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Broady TR, Drysdale K, Brener L, Schroeder S, Marshall AD, Lafferty L, Higgs P, Baldry E, Dietze P, Stoove M, Treloar C. Using theory-informed, arts-based research translation to change community attitudes towards people who inject drugs newly released from prison: A randomised controlled trial. Public Health 2025; 242:103-110. [PMID: 40054291 DOI: 10.1016/j.puhe.2025.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 01/23/2025] [Accepted: 02/17/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVES Community attitudes contribute to social exclusion of people with incarceration and injecting drug use histories. Interventions that positively impact community attitudes can strengthen efforts to reduce recidivism and support positive outcomes. This study aimed to investigate the impact of such interventions on public perceptions towards people who inject drugs newly released from prison. STUDY DESIGN Randomised controlled trial. METHOD A narrative script on the theme of "exhaustion" was produced from an interview study of post-release experiences. Members of the public participated in a three-armed randomised controlled trial: (1) control; (2) neutral intervention (plain English description); (3) narrative intervention (scripted performance). Surveys administered at baseline, post-intervention, and three-month follow-up measured perceptions of the target group through four key dimensions of stigma. Qualitative interviews were conducted with 24 participants to further investigate responses to the narrative intervention. RESULTS 1071 participants completed all phases of the trial. Post-intervention scores indicated more positive perceptions among participants in the neutral and narrative intervention arms than the control arm. Effects were mostly more positive for the narrative intervention arm. At follow-up, scores for the neutral intervention arm indicated more positive perceptions than the control arm on the Opinions scale, while the narrative intervention arm recorded more positive perceptions than the control arm on both Opinions and Attitudes scales. Interviews indicated that participants who were not influenced by the narrative intervention believed that people who inject drugs should be held accountable for not controlling their drug use. CONCLUSION Research-informed, co-designed, arts-based interventions can positively impact public perceptions of a highly stigmatised group. Effects of the interventions attenuated over time, suggesting a need for further interventions focusing on perceptions of controllability of drug use.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Australia; Australian Human Rights Institute, UNSW Sydney, Australia.
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Australia; Australian Human Rights Institute, UNSW Sydney, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Sophia Schroeder
- Disease Elimination Program, Burnet Institute, Australia; School of Public Health and Preventative Medicine, Monash University, Australia
| | - Alison D Marshall
- Centre for Social Research in Health, UNSW Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Australia; Department of Public Health, La Trobe University, Australia
| | - Eileen Baldry
- Professor Emerita Criminology, Law & Justice, UNSW Sydney, Australia
| | - Paul Dietze
- Disease Elimination Program, Burnet Institute, Australia; School of Public Health and Preventative Medicine, Monash University, Australia; National Drug Research Institute, Curtin University, Australia
| | - Mark Stoove
- Disease Elimination Program, Burnet Institute, Australia; School of Public Health and Preventative Medicine, Monash University, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Rabaan AA, Bello KE, Radwan Z, Hassouneh AK, Alrasheed HA, Alotaibi J, Basrana B, Zaidan AA, Garout MA, Zaidan TI, Al Amri KA, Alshaikh SA, Al Alawi KH, A. Alalqam R, Tombuloglu H, Bouafia NA. The Dual Burden of Hepatitis B and C Among Drug Users in Asia: The First Systematic Review and Meta-Analysis. Pathogens 2025; 14:360. [PMID: 40333162 PMCID: PMC12030361 DOI: 10.3390/pathogens14040360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 03/26/2025] [Accepted: 03/31/2025] [Indexed: 05/09/2025] Open
Abstract
Hepatitis B virus (HBV) and Hepatitis C virus (HCV) contribute significantly to morbidity and mortality among drug users in Asia. This study systematically reviews and analyzes the pooled prevalence of HBV and HCV, considering geographic and methodological variations. A meta-analysis following PRISMA guidelines included data from PubMed, Scopus, and Google Scholar on studies on HBV or HCV or a combination of both within Asia. A random-effects model estimated pooled prevalence, with subgroup analyses by region, study design, diagnostic method, and publication year. A total of 112 studies were analyzed. The pooled HBV prevalence among drug users was 14.3% (95% CI: 11.5-17.6), highest in Malaysia (28.7%) and Vietnam (26.6%). HCV prevalence was 58.6% (95% CI: 54.0-63.0), with the highest rates in Vietnam (63.5%) and China (62.9%). Retrospective studies reported a higher prevalence than cross-sectional ones. The use of ELISA for initial screening followed up by PCR reduced heterogeneity, improving diagnostic accuracy. HBV prevalence declined after 2010, while HCV rates remained persistently high. The high burden of HBV and HCV among drug users in Asia underscores an urgent public health concern. Targeted interventions, including vaccination, harm reduction strategies, and improved access to antiviral treatments, are essential to curbing transmission and enhancing health outcomes.
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Affiliation(s)
- Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Kizito E. Bello
- Department of Microbiology, Kogi State (Prince Abubakar Audu) University, Anyigba 10008, Nigeria;
| | - Zaheda Radwan
- Medical Laboratory Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia;
| | - Amal K. Hassouneh
- Clinical Pharmacy Department, King Saud Medical City, Riyadh 11362, Saudi Arabia;
| | - Hayam A. Alrasheed
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Jawaher Alotaibi
- Infectious Diseases Unit, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Bashayer Basrana
- Department of Infectious Disease, King Abdullah Medical Complex, Jeddah 6725, Saudi Arabia;
| | - Ali A. Zaidan
- Gastroenterology Department, King Fahad Armed Forces Hospital, Jeddah 23831, Saudi Arabia;
| | - Mohammed A. Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Tasneem I. Zaidan
- Pediatric Infectious Diseases Unit, Pediatric Department, King Abdulaziz Hospital, Jeddah 23831, Saudi Arabia;
| | | | - Sana A. Alshaikh
- Diagnostic Virology Laboratory, Maternity and Children Hospital, Eastern Health Cluster, Dammam 32253, Saudi Arabia;
| | - Kawthar Haider Al Alawi
- Nursing Department of Vaccine Clinic, Hospital: Al Jamaeen Primary Health Care, Dammam 32467, Saudi Arabia;
| | - Razi A. Alalqam
- Department of Medicine, Royal College of Surgeons, D02 YN77 Dublin, Ireland;
| | - Huseyin Tombuloglu
- Department of Genetics Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Nabiha A. Bouafia
- Infection Prevention and Control Centre of Excellence, Prince Sultan Medical Military City, Riyadh 12233, Saudi Arabia
- Preventive and Community Medicine Department, Faculty of Medicine, University of Sousse, Sousse 4002, Tunisia
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Lee G, Juon H, Kim E, Smith KC, Hann HW, Chang M, Klassen AC. HBV Transmission Knowledge Among Korean-American Chronic Hepatitis B Patients in the United States. J Community Health 2025; 50:306-316. [PMID: 39487356 PMCID: PMC11937223 DOI: 10.1007/s10900-024-01412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 11/04/2024]
Abstract
Chronic hepatitis B (CHB) is a condition that disproportionately affects Asian Americans in the United States. Knowledge of transmission is crucial for CHB patients to practice prevention methods to limit the spread of the hepatitis B virus (HBV), but also live their lives free from unwarranted fears or restrictions. Among Asian CHB patients, several misperceptions about HBV transmission have been identified. This analysis aims to assess the current state of HBV knowledge among a cohort of Korean-American CHB patients. This mixed-methods study includes 363 respondents who completed a survey in either Korean (N = 298) or English (N = 65) at two clinical care settings in Philadelphia (N = 161) and Los Angeles (N = 202); 30 participants also completed in-depth interviews. Knowledge was measured on a 10-point scale, asking patients yes or no transmission questions (n = 10, alpha = 0.87). The average knowledge score was 6.3. In multivariate analyses, older age was associated with lower knowledge (β=-0.25, p < 0.001). More years of formal education (β = 0.09, p = 0.076) and utilizing more sources for health information (β = 0.12, p = 0.023) were both independently associated with higher knowledge scores. Qualitative findings show that misperceptions about transmission through shared food still exist and that provider communication is an important part of knowledge acquisition. These results suggest that despite receiving specialized, culturally concordant medical care for their disease, some Korean-American CHB patients have an inadequate understanding of transmission and that opportunities exist to improve education in this population. Identifying additional factors that influence knowledge acquisition and retention is key to developing culturally effective education interventions for this population.
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Affiliation(s)
- Giyoung Lee
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
| | - HeeSoon Juon
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eunji Kim
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
| | - Katherine C Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hie-Won Hann
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | - Mimi Chang
- Asian Pacific Liver Center, Coalition of Inclusive Medicine, Los Angeles, CA, USA
| | - Ann C Klassen
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA.
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Bhattacharya H, Pattnaik M, Swain A, Padhi A, Rout UK, Pradhan R, Ak K, Kshatri JS, Bhattacharya D, Pati S. Assessing Hepatitis B virus infection, risk factors and immunization among particularly vulnerable tribal groups in Eastern India. Sci Rep 2025; 15:8388. [PMID: 40069229 PMCID: PMC11897223 DOI: 10.1038/s41598-025-91486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 02/20/2025] [Indexed: 03/15/2025] Open
Abstract
In a population-based survey, Hepatitis B virus (HBV) infection status, associated risk factors and vaccine coverage among the 4006 Particularly Vulnerable Tribal Groups (PVTG) participants of Odisha Tribal Family Health Survey (OTFHS) were assessed using various viral markers. All the HBsAg-positive sera were screened for viral load estimation, envelopment antigen (HBeAg) identification and liver profile parameters. The overall prevalence of HBsAg was 5.73% and the Kutia Khond tribes showed highest prevalence (17.85%; 95% CI:17.41-18.29) of HBsAg. Only 2.7% of children born following the implementation of hepatitis B vaccination were HBsAg positive. Among the children between 0 and 36 months, the vaccination coverage was 91% and mean Anti-HBs titre was 142.56 mIU/ml. Tattooing and piercing were found to be positively associated with high HBsAg positivity. Abnormal liver function (high SGOT and SGPT) occurred more often in HBeAg positive with high viral loads (> 2000 IU/ml). Given the high prevalence of HBV DNA with active viral replication, a strategy for regular monitoring and treatment of these individuals combined with risk factor management and health education in this indigenous population is urgently needed.
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Affiliation(s)
- Haimanti Bhattacharya
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Matrujyoti Pattnaik
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Aparajita Swain
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
- Utkal University, Vani Vihar, Bhubaneswar, 751004, Odisha, India
| | - Ankita Padhi
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Usha Kiran Rout
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Rashmita Pradhan
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Kavitha Ak
- ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Jaya Singh Kshatri
- ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Debdutta Bhattacharya
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India.
- Faculty of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India.
| | - Sanghamitra Pati
- Department of Microbiology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India.
- Faculty of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India.
- Indian Council of Medical Research, New Delhi, 110029, India.
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Juon H, Yang D, Fang CX, Hann H, Bae H, Chang M, Klassen AC. Perceived HBV-Related Stigma Is Associated With Lower Antiviral Medication Adherence in Patients With Chronic Hepatitis B. J Viral Hepat 2025; 32:e70010. [PMID: 39953814 PMCID: PMC11829210 DOI: 10.1111/jvh.70010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 01/31/2025] [Accepted: 02/03/2025] [Indexed: 02/17/2025]
Abstract
Medication nonadherence among patients with chronic hepatitis B (CHB) can lead to severe liver disease progression, including liver cirrhosis and hepatocellular carcinoma (HCC). Yet the factors that influence adherence in high-risk groups, like Korean Americans, remain unclear. Thus, this study explored the psychosocial and clinical factors affecting medication adherence in CHB patients. A cohort of 365 Korean American patients with CHB from two clinics in Philadelphia and Los Angeles was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) gauged their adherence to antiviral medication. Using descriptive and multivariable logistic regression analyses, we identified factors associated with MMAS-8 scores. Of the participants, 78% were undergoing antiviral therapy, with over two-thirds (69%) reporting medium to high adherence levels. The multivariable logistic regression analysis revealed that age, knowledge of sequalae of CHB, perceived HBV stigma and possession of pharmacy plan were associated with medication adherence. Older participants had higher medication adherence than younger. High knowledge of sequalae of CHB and low perceived HBV stigma were associated with higher medication adherence. Having pharmacy plans was also associated with higher medication adherence to antiviral therapy. These findings highlight the critical role of person-related factors (e.g., knowledge and stigma) and healthcare factors in medication adherence. Future research should focus on developing targeted educational interventions focusing on personal factors to improve medication adherence among Korean American patients with CHB.
