A 'one stop liver shop' approach improves the cascade-of-care for Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in the Northern Territory of Australia: results of a novel care delivery model

Autor: Paula Binks, George Garambaka Gurruwiwi, Thel K. Hla, Roslyn Gundjirryirr Dhurrkay, Sarah Bukulatjpi, Jane Davies
Rok vydání: 2020
Předmět:
Adult
Male
HBsAg
medicine.medical_specialty
Carcinoma
Hepatocellular
Native Hawaiian or Other Pacific Islander
Cascade of care
030312 virology
Chronic hepatitis B
03 medical and health sciences
Hepatitis B
Chronic
0302 clinical medicine
Northern Territory
Prevalence
medicine
Health Services
Indigenous
Humans
030212 general & internal medicine
Retrospective Studies
0303 health sciences
medicine.diagnostic_test
business.industry
lcsh:Public aspects of medicine
Research
Health Policy
Public health
Medical record
Liver Neoplasms
Public Health
Environmental and Occupational Health
Health services research
lcsh:RA1-1270
Aboriginal Australians
Novel care delivery
Middle Aged
medicine.disease
Hepatocellular carcinoma
Family medicine
Female
business
Liver cancer
Liver function tests
Delivery of Health Care
Viral load
Zdroj: International Journal for Equity in Health
International Journal for Equity in Health, Vol 19, Iss 1, Pp 1-7 (2020)
ISSN: 1475-9276
Popis: Background Aboriginal and Torres Strait Islander Australians are disproportionately affected by Chronic Hepatitis B (CHB) with a prevalence of 6.08% in the Northern Territory (NT) and liver cancer rates 6 times higher than non-Indigenous Australians. Without appropriate care, overall 25% of those living with CHB will die from either liver failure or liver cancer, outcomes that can be minimised with regular follow up, antiviral treatment and hepatocellular carcinoma (HCC) screening. This care including antiviral treatment is publicly funded in the Australian setting however the care cascade still shows inequities in access to treatment for Aboriginal Australians. We describe the impact of a mobile care delivery model, “One Stop Liver Shop”, on the cascade of care for people living with CHB in a remote Australian setting. Methods A retrospective analysis was performed for CHB care received between 2013 and 2018 in one very remote Northern Territory community, where the “One Stop Liver Shop” was iteratively developed with the community. Patients with positive Hepatitis B virus surface antigen (HBsAg) were identified through electronic medical records. Proportions of patients who are up-to-date with monitoring investigations and HCC screening were evaluated and compared to national guidelines and targets. Results Eighty-three HBsAg positive patients were evaluated. Eighty-eight percent were engaged in care, 16% of whom were receiving antiviral treatment. Liver function tests (LFT) were up to date in 71% of patients in 2013 and 88% in 2018. Viral load (VL) monitoring was up to date for 61 (73%) of patients. There were 44 patients in whom HCC screening was indicated. Of these, 38 (86.4%) were up to date with 6 monthly alpha-fetoprotein (AFP), 35 (79.5%) were up to date with 6 monthly liver ultrasound scan (USS), and 34 (77.3%) were up-to-date for both. Conclusions A “One Stop Liver Shop” developed with and including Aboriginal Health Practitioners bridges gaps in the availability of services to those living with CHB in a very remote community and improves the cascade of care.
Databáze: OpenAIRE
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