Improving health outcomes of viral Hepatitis in a migrant population of Australia

Migrants to Australia have higher rates of HBV and HCV infection than people born in Australia. Reflecting this, the morbidity and mortality of HBV- and HCV-related complications is disproportionately higher in the culturally and linguistically diverse population (CALD) when compared to Australian-born individuals. The broad aim of this thesis is to examine the factors that may enhance prevention and treatment uptake of viral hepatitis in migrant population and improve their health outcomes. The first project evaluated knowledge, attitudes and educational requirements of general practitioners which may influence management and referral patterns of viral hepatitis. 42% of GPs lacked confidence in interpreting HCV serology. 22% of GPs did not recognise HCC as a complication of HBV and 18% for HCV. 20% of GPs were unaware of treatment for HBV. 47% of GPs were uncertain whether pregnant women could receive HCV treatment. 23% and 21% of respondents believed that all HCV or HBV infected mothers respectively, should not breast feed. In conclusion the responses from the general practitioners were diverse. Overall there were gaps in knowledge pertaining to diagnosis, natural history and complications of viral hepatitis, treatment availability and viral hepatitis in pregnant and lactating women. The second project was a small pilot study whose primary objective was to identify barriers to diagnosis and treatment from the CALD population perspective. CALD outpatients attending viral hepatitis clinic in a teaching hospital were invited to participate in the survey. Language was perceived to be a major barrier in seeking healthcare by 45% of participants. 22% reported cultural barriers such as stigma, differences in perception of health, culture of silence. 40% of participants reported unawareness of availability of treatment for their condition. Perhaps reflecting this, 37% of participants presented in a late stage of disease after development of a complication. These data demonstrate the need for greater dissemination of information in the CALD population in culturally appropriate mediums unique to that population.The final project further examined the consequences of a diagnosis of hepatitis B in the antenatal population. In the antenatal population routine HBV screening occurs to guide preventative measures for the newborn. However, there is scarce information about the consequences of the diagnosis of HBV infection in the antenatal population, the majority of who are from a CALD population. A retrospective study was undertaken in two antenatal clinics servicing a large CALD population. The HBsAg seroprevalence out of 14 857 mothers was 2%. Liver function tests were only performed in 62% of the pregnancies and importantly none of the mothers had HBV viral load measurement. Strikingly, only 6% had documentation of follow up for their diagnosis. This study highlights the potential for counseling and evaluation of HBsAg positive mothers who are a cohort of the CALD population already engaged in healthcare

Treatment responses in Asians and Caucasians with chronic hepatitis C infection

AIM: To conduct a multicentre retrospective review of virological response rates in Asians infected with genotype 1 chronic hepatitis C (CHC) treated with combination interferon and ribavirin and then to compare their responses to that among Caucasians. METHODS: Asian patients infected with genotype 1 CHC treated at 4 Australian centres between 2001 to 2005 were identified through hospital databases. Baseline demographic characteristics, biochemical, virological and histological data and details of treatment were collected. Sustained virological responses (SVR) in this cohort were then compared to that in Caucasian subjects, matched by genotype, age, gender and the stage of hepatic fibrosis. RESULTS: A total of 108 Asians with genotype 1 CHC were identified. The end of treatment response (ETR) for the cohort was 79% while the SVR was 67%. Due to the relatively advanced age of the Asian cohort, only sixty-four subjects could be matched with Caucasians. The ETR among matched Asians and Caucasians was 81% and 56% respectively (P = 0.003), while the SVR rates were 73% and 36% (P < 0.001) respectively. This difference remained significant after adjusting for other predictive variables. CONCLUSION: Genotype 1 CHC in Asian subjects is associated with higher rates of virological response compared to that in Caucasians