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Affiliation(s)
- Hee‐Soon Juon
- Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Daniel Yang
- Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Cindy Xin Fang
- Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Hie‐Won Hann
- Liver Disease Prevention CenterThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Ho Bae
- Asian Pacific Liver CenterCoalition of Inclusive MedicineLos AngelesCaliforniaUSA
| | - Mimi Chang
- Asian Pacific Liver CenterCoalition of Inclusive MedicineLos AngelesCaliforniaUSA
| | - Ann C. Klassen
- Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
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Chu RV, Sarnala S, Doan TV, Jamal A, Phadke A, So S, So R, Pham H, Chaudhary J, Huang R, Kim G, Palaniappan L, Kim K, Srinivasan M. Feasibility and Acceptability of Universal Adult Screening for Chronic Hepatitis B in Primary Care Clinics. AJPM FOCUS 2024; 3:100240. [PMID: 39582739 PMCID: PMC11584556 DOI: 10.1016/j.focus.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
Introduction Two thirds of Americans infected with chronic hepatitis B are unaware of their infection. In March 2023, the Centers for Disease Control and Prevention recommended moving from risk-based to universal adult chronic hepatitis B screening. In April 2022, Stanford implemented chronic hepatitis B universal screening discussion alerts for primary care providers. Methods After 6 months, the authors surveyed 143 primary care providers at 13 Stanford primary care clinics about universal chronic hepatitis B screening acceptability and implementation feasibility. They conducted semistructured interviews with 15 primary care providers and 5 medical assistants around alerts and chronic hepatitis B universal versus risk-based screening. Results Forty-five percent of surveyed primary care providers responded. A total of 63% reported that universal screening would identify more patients with chronic hepatitis B. Before implementation, 77% ordered 0-5 chronic hepatitis B screenings per month. After implementation, 71% ordered >6 screenings per month. A total of 66% shared that universal screening removed the stigma around discussing high-risk behaviors. Interview themes included (1) low clinical burden, (2) current underscreening of at-risk groups, (3) providers preferring universal screening, (4) patients accepting universal screening, and (5) ease of chronic hepatitis B alert implementation. Conclusions Consistent with Centers for Disease Control and Prevention guidelines, implementing universal chronic hepatitis B screening in primary care clinics in Northern California was feasible, was acceptable to providers and patients, eased health maintenance burdens, and improved clinic workflows.
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Affiliation(s)
- Richie V. Chu
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
- Department of Asian American Studies, College of Social Sciences, University of California Los Angeles, Los Angeles, California
| | - Sai Sarnala
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Chemistry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thanh Viet Doan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Armaan Jamal
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anuradha Phadke
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sam So
- Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Asian Liver Cancer Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Richard So
- Asian Liver Cancer Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
- San Francisco Hep B Free, San Francisco, California
| | - Hang Pham
- Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Asian Liver Cancer Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Joceliza Chaudhary
- Primary Care Clinical Services, Stanford University Medical Partners, Los Gatos, California
| | - Robert Huang
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Asian Liver Cancer Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Gloria Kim
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Karina Kim
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Brener L, Horwitz R, Cama E, Vu HMK, Jin D, Wu KOE, Rance J, Broady T, Treloar C, Mao L, Okeke S, Bryant J. Understanding stigma and attitudes towards hepatitis B among university students in Australia of Chinese and Vietnamese background. BMC Public Health 2024; 24:2801. [PMID: 39396947 PMCID: PMC11472463 DOI: 10.1186/s12889-024-20226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 09/30/2024] [Indexed: 10/15/2024] Open
Abstract
INTRODUCTION Hepatitis B is a significant public health concern and a leading cause of liver cancer across the world. In Australia, hepatitis B is largely endemic in migrant communities, particularly amongst the Chinese and Vietnamese communities. Negative attitudes towards hepatitis B can be a major barrier to hepatitis B testing and linkage to care. This mixed-methods research explores the attitudes and beliefs, including stigma, about hepatitis B among students of Vietnamese and Chinese background in Australia. Students were chosen as participants as there is little research examining hepatitis B among university students in Australia and they provide a point of entry to communities with high prevalence of hepatitis B, that otherwise may be hard to access. METHODS Online surveys were distributed in Chinese, Vietnamese, and English via social media and completed by 112 students of Chinese and 95 students of Vietnamese backgrounds. In-depth interviews were also conducted with 13 Vietnamese and 10 Chinese participants to further explore the survey results. RESULTS Survey findings suggest that students have varied attitudes towards people living with hepatitis B. Around half of the participants reported they would behave negatively towards other people with hepatitis B and that they would expect to experience stigma or discrimination if they had hepatitis B. While over 70% in both samples reported that people who have hepatitis B should not be isolated by family and friends, 47.6% of the Chinese sample and 28.3% of the Vietnamese sample reported they would avoid close contact with someone with hepatitis B. The qualitative data expands on the quantitative data. Four key themes were identified: (1) Caution not discrimination (2) Hepatitis B as a sign of immoral behaviour (3) Discriminatory behaviour based on perceived effects of hepatitis B and (4) Shifting attitudes. CONCLUSION This research provides insights that could inform culturally sensitive health promotion programs to address negative attitudes towards hepatitis B among the broader Chinese and Vietnamese communities living in Australia.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia.
| | - Robyn Horwitz
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Elena Cama
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Hoang Minh Khoi Vu
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Defeng Jin
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Kwok On Eric Wu
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Jake Rance
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Timothy Broady
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Sylvester Okeke
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia
| | - Joanne Bryant
- School of Social Sciences, University of New South Wales, Sydney, 2052, Australia
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Sullivan RP, Bukulatjpi SM, Binks P, Hosking K, Nundhirribala P, Vintour-Cesar E, McKinnon M, Gurruwiwi G, Green A, Davis JS, Davies J. "They feel shame sometime, but that is why we need to talk to them…we need to tell them how important it is not to feel shame": Hepatitis B related shame and improving hepatitis B care in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory, according to the Aboriginal health workforce. Arch Public Health 2024; 82:151. [PMID: 39261962 PMCID: PMC11389596 DOI: 10.1186/s13690-024-01389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The Aboriginal health workforce has unique insights given their healthcare experience and interactions with their communities. The aims of this project were to explore their perceptions of hepatitis B related shame and ways to improve hepatitis B care in Aboriginal and Torres Strait Islander communities of Northern Territory's Top End, Australia. METHODS We conducted a qualitative study with guidance from the Menzies School of Health Research Infectious Diseases Indigenous Reference Group. The Aboriginal health workforce was asked to participate in semi-structured interviews exploring hepatitis B related shame and ways to improve hepatitis B care. Qualitative data were evaluated using reflexive thematic analysis. RESULTS There were fifteen semi-structured interviews with participants representing eight different communities. The experience of shame was reported by the Aboriginal health workforce to be common for individuals diagnosed with hepatitis B and comprised feelings of fear related to transmitting the virus, to being isolated, and to being at fault. Shame was mediated by poor health literacy, communication, the lack of culturally safe spaces and was perpetuated by intersecting stereotypes. Improvements in care can be achieved by utilising the Aboriginal health workforce more effectively, improving communication and the availability of culturally safe spaces, emphasising community connection, and reframing hepatitis B as a chronic condition. CONCLUSIONS Hepatitis B related shame was an important issue and impactful in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory. There were many facets to shame in these communities and it was mediated by several factors. The Aboriginal health workforce has emphasised several pathways to improve care and diminish the impact of shame, such as improving communication and the availability of culturally safe spaces.
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Affiliation(s)
- Richard P Sullivan
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia.
- Department of Infectious Diseases and Immunology, St George and Sutherland Hospital, School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales (NSW), Australia.
| | | | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - Kelly Hosking
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
- Population and Primary Health Care, Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | | | - Emily Vintour-Cesar
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - Melita McKinnon
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - George Gurruwiwi
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - Anna Green
- University of Southern Queensland, Toowoomba, Queensland, Australia
- University of Technology Sydney, Sydney, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
- Infection Research Program, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Jane Davies
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Casuarina, NT, Australia
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9
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Cama E, Brener L, Horwitz R, Broady TR, Khoi Vu HM, Jin D, Wu KOE, Treloar C. Factors associated with hepatitis B knowledge among people of Vietnamese ethnicity in Australia. PSYCHOL HEALTH MED 2024; 29:1536-1547. [PMID: 38762748 DOI: 10.1080/13548506.2024.2350703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
Despite high hepatitis B (HBV) prevalence among people of Vietnamese ethnicity in Australia and elsewhere, there is limited research on levels of HBV knowledge and factors associated with such knowledge. The aim of this study was to examine HBV knowledge and associated demographic and attitudinal factors among people of Vietnamese ethnicity in Australia. People of Vietnamese ethnicity (n = 966) were recruited through community events and social media groups to complete online surveys measuring HBV knowledge, attitudes towards HBV, levels of mistrust in Western medicine, and demographic characteristics. Findings of this study indicate that levels of knowledge are mixed, with gaps in knowledge related to transmission and treatment of the virus. Those with greater knowledge of HBV tended to be older, have higher levels of formal education, have been tested for HBV, and know someone living with HBV. Those with lower levels of knowledge tended to have more negative attitudes towards the virus and greater levels of mistrust in Western medicine. Given that health literacy is connected to effective communication from health providers, we suggest that there is a need for the development of health promotion and education resources targeted at people of Vietnamese ethnicity and translated into Vietnamese. We propose that such resources be developed in consultation with Vietnamese communities and health providers to ensure that they are culturally appropriate and sensitive to people of Vietnamese ethnicity living in Australia.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Robyn Horwitz
- Centre for Social Research in Health, UNSW Sydney, Australia
| | | | | | - Defeng Jin
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - K O E Wu
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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10
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Ali M, Tucker JD, Kpokiri EE, Wu D, Rahman MA, Mia T, Chowdhury MSA, Ahmed F, Hakim HAN, Paiker ZM, Nuha NJ. Crowdsourcing to increase hepatitis B and C testing and reduce hepatitis stigma among medical students in Bangladesh. J Viral Hepat 2024; 31:404-408. [PMID: 38679925 DOI: 10.1111/jvh.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/26/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
This study addresses the pervasive challenges of low hepatitis B (HBV) and hepatitis C (HCV) testing rates coupled with the stigma associated with these diseases in low- and middle-income countries (LMICs) with a special focus on Bangladesh. This study aims to introduce an innovative crowdsourcing intervention that involves medical students, a crucial cohort with the potential to shape healthcare attitudes. Through a structured crowdsourcing approach, the study designs and implements a digital intervention to counter stigma and promote testing among medical students in Dhaka, Bangladesh. Participants submitted brief videos or texts aiming to encourage hepatitis testing and reduce stigma. The call, advertised through meetings, emails, and social media, welcomed entries in English or Bengali over 3 weeks. A panel of six judges evaluated each entry based on clarity, impact potential, innovation, feasibility, and sustainability, awarding prizes to students behind the highest-rated submissions. Seventeen videos and four text messages received an average score of 5.5 among 440 surveyed medical students, predominantly 22 years old (16%) and in their fourth year (21%). After viewing, 360 students underwent screening, identifying two previously undiagnosed HBV cases referred for care; no HCV infections were found. Notably, 41% expressed concerns about individuals with HBV working in hospitals or having a doctor living with HBV. In conclusion, this pilot showcases the power of medical students in spearheading campaigns to counter hepatitis stigma and encourage testing. By utilizing crowdsourcing, the study introduces an innovative approach to a persistent issue in LMICs specially in Bangladesh, offering a model that could potentially be adapted by other regions grappling with similar challenges.
