A pilot programme of community volunteers to improve hepatitis B medication adherence, Kiribati, 2025

Antiviral therapy for chronic hepatitis B (CHB) reduces morbidity and mortality and improves quality of life. Achieving high levels of adherence is challenging due to multiple barriers, including medication fatigue, stigma, transportation and limited health literacy.

Suboptimal adherence to antiviral therapy for CHB is problematic in Kiribati, particularly among high-risk groups including pregnant women and individuals with cirrhosis.

During January-August 2025, a community volunteer intervention was initiated on Kiritimati, a remote island of Kiribati, to address adherence to CHB antiviral therapy. Community volunteers were assigned to patients positive for hepatitis B surface antigen who were commencing antiviral therapy and were pregnant or had cirrhosis. During home visits, volunteers provided education and encouraged medication adherence and clinic follow-up. Adherence in the intervention group was compared with adherence in positive patients being treated on other remote islands without the intervention.

Adherence was measured by medication bottle counts. Outcomes were assessed by overall group adherence and individual adherence > 80%. Group adherence was 77.4% (240.5/310.75) in the volunteer intervention group compared with 52.5% (700/1333) in the group without it (P < 0.001). Overall adherence among pregnant women in the intervention group was 89.7% (52/58). Individual adherence > 80% was met in 58.8% (30/51) of the intervention group and 34.1% (70/205) in the control group (P = 0.0012).

Although findings are preliminary and the intervention and control groups were not matched, this pilot suggests community volunteers are a promising intervention to improve CHB treatment adherence in a high-prevalence Pacific island setting. This strategy could also be explored for other chronic conditions where adherence is important.