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Evaluation of Factors Influencing Specialist Referral Among Individuals Tested Positive for HBsAg in Health Check
Henry Lik Yuen Chan1,2, Judy Man Lee Lee3, Christie Fung Yin Cheng3
1Department of Internal Medicine, Union Hospital, Hong Kong SAR, China.
Insights
Specialist referral rates for hepatitis B virus (HBV)-infected individuals identified in health checks improved over time. Elevated HBV DNA levels significantly increased the likelihood of referral, highlighting the importance of reflex HBV DNA testing for improved care linkage.
Area of Science:
- Hepatology and Viral Hepatitis Research
- Public Health and Preventive Medicine
- Health Services Research
Background:
- Linkage to care for individuals with hepatitis B virus (HBV) infection is a critical challenge in HBV elimination efforts.
- Health check programs identify HBV cases, but specialist referral rates and influencing factors require investigation.
Purpose of the Study:
- To determine the rate of specialist referral for HBV-positive individuals identified through health check programs.
- To identify factors associated with specialist referral in this population.
Main Methods:
- Retrospective study of individuals tested for hepatitis B surface antigen (HBsAg) during hospital health checks from 2014-2023.
- Analysis of clinical data and referral letters from electronic health records.
- Multivariable analysis to identify factors associated with referral.
Main Results:
- Of 673 HBsAg-positive individuals, 47.8% received specialist referral, with a significant annual increase in referral rates (5.0% per year).
- Elevated HBV DNA (≥2000 IU/mL) was strongly associated with referral (aOR 21.42).
- Detectable HBV DNA (<2000 IU/mL) showed a modest association with referral (aOR 1.84).
Conclusions:
- Elevated HBV DNA levels are a key predictor of specialist referral for HBsAg-positive individuals identified in health checks.
- Implementing reflex HBV DNA testing can enhance specialist referral rates.
- Improved referral facilitates crucial linkage to care for HBV-infected patients.
Background And Aims:
Linkage of hepatitis B virus (HBV)-infected individuals to medical care is a major hurdle in the HBV elimination care cascade. This study aimed to investigate the rate and factors influencing specialist referral of HBV cases identified in health check programs.
Methods:
This was a retrospective study among consecutive individuals undergoing health check programs with hepatitis B surface antigen (HBsAg) tested in a hospital from 2014 to 2023. Clinical data were captured from the hospital electronic database. Letter of referral after health check was recorded.
Results:
A total of 28 940 individuals underwent health check with HBsAg tested. Six hundred and seventy-three HBsAg-positive individuals were eligible for analysis. Overall, 322 (47.8%) individuals received referral to hepatology specialist. There was a trend of increasing referral with time over the 10 years; trend slope (95% confidence interval): 5.0% (3.5%-6.4%) per year; p < 0.001. HBV DNA was tested in 207 (30.8%) individuals. On multivariable analysis, with reference to individuals with no HBV DNA tested, HBV DNA ≥ 2000 IU/mL was the strongest independent factor associated with referral (adjusted odds ratio 21.42; 95% confidence interval 8.79-52.24; p < 0.001). Detectable HBV DNA < 2000 IU/mL had a modest association with referral (adjusted odds ratio 1.84; 95% confidence interval 1.08-3.11; p = 0.024).
Conclusions:
Elevated HBV DNA is an important factor associated with specialist referral among HBsAg-positive individuals identified at health check programs. These findings suggest that implementing reflex HBV DNA testing could be a key strategy to improve specialist referral and facilitate linkage to care.
