Kim Thanh Van, Pham Trang Ngoc Doan, Phan Paul, Le Minh Huu Nhat, Le Quan, Nguyen Phuong Thi, Nguyen Ha Thi, Nguyen Dan Xuan, Trang Binh, Cao Chelsea, Gurakar Ahmet, Hoffmann Christopher J, Dao Doan Y
Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Pham Ngoc Thach University of Medicine, Viet Nam.
EClinicalMedicine. 2024 Sep 12;76:102818. doi: 10.1016/j.eclinm.2024.102818. eCollection 2024 Oct.
Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking.
We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components.
7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference = 27.9% [95% Confidence Interval = 3.4-52.4], I = 99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness.
HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets.
Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
通过在初级保健和社区护理环境中有效实施策略来扩大慢性乙型肝炎（CHB）检测对于消除该疾病至关重要。我们的研究旨在确定文献中所有可用策略的有效性，并评估其具体内容和实施结果，从而为未来的规划和政策制定提供参考。
我们进行了一项系统评价和荟萃分析（PROSPERO CRD42023455781），截至2024年6月5日，在Scopus、Embase、PubMed和CINAHL数据库中搜索随机对照试验，这些试验调查了基于初级保健和社区护理的实施策略以促进CHB检测。根据预先设定的纳入标准对研究进行筛选，如果研究被纳入，则使用标准化方案提取其数据。使用ROB-2评估偏倚风险。采用行为改变轮（BCW）框架对实施策略的组成部分进行特征描述。应用随机效应模型汇总各策略的有效性估计值。采用混合效应元回归分析有效性是否因策略的BCW组成部分数量而异。
共识别出7146条独特记录。25项研究符合综述纳入标准，涉及130,598名参与者。19项研究被纳入荟萃分析。低收入和中等收入国家未开展相关研究。仅10项研究（40%）报告了实施结果。基于社区的策略包括由非专业卫生工作者主导的教育（合并风险差异=27.9%[95%置信区间=3.4-52.4]，I²=99.3%）或社交媒体上的众包教育（3.1%[-2.2至8.4]，I²=0.0%）。基于初级保健的策略包括电子警报系统（8.4%[3.7-13.1]，I²=95.0%）和由医疗保健提供者主导的教育（HCPs，62.5%[53.1-71.9]，I²=27.5%）。BCW框架驱动的策略组成部分数量与有效性之间存在显著的剂量反应关系。
由医疗保健提供者主导的教育效果突出，多成分策略越丰富，效果越好。未来的实施策略应考虑关键的背景因素和政策，以实现对消除乙型肝炎目标的可持续影响。
美国巴尔的摩约翰霍普金斯大学医学院肝病学特兰·多尔奇博士后奖学金。
