The Director's Unit, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Division of Medicine, Cairns Hospital, Cairns, Queensland, Australia.
PLoS One. 2020 Sep 3;15(9):e0238719. doi: 10.1371/journal.pone.0238719. eCollection 2020.
Aboriginal and Torres Strait Islander Australians living in remote locations suffer disproportionately from chronic hepatitis B (CHB). Defining the temporospatial epidemiology of the disease-and assessing the ability of local clinicians to deliver optimal care-is crucial to improving patient outcomes in these settings.
The demographic, laboratory and radiology findings in all patients diagnosed with CHB after 1990, and presently residing in remote Far North Queensland (FNQ), tropical Australia, were correlated with their management and clinical course.
Of the 602 patients, 514 (85%) identified as Aboriginal and Torres Strait Islander Australians, 417 (69%) of whom had Torres Strait Islander heritage. Among the 514 Aboriginal and Torres Strait Islander Australians, there were only 61 (12%) born after universal postnatal vaccination was introduced in 1985. Community CHB prevalence varied significantly across the region from 7/1707 (0.4%) in western Cape York to 55/806 (6.8%) in the Eastern Torres Strait Islands. Although 240/602 (40%) are engaged in care, with 65 (27%) meeting criteria for antiviral therapy, only 43 (66%) were receiving this treatment. Among 537 with complete data, 32 (6%) were cirrhotic, of whom 15 (47%) were engaged in care and 10 (33%) were receiving antiviral therapy. Only 64/251 (26%) in whom national guidelines would recommend hepatocellular carcinoma (HCC) surveillance are receiving screening, however, only 20 patients have been diagnosed with HCC since 1999.
Vaccination has had a dramatic effect on CHB prevalence in FNQ in only a generation. However, although engagement in care is the highest in Australia, this is not translating into initiation of antiviral therapy in all those that should be receiving it, increasing their risk of developing cirrhosis and HCC. New strategies are necessary to improve the care of Indigenous Australians living with CHB to reduce the morbidity and mortality of this preventable disease.
居住在偏远地区的澳大利亚原住民和托雷斯海峡岛民（Aboriginal and Torres Strait Islander Australians）中，慢性乙型肝炎（CHB）的发病率不成比例地较高。定义该疾病的时空流行病学，并评估当地临床医生提供最佳护理的能力，对于改善这些人群的患者预后至关重要。
对所有 1990 年后在澳大利亚热带北部远北昆士兰（FNQ）地区被诊断患有 CHB 且目前居住在该地区的患者的人口统计学、实验室和影像学结果进行分析，并将其与治疗和临床病程进行相关性分析。
在 602 名患者中，514 名（85%）为澳大利亚原住民和托雷斯海峡岛民，其中 417 名（69%）具有托雷斯海峡岛民血统。在 514 名澳大利亚原住民和托雷斯海峡岛民中，仅有 61 名（12%）出生于 1985 年普遍开展产后疫苗接种之后。该地区社区 CHB 的患病率差异显著，从西部约克角的 7/1707（0.4%）到东部托雷斯海峡群岛的 55/806（6.8%）。尽管有 240/602 名（40%）患者正在接受治疗，其中 65 名（27%）符合抗病毒治疗标准，但仅有 43 名（66%）接受了该治疗。在 537 名具有完整数据的患者中，有 32 名（6%）患有肝硬化，其中 15 名（47%）正在接受治疗，10 名（33%）接受了抗病毒治疗。尽管有 251 名（64%）患者根据国家指南建议接受肝细胞癌（HCC）监测，但只有 64 名患者正在接受筛查，然而，自 1999 年以来仅有 20 名患者被诊断出 HCC。
在一代人的时间里，疫苗接种对 FNQ 地区的 CHB 患病率产生了巨大影响。然而，尽管澳大利亚的参与治疗率最高，但这并没有转化为所有应接受治疗的患者开始接受抗病毒治疗，这增加了他们发展为肝硬化和 HCC 的风险。需要采取新的策略来改善澳大利亚原住民的 CHB 护理，以降低这种可预防疾病的发病率和死亡率。
