Mutimer David, Brown Maxine, Logan Jacqueline, Kelgeri Chayarani
Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
J Viral Hepat. 2025 Feb;32(2):e14059. doi: 10.1111/jvh.14059.
Hepatitis B elimination objectives can only be realised if new patient linkage to care is matched by long-term patient retention in care. We previously showed in adult chronic hepatitis B (CHB) patients that retention in care was inferior in younger patients and in patients from non-Asian ethnicities. The present study explores further the rates and determinants of loss to follow-up in a cohort of 271 young patients (aged 16-21 years at baseline). 16% of patients were lost to follow-up after a single consultation, and retention in care at 5 and 10 years was 53.7% and 45.9%, respectively. Retention in care was strongly associated with the source of patient referral and was superior for patients referred from the antenatal clinic and those transitioned from paediatric care (68% retention at 5 years for both sources) compared with those from "other" sources (36% at 5 years). In multivariate analyses, patient source of referral and distance of current residence from the Hepatitis Outpatient Clinic were the significant determinants of loss to follow-up. Retention in care may have been promoted by the transition process for those diagnosed in childhood and by the repeated referral from the antenatal clinic of women who had multiple pregnancies during the observation period. Only 20% of asylum seekers and referrals from genitourinary clinics were retained in follow-up at 10 years from baseline. This identifies a group of patients who do not access medical care, cannot benefit from treatment, and who may constitute a long-term public health risk.
只有在新患者与医疗服务建立联系的同时，患者能够长期接受持续治疗，消除乙肝的目标才能实现。我们之前在成年慢性乙肝（CHB）患者中发现，年轻患者和非亚裔患者的持续治疗情况较差。本研究进一步探讨了271名年轻患者（基线年龄为16 - 21岁）队列中的失访率及其决定因素。16%的患者在单次就诊后失访，5年和10年的持续治疗率分别为53.7%和45.9%。持续治疗与患者转诊来源密切相关，与来自“其他”来源的患者相比，产前诊所转诊的患者以及从儿科护理转诊过来的患者持续治疗情况更好（这两种来源的患者5年持续治疗率均为68%）。在多变量分析中，患者转诊来源和当前居住地与肝病门诊的距离是失访的重要决定因素。对于儿童期确诊的患者，转诊过程以及观察期内多次怀孕的女性从产前诊所的反复转诊可能促进了持续治疗。从基线开始10年后，只有20%的寻求庇护者和来自泌尿生殖科诊所的转诊患者仍在接受随访。这确定了一组无法获得医疗服务、无法从治疗中获益且可能构成长期公共卫生风险的患者。
