Hepatitis B testing, care linkage, and vaccination coverage within a registry of hepatitis C infected patients

Abstract

BACKGROUND: 

Hepatitis B virus (HBV) infection testing among persons with hepatitis C virus (HCV) infection is necessary to appropriately care for these patients, yet uptake of HBV testing and vaccination in this population is suboptimal.

METHODS: 

In a retrospective cohort analysis, we describe the prevalence of hepatitis B testing, linkage to hepatitis B care, and hepatitis B vaccination in patients with HCV infection within a large urban safety-net health system. Using a registry of HCV-infected patients with patient-level electronic health record data, that included demographic, clinical, and laboratory information from 2004 to 2016 from Grady Health System in Atlanta, GA, we describe (1) The prevalence of hepatitis B testing (hepatitis B surface antigen [HBsAg], core antibody [anti-HBc], surface antibody [anti-HBs]); (2) The proportion of HBsAg-positive persons receiving HBV DNA and e-antigen (HBeAg) as indicators for linkage to hepatitis B-directed care; and (3) The proportion of persons receiving hepatitis B vaccine.

RESULTS: 

Of 4224 HCV-infected patients, 3629 (86%) had test results for HBsAg and 43 (1.2%) were HBsAg-positive. Of 2342 (55%) with test results for all three HBV serological markers, median age was 60 years, 67% were male, and 83% were African-American, 789 (34%) anti-HBc positive only, 678 (29%) anti-HBc/anti-HBs positive, 190 (8.1%) anti-HBs positive only, and 642 (27%) were HBV-susceptible. Of HBsAg-positive patients, 21% received HBV DNA and 40% HBeAg testing. The proportion of HBV-susceptible patients receiving at least 1 dose of hepatitis B vaccine was 322/642 (50%).

 

CONCLUSIONS: 

In a large cohort of HCV-infected patients, we found a high prevalence of current or past HBV infection, but there were gaps in complete hepatitis B testing, hepatitis B-directed care, and hepatitis B vaccination. Strategies are needed to increase hepatitis B testing, linkage to care, and administration of the hepatitis B vaccine for HCV-infected persons in this healthcare system.

Authors

Harris AM1, Millman AJ2, Lora M3, Osinubi A4, Lom J5, Miller LS6.

 

Vaccine. 2019 Apr 10;37(16):2188-2193. doi: 10.1016/j.vaccine.2019.03.012. Epub 2019 Mar 19.

Author Information

  1. Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: amharris@cdc.gov.

  2. Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: irm6@cdc.gov.

  3. Emory University School of Medicine, Atlanta, GA, USA. Electronic address: Meredith.lora@emory.edu.

  4. Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: nkg5@cdc.gov.

  5. Emory University School of Medicine, Atlanta, GA, USA. Electronic address: Jennifer.elizabeth.lom@emory.edu.

  6. Emory University School of Medicine, Atlanta, GA, USA. Electronic address: lesley.miller@emory.edu.

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