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Affiliation(s)
- Mohammad Ali
- National Liver Foundation of Bangladesh, Dhaka, Bangladesh
| | - Joseph D Tucker
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Global Health and Infectious Diseases, Chapel Hill, North Carolina, USA
| | - Eneyi E Kpokiri
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dan Wu
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Medicine, Nanjing Medical University, Nanjing, China
| | | | - Titu Mia
- Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, Dhaka, Bangladesh
| | | | - Faroque Ahmed
- Department of Hepatology, Dhaka Medical College, Dhaka, Bangladesh
| | - H A Nazmul Hakim
- Department of Surgery of Dhaka Medical College, Dhaka, Bangladesh
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11
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Katcher JG, Klassen AC, Hann HW, Chang M, Juon HS. Racial discrimination, knowledge, and health outcomes: The mediating role of hepatitis B-related stigma among patients with chronic hepatitis B. J Viral Hepat 2024; 31:248-254. [PMID: 38409935 PMCID: PMC11023788 DOI: 10.1111/jvh.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
It is well described in current literature that Hepatitis B virus (HBV) affects Asian Americans more than any other racial group in the United States and that there is a stigma attached to this condition. The effects of stigma can be lasting, penetrating physiologically and psychologically, yet few studies have focused on the consequences of this phenomenon. The purpose of this study was to examine the mediating role of stigma in the effect of racial discrimination and knowledge (of HBV sequelae) on health status of Korean Americans with chronic hepatitis B (CHB). Three hundred sixty-five CHB patients were recruited and enrolled from two clinics in Philadelphia and Los Angeles. Depressive symptoms were measured using the Patient Health Question-9 (PHQ-9), physical health via self-rated health survey and stigma via hepatitis B quality of life (HBQOL)-stigma survey. Perceived racial discrimination and knowledge of CHB sequelae were independent variables. The cohort had an average age of 60.1 years (range 19-84, SD 10.7), 56% were male and 94% were born in South Korea. Mediational analysis found that stigma was a significant mediator between both racial discrimination (indirect effect = .037, Bootstrap 95% CI = [.010-.064]) and sequelae knowledge (indirect effect = .097, Bootstrap 95% CI = [.018-.176]) and depressive symptoms. Stigma also had a direct effect on depressive symptoms (β = .136, p < .01) and self-rated health (β = .018, p < .05). In addition, age, gender, education and employment were related to health outcomes. The findings of this study indicate that HBV-related stigma is an important mediator of mental health outcomes in this population. Future studies should identify other psychosocial factors to develop effective intervention programs to reduce stigma and improve quality of life among CHB patients.
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Affiliation(s)
- Julia G. Katcher
- Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA 19107
| | - Ann C. Klassen
- Dornsife School of Public Health, Drexel University, Philadelphia,
PA 19104
| | - Hie-Won Hann
- Liver Disease Prevention Center, Thomas Jefferson University
Hospital, Philadelphia, PA 19107
| | - Mimi Chang
- Asian Pacific Liver Center, Coalition of Inclusive Medicine, Los
Angeles, CA 90020
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University,
Philadelphia, PA 19107
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12
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Toumi M, Wallace J, Cohen C, Marshall C, Kitchen H, Macey J, Pegram H, Slagle AF, Gish RG, Ning Q, Yatsuhashi H, Cornberg M, Brunetto M, van Bömmel F, Xie Q, Lee D, Habuka N, Sbarigia U, Beumont-Mauviel M, Keever AV, Takahashi Y, Lu Y, Liu A, Chen Q, Ito T, Radunz O, Puggina A, Hilgard G, Chan EKH, Wang S. Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States. BMC Public Health 2024; 24:611. [PMID: 38408941 PMCID: PMC10895774 DOI: 10.1186/s12889-023-17263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/19/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND People with chronic hepatitis B (CHB) commonly experience social and self-stigma. This study sought to understand the impacts of CHB-related stigma and a functional cure on stigma. METHODS Adults with CHB with a wide range of age and education were recruited from 5 countries and participated in 90-minute qualitative, semi-structured interviews to explore concepts related to CHB-associated stigma and its impact. Participants answered open-ended concept-elicitation questions regarding their experience of social and self-stigma, and the potential impact of reduced CHB-related stigma. RESULTS Sixty-three participants aged 25 to 71 years (15 from the United States and 12 each from China, Germany, Italy, and Japan) reported emotional, lifestyle, and social impacts of living with CHB, including prejudice, marginalization, and negative relationship and work experiences. Self-stigma led to low self-esteem, concealment of CHB status, and social withdrawal. Most participants stated a functional cure for hepatitis B would reduce self-stigma. CONCLUSIONS CHB-related social and self-stigma are widely prevalent and affect many aspects of life. A functional cure for hepatitis B may reduce social and self-stigma and substantially improve the health-related quality of life of people with CHB. Incorporating stigma into guidelines along with infectivity considerations may broaden the patient groups who should receive treatment.
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Affiliation(s)
- Mondher Toumi
- Aix-Marseille University, Jardin du Pharo, 58 bd Charles Livon, Marseille, 13284 Cedex 07, France.
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, Marseille, 13385, France.
| | - Jack Wallace
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
| | - Chris Marshall
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Helen Kitchen
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Jake Macey
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Hannah Pegram
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Ashley F Slagle
- Aspen Consulting, LLC, 625 S Lincoln Ave #101, Steamboat Springs, CO, 80487, USA
| | - Robert G Gish
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
| | - Qin Ning
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, China
| | - Hiroshi Yatsuhashi
- National Hospital Organization (NHO) Nagasaki Medical Center, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
- Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, 852-8520, Japan
| | - Markus Cornberg
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maurizia Brunetto
- University Hospital of Pisa, Lungarno Pacinotti 43, Pisa, 56126, Italy
| | - Florian van Bömmel
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Qing Xie
- Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, 227 South Chongqing Road, Shanghai, 20025, China
| | - Dee Lee
- Inno Community Development Organisation, Room 208, Dengzheng Business Center, #57, Dengzhengnan Rd, Yuexiu District, Guangzhou, Guangdong, China
| | - Noriyuki Habuka
- Janssen Pharmaceutical K.K, 3-5-2 Nishi-kanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Urbano Sbarigia
- Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse, B-2340, Belgium
| | - Maria Beumont-Mauviel
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
| | | | - Yasushi Takahashi
- Janssen Pharmaceutical K.K, 3-5-2 Nishi-kanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Yiwei Lu
- Janssen China, 14F, Tower 3, China Central Place, No.77, Jian Guo Road, Chaoyang District, Beijing, 100025, China
| | - Ao Liu
- Janssen China, 14F, Tower 3, China Central Place, No.77, Jian Guo Road, Chaoyang District, Beijing, 100025, China
| | - Qiaoqiao Chen
- Janssen China, 14F, Tower 3, China Central Place, No.77, Jian Guo Road, Chaoyang District, Beijing, 100025, China
| | - Tetsuro Ito
- Janssen Health Economics & Market Access (EMEA), 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG, UK
| | - Olaf Radunz
- Janssen Germany, Johnson-u.-Johnson-Platz 1, 41470, Neuss, Nordrhein-Westfalen, Germany
| | - Anna Puggina
- Janssen Italy, Via Michelangelo Buonarroti, 23, Cologno Monzese, 20093, Italy
| | - Gudrun Hilgard
- Janssen Germany, Johnson-u.-Johnson-Platz 1, 41470, Neuss, Nordrhein-Westfalen, Germany
| | - Eric K H Chan
- Janssen Global Services, LLC, 1000 US 202, Raritan, NJ, 08869, USA.
| | - Su Wang
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
- Cooperman Barnabas Medical Center, 222 Columbia Turnpike, Florham Park, NJ, 07932, USA
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13
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Mendlowitz AB, Mandel E, Capraru CI, Hansen BE, Wong D, Feld JJ, Janssen HLA, Biondi MJ, Arif A, Yim C. Factors associated with knowledge and awareness of Hepatitis B in individuals of Chinese descent: Results from a mass point of care testing and outreach campaign in Toronto, Canada. CANADIAN LIVER JOURNAL 2024; 7:28-39. [PMID: 38505784 PMCID: PMC10946186 DOI: 10.3138/canlivj-2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/22/2023] [Indexed: 03/21/2024]
Abstract
Background Migrants from hepatitis B virus (HBV) endemic regions are at high risk of having chronic infection. Despite this, HBV knowledge and awareness programming, and low-barrier screening methods such as point of care (POC) testing, among this group have yet to become routine. Methods We conducted a mass HBV POC screening and knowledge and awareness campaign for individuals of Chinese descent in Toronto, Canada. POC screening was administered, then participants completed a knowledge questionnaire. Logistic regression identified associations between demographic factors and participants' level of HBV knowledge. Results From 2015 to 2018, 33 outreach events resulted in 891 individuals completing testing and the knowledge questionnaire. Individuals averaged 64.4 years old. Most, 62% (N = 552), were female, and 73.6% (N = 656) have been in Canada for <30 years. The average questionnaire score was 70.7% correct, with 65.2% (N = 581) demonstrating a high level of HBV knowledge. Post-secondary education (OR: 2.19, 95% CI: 1.41, 3.39), income of $50,000 to <$75,000 (OR: 2.74, 95% CI: 1.39, 5.43), and having familial history of HBV (OR: 1.72, 95% CI: 1.06, 2.78) were associated with high knowledge. The observed prevalence of HBV was 1.5%, with 13 individuals testing positive on the POC test and confirmatory laboratory testing. Conclusions Improving knowledge and awareness of HBV is critical to empowering people, especially migrants who experience barriers to care, to pursue vaccination, testing, and treatment. Combining knowledge outreach and POC test campaigns, enabled discussion and screening for HBV with large numbers of people, and can be tailored for optimal effectiveness for specific groups.
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Affiliation(s)
- Andrew B Mendlowitz
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Erin Mandel
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Camelia I Capraru
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Wong
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Harry LA Janssen
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mia J Biondi
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- School of Nursing, York University, Toronto, Ontario, Canada
| | | | - Colina Yim
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
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14
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Cama E, Beadman M, Beadman K, Hopwood M, Treloar C. Health workers' perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia. Harm Reduct J 2023; 20:116. [PMID: 37633903 PMCID: PMC10463284 DOI: 10.1186/s12954-023-00844-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma. METHODS Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia. RESULTS Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services. CONCLUSIONS Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Mitch Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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15
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Sammour AAK, Elijla Y, Alsarafandi M, Aldabbour B, Kanou L, Almaidana F, El Egla M, Harara S, Oda S, Albardaweel N, Skaik A. Knowledge, Attitude and Practice Among Palestinian Healthcare Workers in the Gaza Strip Towards Hepatitis B: Cross-sectional survey. Sultan Qaboos Univ Med J 2023; 23:370-379. [PMID: 37655075 PMCID: PMC10467557 DOI: 10.18295/squmj.1.2023.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives Healthcare workers are at high risk of contracting hepatitis B virus (HBV). This survey aimed to identify the gaps and strengths in the knowledge, attitudes and practices of healthcare workers towards HBV to drive appropriate health interventions. Methods This cross-sectional study was conducted between March and April 2022. A convenience sample of three at-risk healthcare professions from the major health facilities in Gaza was surveyed. A 40-item self-administered questionnaire was used. Statistical data analysis was conducted using Statistical Package for Social Sciences version 25 to obtain descriptive and inferential statistics via various nonparametric, correlation and regression tests (with P <0.05). Results A total of 447 healthcare workers participated in the study. Overall, 105 of the participants (23.5%) demonstrated poor knowledge (below 14/20 points) of HBV, 284 (63.5%) had moderate knowledge (14-17 points) and 58 (13%) showed good knowledge. The majority (n = 367, 82.1%) expressed an excellent attitude. Finally, 287 (64.2%) demonstrated a good level of practice regarding HBV infection. A history of needlestick injury was reported by 233 (52.1%) participants, 170 (73.3%) of whom reported taking appropriate preventive actions after exposure. Conclusion The majority of the participants demonstrated overall good knowledge regarding HBV infection. Nonetheless, significant gaps remain in the different aspects of the knowledge, attitude and practice construct that require appropriate awareness campaigns to further limit the spread of this preventable viral infection.
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Affiliation(s)
| | - Younis Elijla
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Muath Alsarafandi
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Belal Aldabbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Loay Kanou
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Fahmy Almaidana
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Moataz El Egla
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Samah Harara
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Seham Oda
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Nour Albardaweel
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Adnan Skaik
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
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16
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Shamputa IC, Law MA, Kelly C, Nguyen DTK, Burdo T, Umar J, Barker K, Webster D. Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001997. [PMID: 37276222 DOI: 10.1371/journal.pgph.0001997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.
