Hepatitis B contact tracing: what works?

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Chronic hepatitis B (CHB) affects over 239,000 Australians, with increasing prevalence.
• National strategies recommend contact tracing (CT) for CHB identification, but it's often poorly executed.
• Contact tracing remains an underutilized strategy for identifying individuals with CHB.

Purpose of the Study:

• To describe the structure of a systematic CT system in a Melbourne primary health center serving refugees.
• To determine the effectiveness of this CT system in tracing contacts and identifying HBV status.
• To identify enablers contributing to the success of the CT system.

Main Methods:

• Mixed-methods study utilizing field notes for system structure, clinical record audits for CT effectiveness, and thematic analysis of interviews with health professionals.
• Effectiveness measured by proportion of contacts traced and serologically confirmed for HBV infection or immunity.
• Seven health professionals were interviewed to identify success factors.

Main Results:

• The CT system traced 90.0% of 420 contacts from 122 index cases.
• 80.7% of contacts were immune, 28.8% showed previous exposure, and 55.0% were vaccinated.
• A significant 8.1% of contacts were found to be chronically infected with HBV.
• Key enablers identified: Teamwork, Organization, professional expertise, patient education, centralization, patient culture, and nurse utilization.

Conclusions:

• The established systematic CT system is highly effective in identifying chronic hepatitis B cases.
• Teamwork and organization emerged as critical, previously unrecognized factors for successful CT.
• The model, emphasizing an organized, cohesive, nurse-led team, is recommended for implementation in other settings.