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Barriers to Hepatitis B Treatment: A Multicentre Cross-Sectional Registry and Survey Study by the Canadian Hepatitis
Hin Hin Ko1,2, Jordyn Vienneau3, Curtis L Cooper4
1Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
A significant treatment gap exists for chronic hepatitis B (CHB) patients in Canada. This study highlights demographic disparities and differing patient-physician views on treatment barriers, impacting care.
Area of Science:
- Hepatology
- Public Health
- Clinical Research
Background:
- Chronic hepatitis B (CHB) is a major global cause of liver disease, yet treatment rates are low.
- Suboptimal treatment uptake persists even in well-resourced healthcare systems.
- Identifying and addressing treatment gaps is crucial for managing CHB complications like cirrhosis and hepatocellular carcinoma (HCC).
Purpose of the Study:
- To quantify treatment gaps in the Canadian Hepatitis B Network (CanHepB) Registry.
- To compare the characteristics of patients eligible for CHB treatment but not receiving it versus those undergoing therapy.
- To explore patient and specialist perspectives on barriers to CHB treatment.
Main Methods:
- A retrospective analysis of 1983 adults with CHB across 18 Canadian specialty clinics (2018-2024).
- Treatment eligibility assessed using 2018 Canadian Association for the Study of the Liver guidelines.
- Anonymous surveys collected patient (n=191) and specialist (n=54) views on treatment barriers.
Main Results:
- Of 881 untreated patients, 46.4% were eligible for treatment.
- Treatment-eligible, untreated patients were younger, more often female, and from Black/African/Caribbean backgrounds compared to treated patients.
- Untreated patients cited concerns about side effects and long-term therapy; specialists identified cost as the main barrier.
Conclusions:
- A substantial treatment gap in CHB care was identified across Canada.
- Demographic disparities contribute significantly to this gap.
- A mismatch exists between patient concerns (e.g., side effects) and clinician-perceived barriers (e.g., cost), hindering optimal CHB management.
Background & Aims:
Chronic hepatitis B (CHB) remains a leading cause of cirrhosis and hepatocellular carcinoma (HCC) worldwide, yet treatment uptake is suboptimal even in high-resource settings. This pan-Canadian study aimed to quantify treatment gaps within the Canadian Hepatitis B Network (CanHepB) Registry, compare characteristics of treatment-eligible but untreated patients to those receiving therapy, and assess patient and specialist perspectives on barriers to treatment.
Methods:
A cross-sectional, retrospective analysis of 1983 adults with CHB followed in 18 Canadian hepatitis B specialty clinics between January 2018 and November 2024. Treatment eligibility was determined using the 2018 Canadian Association for the Study of the Liver guidelines. An anonymous survey captured patient-reported barriers and perspectives (n = 191), while a separate survey evaluated specialist perceptions (n = 54).
Results:
Among 881 untreated patients, 46.4% (n = 409) were treatment eligible. Compared with the treatment group (n = 1087), the treatment-eligible but untreated patients were younger (median 47.3 vs. 54.5 years), more frequently female (54.2% vs. 39.7%), and more likely to be of Black/African/Caribbean origin (18.2% vs. 9.7%). They had a lower prevalence of cirrhosis (2.4% vs. 20.3%), HCC (0.7% vs. 9.3%), and hypertension (17.1% vs. 22.9%), but a higher prevalence of steatotic liver disease (36.4% vs. 24.6%) and dyslipidemia (14.7% vs. 10.8%). Among untreated respondents, concerns included side effects, the need for long-term therapy, and lack of curative options. Conversely, specialists identified cost as the primary barrier and side effects as the least concerning.
Conclusion:
This nationwide study reveals a significant treatment gap in CHB care, driven by demographic disparities and a mismatch between patient concerns and clinician perceptions.
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