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Affiliation(s)
- Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira A Law
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Clara Kelly
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Duyen Thi Kim Nguyen
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
- Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Tatum Burdo
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Jabran Umar
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Kimberley Barker
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
| | - Duncan Webster
- Division of Microbiology, Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- Division of Infectious Diseases, Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
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17
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Yang K, Kao AS, Ching K, Thomas R, Ang J. Impact of Virtual Seminars on Hepatitis B Knowledge and Attitudes Among Preclinical-Year Medical Students. Cureus 2023; 15:e34609. [PMID: 36883078 PMCID: PMC9985976 DOI: 10.7759/cureus.34609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Background A limited understanding of hepatitis B virus (HBV) disease transmission contributes to fear of routine contact and can stigmatize affected individuals. To reduce potential HBV-related discrimination, there is a need to increase awareness among medical students on HBV knowledge and transmission. We aimed to assess the impact of virtual education seminars on first- and second-year medical students' understanding of HBV and their attitudes toward HBV infection. Methods Pre- and post-seminar surveys were designed and administered to first- and second-year medical students in the February and August 2021 virtual HBV seminars to assess basic knowledge and attitudes toward HBV infection. The seminars consisted of a lecture on HBV followed by case study discussions. Paired samples t-test and McNemar's test for paired proportional differences were used for analysis. Results This study included 24 first-year and 16 second-year medical students who completed both pre- and post-seminar surveys. After attending the seminar, participants demonstrated an increase in correct responses to transmission modes including vertical transmission (p≤0.001) and sharing razors or toothbrushes (p=0.031) rather than sharing utensils or shaking hands (p<0.01). Using 5-point Likert means, improved attitudes were observed in concerns of shaking hands or hugging (pre=2.4, post=1.3, p<0.001) and caring for someone with infection (pre=1.55, post=1.18, p=0.009), and acceptance of an HBV-infected coworker in the same workplace (pre = 4.13, post= 4.78, p<0.001). Conclusion The virtual education seminars clarify misconceptions about transmission and bias towards individuals with HBV infection. Implementation of educational seminars in medical students' training is important to improve overall knowledge of HBV infection.
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Affiliation(s)
- Kelly Yang
- Department of Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Andrew S Kao
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Kaycee Ching
- Department of Family Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Ronald Thomas
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Jocelyn Ang
- Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, USA.,Department of Pediatrics, Wayne State University School of Medicine, Detroit, USA.,Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, USA
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18
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Ghazzawi M, Yendewa SA, James PB, Massaquoi SP, Babawo LS, Sahr F, Deen GF, Kabba M, Ocama P, Lakoh S, Salata RA, Yendewa GA. Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11020177. [PMID: 36673546 PMCID: PMC9859485 DOI: 10.3390/healthcare11020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.
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Affiliation(s)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-2168441988
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19
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Silliman M, Alber JM, Gib S, Gee M, Conover S, Chan C, Cohen C, Freeland C, Racho R. Comparing lengths and inclusion of information in storytelling videos: Implications for Hepatitis B education. PEC INNOVATION 2022; 1:100049. [PMID: 37213761 PMCID: PMC10194295 DOI: 10.1016/j.pecinn.2022.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 05/23/2023]
Abstract
Objectives This study examined whether adding disease-specific facts into storytelling videos and altering video length would lead to differences in overall ratings of the video and the storyteller, as well as hepatitis B prevention beliefs, among Asian American and Pacific Islander adults. Methods A sample of Asian American and Pacific Islander adults (N = 409) completed an online survey. Each participant was randomly assigned to 1 of 4 conditions that varied in video length and use of additional hepatitis B facts. Linear regressions were used to examine differences in outcomes (i.e., video rating, speaker rating, perceived effectiveness, hepatitis B prevention beliefs) by conditions. Results Condition 2, which added facts to the original full-length video, was significantly related to higher speaker ratings (i.e., the storyteller's rating) compared to Condition 1, the original full-length video with no added facts, p = 0.016. Condition 3, which added facts to the shortened video, was significantly related to lower overall video ratings (i.e., how much participants liked the videos overall) compared to Condition 1, p = 0.001. There were no significant differences in higher positive hepatitis B prevention beliefs across conditions. Conclusions Results suggest that adding disease-specific facts to storytelling for patient education may improve initial perceptions of storytelling videos; however, more research is needed to examine long-term effects. Innovation Aspects of storytelling videos such as length and additional information have been rarely explored in storytelling research. This study provides evidence that exploring these aspects is informative to future storytelling campaigns and disease-specific prevention.
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Affiliation(s)
- Miriam Silliman
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Julia M. Alber
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
- Corresponding author at: Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, 1 Grand Avenue, Office 43A-367, San Luis Obispo, CA 93407, USA.
| | - Siena Gib
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Michelle Gee
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Sydney Conover
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Cindi Chan
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, 18902, USA
| | - Catherine Freeland
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, 18902, USA
| | - Rhea Racho
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, 18902, USA
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20
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Jin D, Brener L, Treloar C. Hepatitis B-related stigma among Chinese immigrants living with hepatitis B virus in Australia: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5602-e5611. [PMID: 36068665 PMCID: PMC10086810 DOI: 10.1111/hsc.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/05/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Chinese immigrants in Australia are overrepresented among people with chronic hepatitis B virus (PWCHB) but experience poor access to healthcare. Given the historical discriminatory policies against PWCHB in mainland China, this study aimed to explore the lived experiences of stigma and discrimination surrounding hepatitis B virus (HBV) among Chinese immigrants originally from mainland China. Semi-structured in-depth interviews were conducted by a researcher with a Chinese background in 2019-2020. Sixteen Chinese immigrants living with HBV were recruited across Sydney and Melbourne through advocacy and support groups. This study is positioned in social constructionism. Data analysis was informed by the Health Stigma and Discrimination Framework that highlights the interaction between layered stigmas. This study revealed the historical, social and cultural construction of HBV-related stigma among PWCHB and demonstrated how this stigma was manifested across socioecological levels in China and Australia. Findings show that HBV-related stigma has mostly been driven by knowledge deficits about HBV and fear of HBV infection. HBV-related stigma was mostly demonstrated around social isolation including isolation imposed by family and the community and employment restrictions in the Chinese workplace. In the Australian context, HBV-related stigma was related to the ethnic and cultural background of PWCHB, and primarily occurred as anticipated stigma in the community and in employment. The findings provide significant insights for crosscutting research and policy endeavours to develop and test cross-disciplinary initiatives that more broadly address the complex lived realities of Chinese immigrants living with hepatitis B virus.
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Affiliation(s)
- Defeng Jin
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
| | - Loren Brener
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
| | - Carla Treloar
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
- Social Policy Research Centre, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
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21
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Adjei CA, Stutterheim SE, Bram F, Naab F, Ruiter RAC. Correlates of hepatitis B testing in Ghana: The role of knowledge, stigma endorsement and knowing someone with hepatitis B. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4564-e4573. [PMID: 35701984 PMCID: PMC10083906 DOI: 10.1111/hsc.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Hepatitis B testing is the gateway for prevention and care. However, previous studies document low hepatitis B testing uptake in sub-Saharan Africa. This study investigated knowledge, stigma endorsement and knowing someone with hepatitis B as correlates of hepatitis B testing behaviours among people in the Greater Accra and Northern regions of Ghana. A cross-sectional survey was completed by 971 participants (Greater Accra = 503, and Northern region = 468) between October 2018 and January 2019. Approximately 54% of the participants reported having been tested for hepatitis B. The logistic regression analyses showed that having greater hepatitis B knowledge was positively associated with hepatitis B testing (OR = 1.22, 95% CI: 1.14-1.30). Higher hepatitis B stigma endorsement was negatively related to hepatitis B testing (OR = 0.97, 95% CI: 0.96-0.99). Also, participants who knew someone (i.e. parent, sibling and/or friend) with hepatitis B were more likely to have tested compared to those who did not know someone with hepatitis B (OR = 7.15, 95% CI: 5.04-10.14). This study demonstrates that knowing someone with hepatitis B increases the likelihood of testing, highlighting the need to create safe and non-judgmental contexts for people with hepatitis B (PWHB) to disclose if they want to. Also, given that greater hepatitis B knowledge increases testing and hepatitis B stigma endorsement impedes testing, interventions that increase knowledge and reduce stigma should be incorporated in efforts to promote testing in Ghana.
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Affiliation(s)
| | - Sarah E. Stutterheim
- Department of Health PromotionCare and Public Health Research Institute, Maastricht UniversityMaastrichtThe Netherlands
| | - Fleuren Bram
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Florence Naab
- Department of Maternal and Child HealthUniversity of GhanaAccraGhana
| | - Robert A. C. Ruiter
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
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22
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Lim ZZ, Teo JS, Tan AC, Lim TO. Awareness and treatment of chronic hepatitis B in Malaysia-findings from a community-based screening campaign. BMC Gastroenterol 2022; 22:374. [PMID: 35933362 PMCID: PMC9356500 DOI: 10.1186/s12876-022-02458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In 2016 the World Health Organization (WHO) had adopted a global strategy to eliminate Hepatitis B (HBV) by 2030 through five core interventions. One of which is the "cascade of care", the continuum of services that persons with chronic Hepatitis B Virus (HBV) should receive as they progress from screening to diagnosis to treatment to chronic care. We determined the prevalence of the awareness and treatment of chronic HBV in Malaysia based on a large sample data from a screening campaign. METHODS A total of 10,436 subjects participated in the HBV screening campaign organized by the Hepatitis Free Pahang Malaysia (HFP). Between in 2018 and 2019, HFP organized a total of 109 health fairs in partnership with local non-governmental organizations (NGO) to conduct HBV screening mostly in small towns and villages largely in the state of Pahang. All screen-positive subjects were recalled to undergo laboratory-based HBsAg and HBV DNA tests. Patients with confirmed chronic HBV were referred to local health services, while continued being monitored by HFP. RESULTS We estimated 13.1% of Malaysian adults aged 20 or older with chronic HBV were aware of their HBV status, and of those only 0.7% had received prior anti-viral treatment, but among those with baseline HBV DNA level > 20,000 IU/ml, 15.6% were subsequently treated. Tenofovir disoproxil fumarate was the only medicine used on all treated patients. CONCLUSION Few Malaysian adults with HBV were aware of their infection and even less received anti-viral therapy. Concerted public health efforts are urgently needed to improve HBV screening and care cascade in order to meet WHO's targets for HBV elimination.
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Affiliation(s)
- Zhuo-Zhi Lim
- Hepatitis Free Pahang Malaysia, D7-3-1, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Jau Shya Teo
- Hepatitis Free Pahang Malaysia, D7-3-1, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Ah-Choon Tan
- Hepatitis Free Pahang Malaysia, D7-3-1, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Teck Onn Lim
- Hepatitis Free Pahang Malaysia, D7-3-1, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, 47301, Petaling Jaya, Selangor, Malaysia.
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23
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Marley G, Seto WK, Yan W, Chan P, Tucker JD, Tang W, Wong WCW. What facilitates hepatitis B and hepatitis C testing and the role of stigma among primary care patients in China? J Viral Hepat 2022; 29:637-645. [PMID: 35633086 DOI: 10.1111/jvh.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 01/13/2023]
Abstract
Approximately 80% of primary healthcare facilities in China were ready to deliver hepatitis care services by 2021. This study aimed to assess hepatitis B and C test uptake, identify the factors associated with testing and determine the predictors of hepatitis stigma among primary care patients. We conducted a cross-sectional survey among patients seeking care in the family medicine and primary care unit of the University of Hong Kong-Shenzhen Hospital, China. Participants were 30 years or older and had not tested for HBV and HCV in the preceding 12 months. Test uptake was defined as self-reported previous HBV and HCV testing. Descriptive statistics, Chi-square test, forward multivariable logistic regression and stepwise multiple linear regression were conducted, and a p-value <.05 was deemed statistically significant. A total of 750 eligible patients completed the survey, and 54.5% (404 ± 0.9) were between 30 and 40 years old. Most participants were heterosexuals 98.0% (n = 735), female 57.5% (n = 431), married 78.3% (587) and earned ≤1500 USD per month 54.4% (n = 408). A 66.1% (n = 496) and 13.7% (n = 103) self-reported previous HBV and HCV testing, respectively, and 62% (n = 468) were vaccinated. HCV testing was associated with HBV testing (aOR = 13.7, 95% CI:2.1-91.5); and HBV testing was associated with family history of HBV (aOR = 2.4, 95%CI:1.1-5.5). Overall hepatitis stigma was about average and decreased with family history of HBV (p = .017). In conclusion, HCV testing uptake among primary care patients was low and needs to be further promoted. Integrating HBV and HCV testing interventions and fostering family-based support for disclosure could effectively improve testing uptake.
