Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
Aliment Pharmacol Ther. 2021 Jan;53(1):63-78. doi: 10.1111/apt.16125. Epub 2020 Nov 22.
The World Health Organization (WHO) has set an elimination goal for hepatitis B virus (HBV) by 2030, so a comprehensive review of current HBV testing and care gaps are needed to help formulate solutions and opportunities for action.
To summarise current gaps and barriers, and to propose solutions for HBV prevention, testing and linkage to care in the United States METHODS: Relevant guidelines and studies were reviewed including a systematic review of HCC surveillance adherence.
A total of 64.5 million (95% CI, 61.3-67.5) high-risk US adults had no evidence of HBV immunity. Only 18.6% (95% CI, 13.5-29.9) of privately insured patients with HBV infection have been diagnosed. Among those with known HBV infection, linkage to care rate (33.3%-57%) was poor and the adherence to guidelines regarding anti-viral therapy (30.66% [95% CI, 30.28-31.03]) and HCC surveillance (8%-87%, from a systematic review) were poor with even more concerning data for care and treatment retention. The causes are complex and include lack of access to medical care, lack of physician knowledge, lack of patient health literacy and awareness, linguistic and cultural barriers and fear of stigma.
A 'scale-up' effort is needed to optimise the care continuum to achieve the WHO 2030 targets. As targeted screening policy has leftover 80% of patients undiagnosed, we advocate for universal screening which can help to remove barriers regarding stigma. More active and system level interventions are also needed to improve linkage to care for patients with HBV infection.
世界卫生组织（WHO）设定了 2030 年消除乙型肝炎病毒（HBV）的目标，因此需要全面审查当前的 HBV 检测和护理差距，以帮助制定解决方案和行动机会。
总结当前的差距和障碍，并提出美国 HBV 预防、检测和与护理衔接的解决方案。
综述了相关指南和研究，包括 HCC 监测依从性的系统评价。
共有 6450 万（95%CI，613-675）名美国高危成年人无 HBV 免疫证据。只有 18.6%（95%CI，13.5-29.9）的乙型肝炎病毒感染者有私人保险。在已知乙型肝炎病毒感染者中，与护理衔接的比例（33.3%-57%）较低，抗病毒治疗指南的依从性（30.66%[95%CI，30.28-31.03]）和 HCC 监测（8%-87%，来自系统评价）较差，对护理和治疗保留的担忧更大。原因复杂，包括无法获得医疗保健、医生知识不足、患者健康素养和意识不足、语言和文化障碍以及对耻辱感的恐惧。
需要进行“扩大规模”的努力，以优化护理连续体，实现世卫组织 2030 年的目标。由于有针对性的筛查政策仍有 80%的患者未被诊断，我们提倡进行普遍筛查，这有助于消除耻辱感相关障碍。还需要更积极和系统层面的干预措施，以改善乙型肝炎病毒感染者的护理衔接。
