Be Positive: Monash researchers improving screening rates for hepatitis B

Ms Kate Sievert

Improved screening and vaccination rates for chronic hepatitis B in migrant populations in Melbourne is the aim of a project recently recognised as a winner in the One Monash Health Awards.

Project leaders Ms Kate Sievert and Mr Paul O’Neill from the Department of Gastroenterology and Hepatology, Monash Health received the competitive innovation award for their B_e Positive project, that has challenged both healthcare worker and community preconceived ideas about hepatitis B, and how these populations interact with the Australian healthcare system.

Mr Paul O'Neill

Chronic hepatitis B (CHB) is an emerging challenge for healthcare services in Australia. The estimated prevalence of CHB has increased by 50,000 patients in the last 10 years and affects 1% of all Australians.  The long-term complications of CHB include cirrhosis, liver failure, and liver cancer.

“The burden of CHB is over-represented among migrants from endemic countries, indigenous

Australians, intravenous drug users, and prisoners,” said Ms Sievert.  “Early diagnosis and treatment of CHB can reduce the progression to cirrhosis, liver cancer and the need for liver transplantation.”

Despite recommendations for universal testing for CHB among at-risk migrant populations, it is estimated that 30% of chronically infected adults in Australia may be unaware of their disease.

“The B_e Positive project is the first of its kind at Monash Health and the first in Australia to target the Rohingyan, Afghan, and South Sudanese communities using the same model of peer education and leadership among CHB patients.”

 Public Health strategies aimed at these three communities have been virtually non-existent, despite significantly poor health outcomes in each group relative to the wider Australian-born population.

 “Patients born in countries with high CHB prevalence are 6-12 times more likely to be diagnosed with liver cancer compared to Australian-born individuals,” said Ms Sievert.

“It is imperative that targeted healthcare interventions are developed and carried out within at risk populations to prevent the high morbidity and mortality associated with CHB.”

Opportunistic testing for CHB is considered essential as a prevention strategy for liver cancer but there is a lack of targeted public health projects addressing the poor rates of screening and vaccination among these at-risk populations.

Ms Sievert said that language and cultural barriers, lack of awareness of transmission routes, and poor understanding of severity of disease due to the often-times lack of symptoms are some of the factors contributing to low levels of screening and treatment compliance amongst migrant CHB patients.

“Our B_e Positive project focused on the Sudanese, Rohingyan and Afghani migrant population due to the high prevalence of CHB within these groups (8.6-11%), increased resettlement as asylum seekers within the Monash Health catchment area and the lack of any health promotion within these groups,” said Ms Sievert.

“Monash Health serves a large variety of migrant populations in the south-east of Victoria, and we devised a pilot public health intervention within these difficult to engage new migrant communities aimed at reducing future liver cancer burden.”

Using a trained CHB patient leader to tell their story to their own community, stigma and misinformation about CHB was dispelled while culturally relevant information was exchanged.

“We successfully opened conversations about hepatitis B virus (HBV) through SBS radio and community forums, improving the level of HBV knowledge among patients and their wider communities,” said Ms Sievert.

 “Our goal is to increase the rates of testing for HBV across South-east Melbourne and ensure those who may have been living unknowingly with HBV are monitored by the system and treated if required.”

The B_e Positive project has shown that we must continue to engage sensitively with migrant groups with a high prevalence of CHB and we cannot approach every migrant group using the same general strategy.

The project was supervised by Dr Suong Le and Dr Anouk Dev, Consultant Hepatologists at Monash Health. The B_e Positive project was funded by a Bristol Myers Squibb research grant awarded to Monash Health EMR Benefits Clinician Dr Suong Le, who designed the project.