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Affiliation(s)
- Gifty Marley
- The University of North Carolina Project-China, Global Health Center Office, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Medicine and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
| | - Weihui Yan
- Department of Family Medicine & Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Polin Chan
- World Health Organization Western Pacific Regional Office, Manila, The Philippines
| | - Joseph D Tucker
- The University of North Carolina Project-China, Global Health Center Office, Guangzhou, China.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Faculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Weiming Tang
- The University of North Carolina Project-China, Global Health Center Office, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH), Guangzhou, China.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William C W Wong
- Department of Family Medicine & Primary Care, School of Clinical Medicine, Li Ka Shing Faculty Medicine, The University of Hong Kong, Hong Kong, China
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24
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A randomized controlled trial enhancing viral hepatitis testing in primary care via digital crowdsourced intervention. NPJ Digit Med 2022; 5:95. [PMID: 35853995 PMCID: PMC9296450 DOI: 10.1038/s41746-022-00645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the availability of hepatitis B virus (HBV) and hepatitis C virus (HCV) testing in primary care, testing rates in China remain low. Social media is an inexpensive means of disseminating information and could facilitate hepatitis testing promotion. We evaluated the capacity of digitally crowdsourced materials to promote HBV/HCV testing uptake via a randomized controlled trial (identifier: ChiCTR1900025771), which enrolled 750 Chinese primary care patients. We randomized patients (1:1) to receive crowdsourced HBV/HCV promotion materials through social media or facility-based care without promotional materials for four weeks. Exposure to all intervention materials was associated with increased odds of HBV (aOR = 1.79, 95% CI: 1.09–3.00) and HCV (aOR = 1.95, 95% CI: 1.29–2.99) testing compared to facility-based care. There was a significant reduction in hepatitis stigma among intervention group participants (HBV slope: −0.15, p < 0.05; and HCV slope: −0.13, p < 0.05). Digitally crowdsourced promotion messages could enhance hepatitis testing uptake and should be considered in hepatitis reduction strategies. Trial registration: Chinese Clinical Trial Registry (ChiCTR1900025771) on September 9, 2019. Available from: http://www.chictr.org.cn/showproj.aspx?proj=42788
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25
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Stahl HJ, Wu AK, Li H, Hu D, Liu W, Lam SK. Elucidating a Silent Illness: Hepatitis B Knowledge Among Asian Individuals in an Urban Center. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:417-424. [PMID: 35389958 DOI: 10.1097/phh.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite comprising less than 6% of the US population, Asian individuals make up more than half of the approximately 1.6 million chronic hepatitis B virus (HBV) infections in the United States. The purpose of this investigation was to identify characteristics associated with HBV knowledge in this disproportionately affected population. METHODS A cross-sectional, multilingual survey study using convenience sampling was conducted in a Midwestern urban city to collect information on respondents' demographics, health care access, and HBV knowledge. Hepatitis B virus knowledge was categorized into epidemiology, natural history, transmission, and vaccination. Data were analyzed using Kruskal-Wallis and Spearman correlation tests. RESULTS Of the 174 individuals who completed surveys, 139 (79.9%) were Asian. Characteristics of univariate analyses associated with higher knowledge scores included younger age (18-49 years), proficiency in reading English, college education, current employment status, physician using preferred language, last physician's visit in 2018 or prior, perceived lack of time to see a physician, use of emergency department, prior HBV vaccination, prior HBV testing, higher level of self-reported knowledge about HBV, and acquiring health information from the Internet, messaging applications, friends, and family (P < .05). In the multivariable analysis, shorter residency in the United States (0-10 years), current employment status, having heard of HBV, and confidence in their HBV knowledge were associated with higher knowledge scores. CONCLUSION Knowledge deficits existed in our study population regarding HBV transmission, vaccination, and epidemiology, while knowledge was higher regarding HBV natural history. Education efforts should be designed to improve knowledge deficits about HBV for individuals with risk factors using culturally sensitive Internet and social media platforms.
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Affiliation(s)
- Heidi J Stahl
- Case Western Reserve University School of Medicine, Cleveland, Ohio (Mss Stahl and Wu, Messrs Li and Hu, and Dr Lam); Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (Ms Liu); Cleveland Clinic Children's, Department of Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, Ohio (Dr Lam); and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Lam)
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26
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Jin D, Brener L, Treloar C. Knowledge and beliefs about hepatitis B virus infection and associated factors among Chinese migrants in Australia: The result of a quantitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:918-925. [PMID: 33237628 DOI: 10.1111/hsc.13239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 06/11/2023]
Abstract
Chinese immigrants to Australia have an increased prevalence of hepatitis B virus (HBV) infection compared to the general population. Despite this, engagement with HBV screening and healthcare for chronic hepatitis B (CHB) among immigrants of Chinese background is relatively low. This study investigated knowledge about HBV among this high-risk community and explored sociodemographic factors that might influence this knowledge. During February to September 2019, first generation Chinese immigrants from mainland China and their immediate descents residing in Sydney and Melbourne were recruited via convenience and snowball sampling and completed a survey in either English or Chinese. Survey items included HBV knowledge, attitudes towards people living with CHB and demographic information. Three hundred and ninety-six participants completed the survey. The median HBV knowledge score was 53% correct, indicating that knowledge about HBV was low to middle range among participants. While participants had the most knowledge in the domain of perceptions and understandings of HBV, this was still low. Participants also had limited knowledge about HBV prevention, transmission and treatment. Those with higher English proficiency, post-secondary education, lower levels of HBV-related stigma and those who had contact with people living with CHB appeared to have greater HBV knowledge. This study showed that HBV knowledge among Chinese people originally from mainland China living in Australia is limited and even deficient in some key areas. Additionally, the relationships between HBV knowledge and particular sociodemographic variables, knowing someone living with HBV and stigma associated with HBV provides key information to assist in the development of targeted health promotion to increase HBV knowledge and change stigmatising attitudes towards HBV among the Chinese community in Australia.
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Affiliation(s)
- Defeng Jin
- Faculty of Arts & Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Loren Brener
- Faculty of Arts & Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Faculty of Arts & Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
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27
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Nankya-Mutyoba J, Ejalu D, Wandera C, Beyagira R, Amandua J, Seremba E, Mugagga K, Kambugu A, Muganzi A, Easterbrook P, Ocama P. A training for health care workers to integrate hepatitis B care and treatment into routine HIV care in a high HBV burden, poorly resourced region of Uganda: the '2for1' project. BMC MEDICAL EDUCATION 2022; 22:297. [PMID: 35443646 PMCID: PMC9020110 DOI: 10.1186/s12909-022-03329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The "2for1" project is a demonstration project to examine the feasibility and effectiveness of HBV care integrated into an HIV clinic and service. An initial phase in implementation of this project was the development of a specific training program. Our objective was to describe key features of this integrated training curriculum and evaluation of its impact in the initial cohort of health care workers (HCWs). METHODS A training curriculum was designed by experts through literature review and expert opinion. Key distinctive features of this training program (compared to standard HBV training provided in the Government program) were; (i) Comparison of commonalities between HIV and HBV (ii) Available clinic- and community-level infrastructure, and the need to strengthen HBV care through integration (iii) Planning and coordination of sustained service integration. The training was aided by a power-point guided presentation, question and answer session and discussion, facilitated by physicians and hepatologists with expertise in viral hepatitis. Assessment approach used a self-administered questionnaire among a cohort of HCWs from 2 health facilities to answer questions on demographic information, knowledge and attitudes related to HBV and its prevention, before and after the training. Knowledge scores were generated and compared using paired t- tests. RESULTS A training curriculum was developed and delivered to a cohort of 44 HCWs including medical and nursing staff from the two project sites. Of the 44 participants, 20 (45.5%) were male, average age (SD) was 34.3 (8.3) with an age range of 22-58 years. More than half (24, 54.5%) had been in service for fewer than 5 years. Mean correct knowledge scores increased across three knowledge domains (HBV epidemiology and transmission, natural history and treatment) post-intervention. However, knowledge related to diagnosis and prevention of HBV did not change. CONCLUSION A structured HBV education intervention conducted as part of an HIV/HBV care integration training for health care workers yielded improved knowledge on HBV and identified aspects that require further training. This approach may be replicated in other settings, as a public health strategy to heighten HBV elimination efforts.
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Affiliation(s)
- Joan Nankya-Mutyoba
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - David Ejalu
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Claude Wandera
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rachel Beyagira
- Program On Viral Hepatitis, Ministry of Health, Kampala, Uganda
| | - Jacinto Amandua
- Program On Viral Hepatitis, Ministry of Health, Kampala, Uganda
| | - Emmanuel Seremba
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Muganzi
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Ponsiano Ocama
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Mude WW, Fisher CM, Richmond J, Gautier RL, Wallace J. Social impacts of living with chronic hepatitis B in South Sudanese community in Australia. ETHNICITY & HEALTH 2022; 27:529-541. [PMID: 32568555 DOI: 10.1080/13557858.2020.1782849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Chronic hepatitis B presents significant issues to public health and clinical practices. The infection requires lifelong clinical management and is a leading risk factor for liver cancer and liver cirrhosis. Limited studies currently exist on the social impacts of living with chronic hepatitis B, especially for people from Sub-Saharan Africa. The current study explored the experiences of South Sudanese people living with chronic hepatitis B in Australia.Methods: A qualitative inquiry using face-to-face interviews with fifteen South Sudanese people with chronic hepatitis B in Australia explored the social impacts of living with chronic hepatitis B. The study purposively sampled participants who self-identified as South Sudanese with hepatitis B and over 18 years of age. Interviews were coded and analysed using thematic analysis.Results: The study identified three themes relating to the experiences of living with chronic hepatitis B, and were grouped into psychological, interpersonal and healthcare system levels. Psychological level experiences related to the uncertainty of living with chronic hepatitis B and liver cancer risk, where participants expressed persistent fear of disease progression and anxiety around death related to the disease. Interpersonal level experiences involved the disclosure of hepatitis B and its social impacts including stigma, social distancing and isolation. Healthcare system level experiences included receiving mixed messages about hepatitis B, challenges with regular testing and difficulty receiving hepatitis B treatment.Conclusion: The findings provide valuable insights into the social impacts of hepatitis B. It underlines the importance of integrated public health interventions at the community level to improve knowledge and awareness of hepatitis B which address stigma in the South Sudanese community in Australia.
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Affiliation(s)
- William W Mude
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Christopher M Fisher
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Roslyn Le Gautier
- Palliative Medicine Research Group, The University of Melbourne & St Vincent's Hospital, Melbourne Australia
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Behera MK, Nath P, Behera SK, Padhi PK, Singh A, Singh SP. Unemployment and Illiteracy Are Predictors of Hepatitis B Virus-Related Stigma and Discrimination. J Clin Exp Hepatol 2022; 12:767-773. [PMID: 35677504 PMCID: PMC9168712 DOI: 10.1016/j.jceh.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND HBV is a serious threat to society in India as around 1,00,000 people die from HBV every year. However, very few studies from India have evaluated the magnitude of stigma faced by HBV patients. So, there was an unmet need to estimate the HBV-related stigma to design the preventive strategies. Hence, the aim of this study was to quantitatively assess the proportions of stigma and discrimination and factors predicting them among HBV patients. METHODS A cross-sectional study was conducted from May 2016 to October 2019. A total of 350 HBV patients and 100 healthy respondents were interviewed for knowledge and awareness about HBV and various stigma characteristics. RESULTS The mean age of HBV subjects was 45.10 ± 11.70 years, and controls were 36.20 ± 12.27 years; males constituted 60% of HBV subjects and 71% of controls. Negative symptoms such as shame, avoidance, and putting others in danger were felt by 70-90% of HBV patients. Around 60% of HBV patients felt that hepatitis B could be transmitted by sharing utensils thinking that saliva is the mode of transmission. The knowledge about transmission of HBV by sexual intercourse, intravenous drug use, and mother to child was present in 88%, 75%, and 52% of HBV patients and 32%,38%, and 40% of healthy individuals, respectively. Multivariate logistic regression revealed that male gender (AOR-2.38, CI 1.48-3.81, P < 0.01), under matriculates (AOR-2.03, CI 1.22-3.44, P < 0.01) and unemployed (AOR-2.16, CI 1.33-3.53, P < 0.01) were significant independent predictors of significant discrimination. CONCLUSION The magnitude of HBV-related stigma is high in the Indian population, and illiteracy and unemployment were significant predictors of a severe grade of discrimination associated with HBV.
