Assuntos
Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Hepatite B/diagnóstico , Programas de Rastreamento/métodos , Adulto , Idoso , Antivirais/administração & dosagem , Antivirais/economia , Antivirais/uso terapêutico , Austrália/epidemiologia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Fibrose/economia , Fibrose/epidemiologia , Fibrose/prevenção & controle , Acessibilidade aos Serviços de Saúde/normas , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/uso terapêutico , Humanos , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , PrevalênciaAssuntos
Acessibilidade aos Serviços de Saúde , Vacinas contra Hepatite B/economia , Hepatite B/prevenção & controle , Programas de Imunização/economia , Austrália , Disparidades em Assistência à Saúde , Hepatite B/economia , Vacinas contra Hepatite B/provisão & distribuição , Humanos , Populações VulneráveisRESUMO
OBJECTIVE: To estimate the level of access to diagnosis, management and treatment for people living with chronic hepatitis B (CHB) in Australia, and to identify the gaps in clinical care for people living with CHB. METHODS: Analysis of publicly available population level data including infectious disease notifications, Medicare and Pharmaceutical Benefits Scheme utilisation data, census-based estimates of CHB prevalence and burden, and mathematical modelling. RESULTS: In 2012, of the estimated 218,567 Australians living with CHB, 57% had been diagnosed, 17,367 people (8%) received recommended HBV DNA viral load testing (without treatment) and 10,987 (5%) received antiviral therapy. CONCLUSIONS: This analysis reveals substantial gaps in the cascade of care for CHB in Australia, most notably in diagnosis (with 43% undiagnosed) and in recommended yearly monitoring (87% not in care). The number receiving therapy represents only one-third of those estimated to require treatment to prevent progressive liver disease and liver cancer. IMPLICATIONS: These findings demonstrate that the majority of those affected are not receiving guideline-based care; highlight the need for improvements in opportunistic screening, engagement in care, and access to therapy; and provide a method to assess the impact of public health and clinical interventions in response to CHB over time.