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Patient Source of Referral Is a Key Determinant of Subsequent Retention in Care for Young Chronic Hepatitis B
David Mutimer1,2, Maxine Brown3, Jacqueline Logan3
1Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Insights
Long-term patient retention in care is crucial for Hepatitis B elimination. Young patients, especially those referred from non-antenatal or genitourinary sources, face significant loss to follow-up, posing a public health risk.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Hepatitis B elimination requires sustained patient engagement.
- Previous studies indicated lower retention in younger and non-Asian adult patients with chronic hepatitis B (CHB).
- Understanding loss to follow-up in young CHB patients is vital for improving care.
Purpose of the Study:
- To investigate the rates and determinants of loss to follow-up in young patients (16-21 years) with CHB.
- To identify factors associated with long-term retention in care for this demographic.
Main Methods:
- Retrospective cohort study of 271 young patients with CHB.
- Analysis of patient referral sources, residence distance, and follow-up duration.
- Multivariate analysis to determine significant predictors of loss to follow-up.
Main Results:
- 16% of young CHB patients were lost after one visit; 5- and 10-year retention rates were 53.7% and 45.9%.
- Referral source was a key factor: antenatal clinic and pediatric transitions showed higher retention (68% at 5 years) than 'other' sources (36%).
- Residence distance and referral source were significant determinants of loss to follow-up; asylum seekers and genitourinary referrals had very low retention (20% at 10 years).
Conclusions:
- Patient referral source and proximity to the clinic significantly impact retention in care for young CHB patients.
- Transition from pediatric care and antenatal referrals facilitate better long-term follow-up.
- Specific groups, including asylum seekers and genitourinary referrals, represent a vulnerable population with poor retention, posing a potential public health risk.
Abstract:
Hepatitis B elimination objectives can only be realised if new patient linkage to care is matched by long-term patient retention in care. We previously showed in adult chronic hepatitis B (CHB) patients that retention in care was inferior in younger patients and in patients from non-Asian ethnicities. The present study explores further the rates and determinants of loss to follow-up in a cohort of 271 young patients (aged 16-21 years at baseline). 16% of patients were lost to follow-up after a single consultation, and retention in care at 5 and 10 years was 53.7% and 45.9%, respectively. Retention in care was strongly associated with the source of patient referral and was superior for patients referred from the antenatal clinic and those transitioned from paediatric care (68% retention at 5 years for both sources) compared with those from "other" sources (36% at 5 years). In multivariate analyses, patient source of referral and distance of current residence from the Hepatitis Outpatient Clinic were the significant determinants of loss to follow-up. Retention in care may have been promoted by the transition process for those diagnosed in childhood and by the repeated referral from the antenatal clinic of women who had multiple pregnancies during the observation period. Only 20% of asylum seekers and referrals from genitourinary clinics were retained in follow-up at 10 years from baseline. This identifies a group of patients who do not access medical care, cannot benefit from treatment, and who may constitute a long-term public health risk.
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