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Affiliation(s)
- Manas K. Behera
- Department of Hepatology, SCB Medical College and Hospital, Cuttack, India
| | - Preetam Nath
- Department of Gastroenterology, KIMS Hospital, Bhubaneswar, India
| | - Sambit K. Behera
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India
| | - Pradeep K. Padhi
- Department of Medicine, Fakir Mohan Medical College and Hospital, Balasore, India
| | - Ayaskanta Singh
- Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India,Address for correspondence: Shivaram Prasad Singh, Professor and Head, Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India.
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Greten TF, Abou-Alfa GK, Cheng AL, Duffy AG, El-Khoueiry AB, Finn RS, Galle PR, Goyal L, He AR, Kaseb AO, Kelley RK, Lencioni R, Lujambio A, Mabry Hrones D, Pinato DJ, Sangro B, Troisi RI, Wilson Woods A, Yau T, Zhu AX, Melero I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma. J Immunother Cancer 2021; 9:e002794. [PMID: 34518290 PMCID: PMC8438858 DOI: 10.1136/jitc-2021-002794] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with advanced hepatocellular carcinoma (HCC) have historically had few options and faced extremely poor prognoses if their disease progressed after standard-of-care tyrosine kinase inhibitors (TKIs). Recently, the standard of care for HCC has been transformed as a combination of the immune checkpoint inhibitor (ICI) atezolizumab plus the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was shown to offer improved overall survival in the first-line setting. Immunotherapy has demonstrated safety and efficacy in later lines of therapy as well, and ongoing trials are investigating novel combinations of ICIs and TKIs, in addition to interventions earlier in the course of disease or in combination with liver-directed therapies. Because HCC usually develops against a background of cirrhosis, immunotherapy for liver tumors is complex and oncologists need to account for both immunological and hepatological considerations when developing a treatment plan for their patients. To provide guidance to the oncology community on important concerns for the immunotherapeutic care of HCC, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for HCC, including diagnosis and staging, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with HCC.
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Affiliation(s)
- Tim F Greten
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Medical College at Cornell University, New York, New York, USA
| | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
| | - Austin G Duffy
- The Mater Hospital/University College Dublin, Dublin, Ireland
| | - Anthony B El-Khoueiry
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Richard S Finn
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Lipika Goyal
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aiwu Ruth He
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robin Kate Kelley
- Department of Medicine (Hematology/Oncology), UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Riccardo Lencioni
- Department of Radiology, University of Pisa School of Medicine, Pisa, Italy
- Miami Cancer Institute, Miami, Florida, USA
| | - Amaia Lujambio
- Oncological Sciences Department, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Donna Mabry Hrones
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Bruno Sangro
- Clinica Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Andrea Wilson Woods
- Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, Alabama, USA
| | - Thomas Yau
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Andrew X Zhu
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Jiahui Health, Jiahui International Cancer Center, Shanghai, China
| | - Ignacio Melero
- Clinica Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Foundation for Applied Medical Research (FIMA), Pamplona, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
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A mixed-methods evaluation of hepatitis B knowledge, attitudes, and practices among migrant women in Thailand. BMC Pregnancy Childbirth 2021; 21:525. [PMID: 34301179 PMCID: PMC8305500 DOI: 10.1186/s12884-021-03914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally 90 % of transmission of Hepatitis B virus (HBV) is from mother-to child and occurs predominantly in resource limited countries where the prevalence of HBV is high. Transmission could be interrupted by timely vaccinations but coverage remains problematic in these areas. Low knowledge or awareness of HBV may play a part in low vaccination coverage. This study examines the provision of antenatal care counselling with a focus on HBV in two different regions of northern Thailand, Sarapee Hospital (SH), Chiang Mai, and Shoklo Malaria Research Unit (SMRU), Tak Province. METHODS A mixed-methods sequential explanatory study design was used to evaluate antenatal services for migrants. Cross-sectional knowledge, attitude and practice (KAP) surveys were conducted immediately after counselling at first ANC contact, at 3-6 months after first ANC contact and at delivery. Surveys provided quantitative data, and qualitative methods included observations, focus group discussions (FGD) and in-depth interviews (IDI); analysed thematically to explore concepts of knowledge and understanding, attitude and practice of pregnant women and providers. RESULTS Between September-2019 and May-2020, 757 women participated to KAP surveys, and 31 observations of counselling, 16 FGD and 9 IDI were conducted. KAP surveys showed in spite of low knowledge about HBV transmission, infection, or vaccination (correct response: SH 5.7 %, 9/157; SMRU 34.0 %, 204/600), most women (≥ 93 %, either site) understood they were screened for HBV and were willing to vaccinate infants for HBV. In explaining KAP survey results, qualitative analysis suggests counselling should: use the appropriate language; be tailored to the local health literacy level, provide only pertinent information, be repeated over the antenatal period; and attempt to ensure patient privacy (where possible). Programme effectiveness benefits from positive attitudes to screening and vaccinations and a high level of trust in the providers nevertheless participants provided good suggestions for improvements of the service. CONCLUSIONS Limited knowledge of HBV among migrant women can be improved by counselling that emphasizes actionable knowledge such as vaccination schedule. Key improvements to the counselling process include training counsellors to conduct interactive counselling sessions in the woman's language, using appropriate visual aids and timely repetition over the course of the antenatal period.
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Broady TR, Brener L, Vuong T, Cama E, Treloar C. Online interventions to reduce stigma towards population groups affected by blood borne viruses in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103292. [PMID: 34053824 DOI: 10.1016/j.drugpo.2021.103292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stigmatising attitudes and behaviours by others can have a range of negative effects for population groups and individual people affected by blood borne viruses. The reduction of stigma is a major goal within current Australian national health strategies, however, there is a lack of evidence regarding effective interventions to achieve this goal. Drawing on Allport's (1954) intergroup contact theory, this study aimed to evaluate the effectiveness of an online stigma reduction intervention implemented with the Australian public. METHODS The study was conducted between February and May 2020. Australian adults recruited via Facebook advertising were randomly allocated to a control group (n=316) or one of five intervention groups: people living with HIV (n=320), people living with hepatitis C (n=347), people living with hepatitis B (n=333), people who inject drugs (n=316), or sex workers (n=296). Participants viewed a short video depicting lived experiences of their assigned group. Participants completed attitudinal measures about the group before and immediately after the video, and then at three-month follow-up. These measures related to overall attitudes towards the group, controllability of the stigmatised condition/behaviour, desire to maintain personal distance from the group, and opinions regarding treatment of the group in health care and public policy. Longitudinal changes in attitudes were analysed using a mixed effects regression model with maximum likelihood estimation. RESULTS Across each of the intervention groups, reductions in negative attitudes were found immediately after watching the videos on almost all outcome measures. By three-month follow-up, the HIV intervention group demonstrated long-term improvements in relation to personal distance compared to the control group, and the hepatitis B intervention group demonstrated long-term improvements in relation to attitudes and personal distance compared to the control group. Across intervention and control groups, long-term reductions in negative attitudes were found in relation to HIV controllability, hepatitis B controllability and opinions, hepatitis C controllability and opinions, and injecting drug use attitudes and opinions. CONCLUSION Brief online videos depicting priority populations groups demonstrated positive results in terms of reducing some stigmatising attitudes towards those groups amongst members of the Australian public. Online contact interventions have the potential to be scaled up and rolled out across jurisdictions at national and international levels. These findings suggest that these interventions could be an effective way to contribute to the reduction of stigma and discrimination towards populations affected by blood borne viruses.
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Affiliation(s)
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Thu Vuong
- Social Policy Research Centre, UNSW Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Brener L, Cama E, Broady T, Hopwood M, Treloar C. Comparing Australian health worker and student attitudes and concerns about providing care to people living with hepatitis B. Health Promot J Austr 2021; 33:282-288. [PMID: 33687771 DOI: 10.1002/hpja.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
ISSUE ADDRESSED Hepatitis B (HBV) is a major public health issue with over 250 million people chronically infected worldwide. In Australia, prevalence is higher among migrant communities and these groups may be reticent to attend health care services due to concerns about experiencing stigma and discrimination. The way health workers perceive their clients, particularly those of migrant backgrounds, may influence the way they treat these clients and the quality of care provided. This study investigated and compared the attitudes and concerns health workers and health students have towards working with clients living with HBV. METHODS Health workers (n = 551) and students (n = 199) completed an online survey which investigated attitudes towards people living with HBV, comfort with providing care for these clients and concerns they have about working with them. RESULTS Health students expressed less comfort (U = 47 611, z = -2.73, P = .006) and reported more concerns about working with people with HBV than qualified health workers (U = 61611.50, z = 2.64, P = .008). Students' concerns were centred around their own ability to provide care rather than issues related to clients. There were no differences in overall attitudes towards people living with HBV between health workers and students. CONCLUSION To address concerns that health workers and students may have in working with people living with HBV, particularly those from migrant communities, and to ensure that health workers feel comfortable and confident, HBV workforce development should be included in undergraduate and postgraduate training programmes as well as in continuing professional education. SO WHAT?: This will assist the health workforce to develop competency in the treatment of people living with HBV, with the ultimate aim of providing best quality, non-judgemental care to all people living with HBV.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Elena Cama
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Tim Broady
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Max Hopwood
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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Li G, Wang G, Hsu FC, Xu J, Pei X, Zhao B, Shetty A. Effects of Depression, Anxiety, Stigma, and Disclosure on Health-Related Quality of Life among Chronic Hepatitis B Patients in Dalian, China. Am J Trop Med Hyg 2020; 102:988-994. [PMID: 32124716 DOI: 10.4269/ajtmh.19-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection is a major public health problem in China. We evaluated the impact of psychosocial factors (stigma, disclosure, depression, and anxiety) on health-related quality of life (HRQoL) among people living with chronic HBV infection (CHB) in the city of Dalian, Liaoning Province, China. In this hospital-based cross-sectional study, 401 patients living with chronic HBV infection were enrolled as study participants. Study measures included the Beck depression and anxiety inventory, the WHO Quality of Life (WHOQOL-BREF) assessment, the Toronto Chinese HBV Stigma Scale, and disclosure of HBV status to sexual partners. The primary outcome was HRQoL score as measured by the WHOQOL-BREF. A linear regression model was used to examine the association between HRQoL and the potential risk factors including stigma, disclosure, depression, anxiety, and sociodemographic variables. Stigma, disclosure, depression, and anxiety were the covariates of interest. A majority of the participants were females (n = 251, 65.6%), married (81.6%), and had a college or higher degree (32.4%). Depression, anxiety, stigma, and disclosure of HBV infection were associated with low HRQoL in all four domains of the WHOQOL-BREF (physical, psychological, social, and environmental domains) (P < 0.05), when all psychological factors were included in the model separately. Depression was found to be independently associated with low HRQoL in people living with HBV, when all psychological factors were included in the model simultaneously (P < 0.0001). Our data indicate the urgent need for healthcare providers (HCPs) and policy-makers to implement psychological interventions to improve HRQoL among people living with CHB.
