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Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan
Qurat-Ul-Ain Hafeez1, Amna S Butt1, Furqaan Ahmed1
1Aga Khan University Hospital, Karachi, Pakistan.
Insights
Physician knowledge and practices for managing chronic hepatitis B (CHB) in Pakistan revealed significant gaps compared to international guidelines. Targeted education and improved coordination are crucial for effective hepatitis B virus (HBV) patient care.
Area of Science:
- Hepatology
- Internal Medicine
- Public Health
Background:
- Chronic hepatitis B (CHB) affects approximately 4.5 million people in Pakistan.
- Physician adherence to hepatitis B virus (HBV) management guidelines remains largely unassessed.
- This study is the first in Pakistan to compare physician knowledge and practices against APASL, EASL, and AASLD guidelines.
Purpose of the Study:
- To evaluate the knowledge and practices of physicians managing CHB patients in Pakistan.
- To compare physician adherence to international HBV management guidelines (APASL, EASL, AASLD).
Main Methods:
- A cross-sectional study conducted in four tertiary care hospitals in Karachi, Pakistan (2014-2015).
- Participants included internists, gastroenterologists, and senior residents involved in CHB patient management.
- Data collected via questionnaires assessing knowledge and practices related to HBV management.
Main Results:
- 179 physicians participated; about one-third followed AASLD or EASL guidelines.
- First-line therapies varied, with entecavir, tenofovir, and Peg IFN α 2a being common choices.
- 40.2% demonstrated poor knowledge regarding liver biopsy indications, treatment initiation, and antiviral prophylaxis.
- Higher knowledge scores correlated with younger age, consultant status, and gastroenterology/hepatology specialty.
Conclusions:
- Significant gaps exist in physician knowledge and practices for managing CHB in Pakistan.
- Improving physician education and interdisciplinary coordination is essential for effective HBV patient management.
- Refresher courses and collaboration between gastroenterologists and internists can enhance patient follow-up and care.
Background:
In Pakistan, approximately 4.5 million people are afflicted with chronic hepatitis B (CHB). The compliance with hepatitis B virus (HBV) management guidelines is still unknown. This was the first study from Pakistan in which the knowledge and practices of treating physicians were compared with three standardized guidelines (Asia Pacific Association for the Study of the Liver (APASL) 2012/European Association for the Study of the Liver (EASL) 2012/American Association for the Study of Liver Diseases (AASLD) 2009).
Methods:
A cross-sectional study was conducted during 2014-2015 at four tertiary care teaching hospitals of Karachi, Pakistan. The study participants were internists, gastroenterologist, senior residents who were involved in the management of CHB patients. All participants were offered to fill the study questionnaire.
Results:
A total of 179 physicians (103 residents, 76 consultants) participated. Mean age of participant was 35 ± 9.3 years. Approximately one-third of them followed AASLD (27.3%) and EASL (24.0%) guidelines. Entecavir, tenofovir or Peg IFN ∞ 2a were considered as first line therapy by 43%, 38.5% and 30.2% respectively. However, 17.9% preferred entecavir with tenofovir for rescue therapy, 25.7% and 23.5% preferred tenofovir or entecavir as both first line and rescue therapy respectively. Serum HBV DNA, alanine transaminase levels were used to monitor during oral antivirals therapy by 45.3%. hepatocellular carcinoma screening was considered for all HBV cases by 51.4% using ultrasound (55.3%) and alfa fetoprotein (52.5%) every 6 months.Overall 40.2% participants had poor knowledge about indication of liver biopsy, treatment initiation and antiviral prophylaxis. Significant association was found between grades of knowledge and gender, age group, designation and specialty (P < 0.05). Younger physicians, consultants (age 25-40 years) and those who were practicing gastroenterology/hepatology were more likely to have higher knowledge scores in compliance with the guidelines as compared to others.
Conclusion:
Our study highlighted the gaps in knowledge and practices in managing CHB patients according to guidelines. Efforts to improve knowledge, refresher courses and appropriate coordination between gastroenterologists and internal medicine physicians could enable management and follow-up of patients with CHB effectively.
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