The key to reducing the number of people at risk of serious illness and death caused by chronic hepatitis B is learning to talk and listen more effectively, says Royal Melbourne Hospital infectious diseases physician, Professor Ben Cowie.
“Three-quarters of the people living with chronic hepatitis B in Victoria were either born overseas or are Aboriginal or Torres Strait Islander people,” says Professor Cowie, who is also Director of the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute.
“In most cases these are communities who already have reduced access to health care and treatment, so it is absolutely crucial that they are reached and supported.”
Around about 205,000 people in Australia live with chronic hepatitis B, which can develop into severe liver disease including cirrhosis and liver cancer.
Among people born in Australia the incidence of newly acquired hepatitis B is decreasing sharply, thanks to a vaccination program introduced in the year 2000 that now reaches between 90 and 95 per cent of newborns.
After a brief pause due to halts to immigration during the COVID-19 pandemic, the number of people living with chronic hepatitis B is increasing once more due to infections in people arriving from countries with a higher prevalence of the disease. Most of these people acquire hepatitis B at birth or earlier in life.
Its prevalence among migrants from our region has been falling, however, thanks to highly effective and longstanding infant vaccination programs in countries including China, Taiwan, Vietnam, and the Philippines.
Because chronic hepatitis B is asymptomatic for decades for most people affected, ensuring people living with it are diagnosed can be a challenge.
In Victoria, around 40 per cent of people who have chronic hepatitis B are unaware of the fact. And of those who have been screened and diagnosed, only around one-third go on to receive guideline-based monitoring – and only half those who need antiviral treatment to prevent liver disease and liver cancer are receiving it.
There are several reasons for this. On one hand, people may not have been offered opportunistic testing – despite this being a recommendation for decades. On the other, many people are unable to access effective, culturally appropriate health care.
These issues, says Professor Cowie, need to be addressed through educating and supporting health care providers – a process which must include the voices and insight of patients.
“It is extremely important that primary care clinicians have access to support, guidance and mentorship in this field,” he says.
He points to collaborations such as the Victorian HIV and Hepatitis Integrated Training and Learning (VHHITAL) program as critical elements in strengthening the capacity of general practice to tackle the virus.
VHHITAL, coordinated by North Western Melbourne Primary Health Network (NWMPHN), delivers comprehensive education and training for the primary health care workforce for the diagnosis, treatment and management of hepatitis B, hepatitis C, HIV and sexually transmitted infections.
A central aspect of its training courses is the inclusion of people living with hepatitis B.
“This is very important,” says Professor Cowie. “Being able to meet and hear the voices of people with lived experience – hear them describe how they respond to their diagnosis and the care they receive – gives doctors an invaluable consumer perspective.”
Professor Cowie says that he would like to see the role of people living with hepatitis B to be enormously expanded.
“I would like to see funding to develop comprehensive peer support programs,” he says.
“I want to see a dedicated workforce of people with lived experience of hepatitis B to help and advocate for others living with it.
“This would create much more accessible and responsive health care for people who currently find it difficult to get the diagnosis and treatments that could save their lives and reduce the incidence of liver cancer.”
He points out that employing people with lived experience is these days considered routine for the treatment, support and management of people with a range of long-term health conditions, including HIV.
“This is a workforce that is funded by state and federal sources, and provides clear and valuable support people with HIV, positively impacting their social connections, mental health, cancer survivorship and much more,” he says.
“A similar structure for people living with chronic hepatitis B will deliver enormously valuable results.”
VHHITAL’s next hepatitis B s100 prescriber course starts on Tuesday, 6 August 2024, with three sessions to be held over three weeks. Its presenters include Professor Cowie and Dr Lester Mascarenhas from Utopia Refugee and Asylum Seeker Health.
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