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Affiliation(s)
- Ge Li
- Department of Precision Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Gongchen Wang
- Department of Infectious Disease, Dalian Sixth People Hospital, Liaoning, China
| | - Fang-Chi Hsu
- Division of Public Health, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Xia Pei
- Department of Infectious Disease, Dalian Sixth People Hospital, Liaoning, China
| | - Bo Zhao
- Department of Infectious Disease, Dalian Sixth People Hospital, Liaoning, China
| | - Avinash Shetty
- Office of Global Health, Department of Pediatric/Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. "To die is better than to tell": reasons for and against disclosure of chronic hepatitis B status in Ghana. BMC Public Health 2020; 20:663. [PMID: 32398150 PMCID: PMC7216649 DOI: 10.1186/s12889-020-08811-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with a condition subject to stigmatisation, such as chronic hepatitis B, face the dilemma of whether or not to disclose their status. In Ghana, 12.3% of the adult population has the hepatitis B virus (HBV). One key strategy for breaking the cycle of hepatitis B transmission is the disclosure of hepatitis B status by people with chronic hepatitis B (PWHB). Disclosure can facilitate preventive actions to reduce hepatitis B transmission (e.g., not sharing personal items and avoiding contact with blood and body fluids). Disclosure can also motivate family members of PWHB to get tested, linked to care and clinically managed in order to reduce the progression of hepatitis B to liver cirrhosis and cancer. Given the importance of disclosure, we set out to explore reasons for and against disclosure of chronic hepatitis B status in the Greater Accra and Upper East region of Ghana. METHODS In this exploratory qualitative study, 18 participants (10 from the Greater Accra region and 8 from the Upper East region) were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Data were then processed using QSR Nvivo version 10.0 and analysed for themes. RESULTS Participants were selective disclosers, disclosing in some contexts and not in others. Reasons for non-disclosure of chronic hepatitis B status were: 1) fear of stigmatisation and 2) previous negative experiences with disclosure. Reasons for disclosure were: 1) wanting close contacts to get tested or vaccinated, 2) trusting the disclosure target(s), and 3) needing social and/or financial support. CONCLUSIONS Our findings highlight various reasons for and against disclosure of chronic hepatitis B status in Ghana. Because anticipated, observed, and experienced stigma were important motivations for non-disclosure of chronic hepatitis B status, we recommend the development and implementation of theory and evidence-based stigma reduction interventions that are culturally appropriate, and that prioritize the participation of target populations. We also recommend the provision of counselling and support services that assist PWHB in their disclosure decision-making processes.
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Affiliation(s)
- Charles Ampong Adjei
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands.
- Department of Community Health Nursing, University of Ghana, Accra, Ghana.
| | - Sarah E Stutterheim
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Florence Naab
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
| | - Robert A C Ruiter
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
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The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure. Viruses 2020; 12:v12050515. [PMID: 32392763 PMCID: PMC7290920 DOI: 10.3390/v12050515] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world. It is currently incurable and can lead to liver cirrhosis and cancer. The considerable impacts on society caused by CHB through patient mortality, morbidity, and economic loss are well-recognised in the field. This is, however, a narrow view of the harms, given that people living with CHB can be asymptomatic for the majority of their life-long infection. Of less-appreciated importance are the psychosocial harms, which can continue throughout an affected person's lifetime. Here we review the broad range of these impacts, which include fear and anxiety; financial loss and instability; stigma and discrimination; and rejection by society. Importantly, these directly affect patient diagnosis, management, and treatment. Further, we highlight the roles that the research community can play in taking these factors into account and mitigating them. In particular, the development of a cure for hepatitis B virus infection would alleviate many of the psychosocial impacts of CHB. We conclude that there should be a greater recognition of the full impacts associated with CHB to bring meaningful, effective, and deliverable results to the global community living with hepatitis B.
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Ogawa E, Yeo YH, Dang N, Le MH, Jeong D, Tran S, Henry L, Cheung R, Nguyen MH. Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States. JAMA Netw Open 2020; 3:e201844. [PMID: 32271388 PMCID: PMC7146097 DOI: 10.1001/jamanetworkopen.2020.1844] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment. OBJECTIVE To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020. MAIN OUTCOMES AND MEASURES The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma. RESULTS Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma. CONCLUSIONS AND RELEVANCE In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease.
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Affiliation(s)
- Eiichi Ogawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Nolan Dang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Michael H. Le
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Donghak Jeong
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Sally Tran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
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Smith-Palmer J, Cerri K, Sbarigia U, Chan EKH, Pollock RF, Valentine WJ, Bonroy K. Impact of Stigma on People Living with Chronic Hepatitis B. PATIENT-RELATED OUTCOME MEASURES 2020; 11:95-107. [PMID: 32214859 PMCID: PMC7082540 DOI: 10.2147/prom.s226936] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022]
Abstract
Background People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it. Methods A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted. Results A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV. Conclusion HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.
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Shen K, Yang NS, Huang W, Fitzpatrick TS, Tang W, Zhao Y, Wang Y, Li L, Tucker JD. A crowdsourced intervention to decrease hepatitis B stigma in men who have sex with men in China: A cohort study. J Viral Hepat 2020; 27:135-142. [PMID: 31571341 PMCID: PMC8163661 DOI: 10.1111/jvh.13213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Stigma against people with hepatitis B virus (HBV) is a barrier to prevention, diagnosis and treatment of HBV in China. Our study examined an innovative intervention to reduce HBV stigma among men who have sex with men (MSM) in China. We extracted data from a randomized controlled trial conducted in May 2018, where the intervention consisted of crowdsourced images and videos to promote viral hepatitis testing and reduce HBV stigma. HBV stigma was assessed using a 20-item scale at baseline and four weeks post-enrolment. Participants were divided into three groups based on their exposure to intervention: full exposure, partial exposure and no exposure. Linear regression was used to determine associations between baseline stigma and participant characteristics. Data from 470 MSM were analysed. Mean participant age was 25 years old and 56% had less education than a college bachelor's degree. Full exposure to intervention was associated with significant stigma reduction (adjusted beta = -3.49; 95% CI = -6.11 to -0.87; P = .01), while partial exposure led to stigma reduction that was not statistically significant. The mean stigma score was 50.6 (SD ± 14.7) at baseline, and stigma was most prominent regarding physical contact with HBV carriers. Greater HBV stigma was associated with not having a recent doctor's visit (adjusted beta = 4.35, 95% CI = 0.19 to 8.52; P = .04). In conclusion, crowdsourcing can decrease HBV stigma among MSM in China and may be useful in anti-stigma campaigns for vulnerable populations in low- and middle-income countries.
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Affiliation(s)
- Karen Shen
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Nancy S Yang
- University of Minnesota Medical School - Twin Cities, Minneapolis, MN, USA
| | - Wenting Huang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China
- Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Thomas S Fitzpatrick
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China
- Social Entrepreneurship to Spur Health Global, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yang Zhao
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China
- School of Social Science, University of Queensland, Brisbane, Queensland, Australia
| | - Yehua Wang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China
- Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Linghua Li
- Center for Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China
- Social Entrepreneurship to Spur Health Global, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Psychiatric Morbidity, Fatigue, Stigma and Quality of Life of Patients With Hepatitis B Infection. J Clin Exp Hepatol 2020; 10:429-441. [PMID: 33029051 PMCID: PMC7527840 DOI: 10.1016/j.jceh.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS This study aimed to evaluate the prevalence of psychiatric morbidity, fatigue, stigma and quality of life (QOL) of patients with hepatitis B infection. Additional aim of the study was to evaluate the correlates of psychiatric morbidity and QOL in patients with hepatitis B infection. METHODS A total of 150 patients with hepatitis B virus (HBV) infection (75 inactive carriers and 75 patients with chronic hepatitis) were evaluated on Mini International Neuropsychiatric Interview-PLUS, World Health Organization-QOL-BREF scale, Chronic Liver Disease Questionnaire, Toronto Chinese HBV Stigma Scale, HBV knowledge scale and Fatigue Severity scale. RESULTS About half of the study participants (49.3%) had at least one lifetime psychiatric morbidity and of these more than one-third (37.3%) fulfilled at least one current psychiatric diagnosis. Generalized anxiety disorder was seen in 19.3% of the participants. Major depressive disorder was the second most common psychiatric diagnosis fulfilled at the time of assessment, with nearly equal prevalence of first episode of depression (8%) and recurrent depressive disorder (7.3%). Compared to those with inactive hepatitis, patients in the chronic hepatitis group had poorer QOL and experienced more fatigue. However, both the groups did not differ in terms of knowledge and stigma. Compared to those without current or lifetime psychiatric diagnosis, those with current or lifetime psychiatric diagnosis had poorer QOL, higher level of stigma and higher fatigue scale. CONCLUSION About half of the patients with HBV infection have psychiatric morbidity, which has negative impact on QOL of patients. Hence, it is important to recognize psychiatric morbidity among patients with HBV.
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. Barriers to chronic Hepatitis B treatment and care in Ghana: A qualitative study with people with Hepatitis B and healthcare providers. PLoS One 2019; 14:e0225830. [PMID: 31794577 PMCID: PMC6890212 DOI: 10.1371/journal.pone.0225830] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatitis B viral (HBV) infection remains an important public health concern particularly in Africa. Between 1990 and 2013, Hepatitis B mortality increased by 63%. In recent times, effective antiviral agents against HBV such as Nucleos(t)ide analogs (NAs) are available. These drugs are capable of suppressing HBV replication, preventing progression of chronic Hepatitis B to cirrhosis, and reducing the risk of hepatocellular carcinoma and liver-related death. Notwithstanding, these treatments are underused despite their effectiveness in managing Hepatitis B. This study sought to explore barriers to treatment and care for people with Hepatitis B (PWHB) in Ghana, paying particular attention to beliefs about aetiology that can act as a barrier to care for PWHB. METHODS We used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews were conducted for 18 persons with Hepatitis B (PWHB) and 15 healthcare providers (HCP; physicians, nurses, and midwives). In addition, four focus group discussions (FGD) with a composition of eight HCPs in each group were done. Participants were recruited from one tertiary and one regional hospital in Ghana. Data were processed using QSR Nvivo version 10.0 and analysed using the procedure of inductive thematic analysis. Participants were recruited from one tertiary and one regional hospital in Ghana. RESULTS Three main cultural beliefs regarding the aetiology of chronic Hepatitis B that act as barriers to care and treatment were identified. These were: (1) the belief that chronic Hepatitis B is a punishment from the gods to those who touch dead bodies without permission from their landlords, (2) the belief that bewitchment contributes to chronic Hepatitis B, and (3) the belief that chronic Hepatitis B is caused by spiritual poison. Furthermore, individual level barriers were identified. These were the absence of chronic Hepatitis B signs and symptoms, perceived efficacy of traditional herbal medicine, and PWHB's perception that formal care does not meet their expectations. Health system-related barriers included high cost of hospital-based care and inadequate Hepatitis B education for patients from HCPs. CONCLUSION Given that high cost of hospital based care was considered an important barrier to engagement in care for PWHB, we recommend including the required Hepatitis B laboratory investigations such as viral load, and the recommended treatment in the National Health Insurance Scheme (NHIS). Also, we recommend increasing health care providers and PWHB Hepatitis B knowledge and capacity in a culturally sensitive fashion, discuss with patients (1) myths about aetiology and the lack of efficacy of traditional herbal medicines, and (2) patients' expectations of care and the need to monitor even in the absence of symptoms.
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Affiliation(s)
- Charles Ampong Adjei
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
- School of Nursing and Midwifery University of Ghana, Accra, Ghana
- * E-mail:
| | - Sarah E. Stutterheim
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Florence Naab
- School of Nursing and Midwifery University of Ghana, Accra, Ghana
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
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van der Scheun FC, Nagelkerke MCM, Kilaru A, Shridhar V, Prasad R, van der Werf TS. Stigma among healthcare workers towards hepatitis B infection in Bangalore, India: a qualitative study. BMC Health Serv Res 2019; 19:736. [PMID: 31640692 PMCID: PMC6805630 DOI: 10.1186/s12913-019-4606-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 10/02/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND With about 50 million people infected with hepatitis B (HBV) in India the burden of disease is high. Stigma has been identified to have a major negative impact on screening, diagnosis and treatment of hepatitis B patients. The aim of this study was to assess the stigma in nurses and physicians in Bangalore, India; studies on stigma in HBV have only been published outside of India. METHODS Semi-structured in-depth-interviews were conducted in the period of March 20th and April 16th 2018 to study stigma and other problems in the care of hepatitis B patients. Stigma was pragmatically defined as a mark of disgrace associated with having a hepatitis B infection. Thirty physicians and nurses in different clinics and hospitals across the city of Bangalore were selected by purposeful sampling and snowball effect until theoretical saturation was reached. RESULTS The following themes were identified during the interviews: feelings when treating a patient; pregnancy and marriage; confidentiality; morality; improvement in care and the difference with HIV. The most stigma was discovered in the theme morality. The majority of our participants mentioned lack of awareness as biggest obstacle in health care of hepatitis B patients. CONCLUSIONS This is the first qualitative study in India exploring hepatitis B stigma among health care workers. Stigma was found in certain themes, such as morality. Though, no unwillingness to treat was found. There was a general lack of awareness amongst patients according to our participants and could jeopardize proper treatment. These results will further help in developing strategies to tackle hepatitis B in India.
