvement along the care continuum for viral hepatitis. The survey found a need for the comprehensive simplification of clinical management and health care services related to hepatitis B. A thematic analysis of the open-ended survey responses highlighted major overarching themes including the cost and access burdens associated with hepatitis B management and treatment, and challenges in finding knowledgeable providers. Results from this mixed methods survey were used to inform the WHO hepatitis B guidelines update. Efforts should continue to explore public health approaches to address barriers and facilitators to testing, care, and treatment for people with hepatitis B to improve awareness of hepatitis B and access, care, and treatment among patients and providers.

Introduction Longitudinal studies can provide timely and accurate information to evaluate and inform COVID-19 control and mitigation strategies and future pandemic preparedness. The Optimise Study is a multidisciplinary research platform established in the Australian state of Victoria in September 2020 to collect epidemiological, social, psychological and behavioural data from priority populations. It aims to understand changing public attitudes, behaviours and experiences of COVID-19 and inform epidemic modelling and support responsive government policy.Methods and analysis This protocol paper describes the data collection procedures for the Optimise Study, an ongoing longitudinal cohort of ~1000 Victorian adults and their social networks. Participants are recruited using snowball sampling with a set of seeds and two waves of snowball recruitment. Seeds are purposively selected from priority groups, including recent COVID-19 cases and close contacts and people at heightened risk of infection and/or adverse outcomes of COVID-19 infection and/or public health measures. Participants complete a schedule of monthly quantitative surveys and daily diaries for up to 24 months, plus additional surveys annually for up to 48 months. Cohort participants are recruited for qualitative interviews at key time points to enable in-depth exploration of people’s lived experiences. Separately, community representatives are invited to participate in community engagement groups, which review and interpret research findings to inform policy and practice recommendations.Ethics and dissemination The Optimise longitudinal cohort and qualitative interviews are approved by the Alfred Hospital Human Research Ethics Committee (# 333/20). The Optimise Study CEG is approved by the La Trobe University Human Ethics Committee (# HEC20532). All participants provide informed verbal consent to enter the cohort, with additional consent provided prior to any of the sub studies. Study findings will be disseminated through public website (https://optimisecovid.com.au/study-findings/) and through peer-reviewed publications.Trial registration number NCT05323799.

Over 250 million individuals live with chronic hepatitis B (CHB) infection worldwide. A significant proportion of these people often face discrimination defined as the unjust, unfair, or prejudicial treatment of a person on the grounds of their hepatitis B status. Hepatitis B related discrimination has not been widely documented in the literature. This study aims to describe the lived experience of discrimination, document its impact, and shed light on its consequences. A hepatitis B discrimination registry was launched to record self-reported discrimination associated with hepatitis B. The registry included brief demographic questions (age, gender, country of origin), discrimination-specific questions (where, when, and how discrimination occurred), and open-ended questions to detail specific experiences. The registry was distributed to hepatitis B patient/people-focused listservs, social media networks, and community-based organizations around the globe. Descriptive data were analyzed including comparative analysis by country and type of discrimination occurring along with qualitative data (open-ended responses) which were analyzed using thematic analysis techniques A total of 569 individuals responded to the survey between May 2021 and December 2023. Individuals identified as residing in the Philippines (34%; N = 194), Nigeria (11%; N = 60), Pakistan (8%; N = 45), India (6%, N = 34), Uganda (5%; N = 31), the United States of America (4%, N = 26), Ghana (3%; N = 15), Ethiopia (2%; N = 14), and other countries in smaller number with a total of 65 countries reported discrimination at least by one individual. Of these, 461 individuals shared details about their experiences of discrimination with most relating to restrictions on access to work visas, followed by in-country hepatitis B-related employment restrictions, educational-based discrimination, discrimination within the community and health facilities, and the emotional impact of hepatitis B discrimination. This is the largest primary collection of hepatitis B-associated discrimination events and highlights how hepatitis B discrimination clearly has a significant impact on individuals' lives and limits economic opportunities regardless of physical symptoms. Such impacts likely act as barriers to diagnosis and engagement in care, so need to be addressed to achieve the global hepatitis B elimination goals. The data highlight a need for global, national responses and more systematic responses to discrimination experienced by people with hepatitis B.