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Affiliation(s)
- F C van der Scheun
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands.
| | - M C M Nagelkerke
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands
| | - A Kilaru
- PCMH Restore Health Center, Bangalore, India
| | - V Shridhar
- PCMH Restore Health Center, Bangalore, India
| | - R Prasad
- PCMH Restore Health Center, Bangalore, India.,Academy of Family Physicians of India (AFPI), Karnataka, India
| | - T S van der Werf
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. Chronic Hepatitis B stigma in Ghana: a qualitative study with patients and providers. BMJ Open 2019; 9:e025503. [PMID: 31248915 PMCID: PMC6597648 DOI: 10.1136/bmjopen-2018-025503] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study explored beliefs contributing to Hepatitis B stigma, and the ways in which Hepatitis B stigma manifests, from the perspectives of people with chronic Hepatitis B as well as healthcare providers in Northern and Southern Ghana. DESIGN We used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews and focus group discussions were conducted. Data were processed using QSR Nvivo V.10.0 and analysed using inductive thematic analysis. SETTINGS Participants were recruited from one tertiary and one regional hospital in Ghana between February and November 2017. PARTICIPANTS Overall, 18 people with chronic Hepatitis B (PWHB) and 47 healthcare providers (primary care physicians, nurses and midwives) between the ages of 21 and 57 years participated in the study. RESULTS PWHB face stigma in their sociocultural context and the healthcare environment. Three main beliefs underlying stigma were found: (1) the belief that Hepatitis B is highly contagious; (2) the belief that Hepatitis B is very severe and (3) the belief that Hepatitis B is caused by curses. Stigmatisation manifested as avoidance and social isolation (discrimination). In healthcare settings, stigmatisation manifested as excessive cautiousness, procedure postponement or avoidance, task-shifting and breaches of confidentiality. CONCLUSIONS Given the prevalence of incorrect knowledge, as reflected in the beliefs about Hepatitis B, we recommend public awareness campaigns that emphasise Hepatitis B transmission routes. Also, given the manifestations of the stigma in healthcare settings, we recommend the development and implementation of a continuing professional development programme on Hepatitis B and adjusted policy on Hepatitis B vaccination for Healthcare providers (HCPs).
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Affiliation(s)
- Charles Ampong Adjei
- Community Health Nursing Department, University of Ghana, Accra, Ghana
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Sarah E Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Florence Naab
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
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Social Determinants of Stigma and Discrimination in Vietnamese Patients with Chronic Hepatitis B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030398. [PMID: 30708943 PMCID: PMC6388214 DOI: 10.3390/ijerph16030398] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/26/2022]
Abstract
Vietnam is among the countries with the highest prevalence of chronic hepatitis B (CHB) and individuals who suffer from CHB oftentimes perceive high levels of stigma and discrimination. Our study aimed to provide evidence on the prevalence of stigma against hepatitis B virus (HBV), HBV infection, and social determinants of stigma and discrimination in patients. A cross-sectional study was conducted at Viet-Tiep Hospital, Hai Phong, Vietnam. Stigma and discrimination against CHB in the last month were measured via four dimensions: (1) Blame/Judgment; (2) Shame; (3) Discrimination in different settings; (4) Disclosure of CHB status. Multivariate Logistic and Tobit regressions were used to identify factors associated with CHB-related stigma and discrimination. Among 298 enrolled patients, 4.8% experienced blame/judgement, 10.2% perceived shame, 48.5% felt discriminated in healthcare facilities, and 90.6% disclosed their health status with spouses/partners. Factors associated with lower odds of CHB-related stigma/discrimination included living with spouses/partners, old age, being employed, and the existence of comorbidities was linked with higher odds of stigma. Anti-stigma programs should target those who are younger and have comorbidities. This could be done by community-based interventions which focus on inaccurate beliefs about viral hepatitis. Furthermore, families, healthcare providers, and society should play a crucial role in supporting CHB patients.
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Fitzpatrick T, Zhou K, Cheng Y, Chan PL, Cui F, Tang W, Mollan KR, Guo W, Tucker JD. A crowdsourced intervention to promote hepatitis B and C testing among men who have sex with men in China: study protocol for a nationwide online randomized controlled trial. BMC Infect Dis 2018; 18:489. [PMID: 30268114 PMCID: PMC6162889 DOI: 10.1186/s12879-018-3403-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The World Health Organization recommends all men who have sex with men (MSM) receive Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) testing. MSM in China are a high-risk group for HBV and HCV infection, but test uptake is low. Crowdsourcing invites a large group to solve a problem and then shares the solution with the public. This nationwide online randomized controlled trial will evaluate the effectiveness of a crowdsourced intervention to increase HBV and HCV testing among MSM in China. METHODS Seven hundred MSM will be recruited through social media operated by MSM organizations in China. Eligible participants will be born biologically male, age 16 years or older, report previous anal sex with another man, and reside in China. After completing a baseline online survey, participants will be randomly assigned to intervention or control arms with a 1:1 allocation ratio. The intervention will include two components: (1) a multimedia component will deliver two videos and two images promoting HBV and HCV testing developed through a crowdsourcing contest in China; (2) a participatory component will invite men to submit suggestions for how to improve crowdsourced videos and images. The control arm will not view any images or videos and will not be invited to submit suggestions. All participants will be offered reimbursement for HBV and HCV testing costs. The primary outcome is HBV and HCV test uptake confirmed through electronic submission of test report photos within four weeks of enrolment. Secondary outcomes include self-reported HBV and HCV test uptake, HBV vaccination uptake, and change in stigma toward people living with HBV after four weeks. Primary and secondary outcomes will be calculated using intention to treat and as-exposed analyses and compared using two-sided 95% confidence intervals. DISCUSSION Few previous studies have evaluated interventions to increase HBV and HCV testing in middle-income countries with a high burden of hepatitis. Delivering a crowdsourced intervention using social media is a novel approach to increasing hepatitis testing rates. HBV and HCV test uptake will be confirmed through test report photos, avoiding the limitations of self-reported testing outcomes. TRIAL REGISTRATION NCT03482388 (29 March 2018).
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Affiliation(s)
| | - Kali Zhou
- Department of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, USA
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Po-Lin Chan
- Division of Communicable Disease, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, Peking University, Beijing, China
| | - Weiming Tang
- UNC - Project China, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie R Mollan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wilson Guo
- Gillings School of Global Public Health - Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- UNC - Project China, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Franklin S, Mouliom A, Sinkala E, Kanunga A, Helova A, Dionne-Odom J, Turan JM, Vinikoor M. Hepatitis B virus contact disclosure and testing in Lusaka, Zambia: a mixed-methods study. BMJ Open 2018; 8:e022522. [PMID: 30244215 PMCID: PMC6157559 DOI: 10.1136/bmjopen-2018-022522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to estimate the frequency of disclosure to and testing of contacts of patients with hepatitis B virus (HBV) in Zambia. DESIGN We used a convergent parallel mixed-method research design including a quantitative survey and focus group discussions with patients with HBV. SETTING A university hospital in Lusaka, Zambia. PARTICIPANTS 79 hepatitis B surface antigen (HBsAg)-positive, HIV-negative, adults (18+ years) receiving HBV care completed a quantitative survey and 32 also participated in a focus group discussion. OUTCOMES AND ANALYSIS Contacts of patients with HBV were enumerated and patient-reported disclosure, contact testing and contact HBV test results were used to develop a testing cascade. Using multivariable logistic regression, we identified factors associated with disclosure of HBV status. In focus groups, we explored how index patient knowledge and awareness of their condition shaped perspectives on contact disclosure and testing. Focus groups coding and analysis followed a thematic analysis approach. RESULTS Among 79 patients with HBV (median age 35 years; 26.6% women), the majority reported disclosure to ≥1 contact. According to the index patients' knowledge, of 776 contacts enumerated, 326 (42.1%) were disclosed to, 77 (9.9%) were tested, 67 (8.6%) received results and 8 (11.9%) were HBsAg-positive. Increased stigma score was associated with reduced disclosure. In focus groups, HBV awareness, knowledge and stigma emerged as barriers to disclosure and referral of contacts for testing. Association of HBV with HIV-related stigma was also reported as a strong barrier to contact disclosure and testing and to taking antivirals for HBV monoinfection. CONCLUSIONS HBV contact disclosure and testing were feasible and yielded new diagnoses in Zambia. A better understanding of barriers to seeking HBV testing and treatment is needed to scale-up this important intervention in Africa. TRIALS REGISTRATION NUMBER NCT03158818.
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Affiliation(s)
- Sarah Franklin
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amina Mouliom
- School of Pharmacy, Southwestern Oklahoma State University, Weatherford, Oklahoma, USA
| | - Edford Sinkala
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Annie Kanunga
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Anna Helova
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodie Dionne-Odom
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Vinikoor
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 PMCID: PMC6234740 DOI: 10.12688/wellcomeopenres.14273.2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms ‘hepatitis B’, ‘stigma’ to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a ‘blind spot’, representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
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Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 DOI: 10.12688/wellcomeopenres.14273.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms 'hepatitis B', 'stigma' to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a 'blind spot', representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
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An Investigation into the High Prevalence of Hepatitis B in a Rural Area of Kerala State, India: Hypothesis on Chrysops sp. (Diptera: Tabanidae) Transmission. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4612472. [PMID: 29984234 PMCID: PMC6015714 DOI: 10.1155/2018/4612472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 12/11/2022]
Abstract
Objective Since 2005 there have been several reports of hepatitis B outbreak in the state of Kerala in southern India. Objective of this study was to analyze such outbreaks and to explore hypothesis pertaining the transmission mode. Methods Retrospective observational study involving cases of acute hepatitis B acquired between 1 January 2015 and 31 December 2015 and their family members residing in Mazhuvanoor village in Ernakulam district of Kerala State in southern India. Results 59 houses were included in the survey. The number of patients diagnosed to have acute viral hepatitis B was 59. Majority (66.10%) were over 50 years old. There were no cases below the age of 15 years. All 59 patients claimed to have been bitten frequently by a fly which was identified as “deer fly” belonging to the genus Chrysops. Conclusion Given the current understanding of mechanical transmission of pathogens in both humans and animals by insects belonging to the Tabanidae family which also includes Chrysops, it is plausible that the same mechanism may hold true for hepatitis B also. However this needs to be proven in further studies both at the laboratory level and at field studies.
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Let's Talk About B: Barriers to Hepatitis B Screening and Vaccination Among Asian and South Asian Immigrants in British Columbia. J Racial Ethn Health Disparities 2018; 5:1337-1345. [PMID: 29557047 DOI: 10.1007/s40615-018-0483-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 02/03/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Chronic hepatitis B (HBV) is prevalent among Asian immigrants in Canada with high morbidity and mortality rates. While some studies have identified barriers to health care and information access, few have studied the impact of culturally relevant information and addressed challenges with recommendations for effective public education and outreach programs. METHODS Culturally tailored HBV education workshops were delivered over a 12-month period to Chinese, Filipino, Korean and Punjabi immigrants in Lower Mainland, British Columbia (BC). Data from pre- and post-workshop surveys and 2-week and 1-month follow-up interviews were collected and analyzed to evaluate knowledge gaps and challenges around HBV prevention and screening. Barriers, health care service gaps and facilitators identified in the interviews were coded and analyzed. RESULTS Data were collected from 827 workshop participants. Our results show that targeted immigrants in Lower Mainland, BC face many barriers to accessing HBV screening and vaccination. Limited knowledge and awareness of HBV vaccination/prevention/treatment, limited English proficiency and eLiteracy skills, system and provider level barriers to accessing HBV care, and immigration related barriers are among the reported challenges. More than half of participants who took part in the HBV education workshops engaged in actions related to HBV prevention or management. CONCLUSION Study findings support the need for culturally tailored HBV public education and outreach programs to further advance HBV immunization and awareness in BC. Addressing barriers and developing targeted programmatic strategies identified in this study will promote more effective HBV education programming and improve uptake of HBV screening and vaccination in BC's immigrant populations.
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