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1.
Ethn Health ; : 1-13, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32568555

RESUMO

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.

2.
BMC Public Health ; 19(1): 1355, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647001

RESUMO

BACKGROUND: The low diagnosis rate and poor access to clinical care among people with CHB is a major barrier to reducing HBV-related morbidity and mortality in Australia. One explanation for this is a lack of disease-specific knowledge among people living with CHB. Health literacy has been shown to be important for maximising engagement with medical care and adherence to recommended management. The 'teach-back' communication strategy has been shown to improve patient understanding in other clinical areas. This study aims to assess disease-specific knowledge; and evaluate the efficacy of the teach-back strategy for improving HBV knowledge, compared to a standard medical consultation. METHOD: A randomized pilot study was conducted between February and June 2017. Participants were recruited from the liver clinic at an inner-city tertiary hospital. English-speaking patients aged ≥18 years and diagnosed with CHB were eligible for the study. Participants were randomised to a control group (medical specialist appointment) and intervention group (teach-back). Knowledge was assessed at baseline, immediately post-intervention and at one month using a validated questionnaire. Participants in the intervention group received a one-on-one teach-back session about CHB. The main outcome measure was a combined knowledge score of the domains assessed - transmission, natural history, epidemiology and prevention and clinical management. RESULTS: Seventy participants were recruited (control n = 32, teach-back n = 38). Mean baseline knowledge score was 19.1 out of 23 with 55 (79%) participants scoring ≥17.3 (defined as high knowledge) (7). Sub-analysis of CHB knowledge domains identified focal deficits concerning transmission and whether HBV is curable. Knowledge scores were found to be positively associated with English proficiency and antiviral treatment experience (p < 0.05). Teach-back was associated with a significant increase in CHB knowledge at early recall (22.5 vs 18.7, p < 0.001) and at 1-month follow-up (21.9 vs 18.7, p < 0.001); there was no improvement in CHB knowledge associated with standard clinical consultant (early recall: 19.6 vs 19.4, p = 0.49, one-month follow-up: 19.5 vs 19.4, p = 0.94). CONCLUSION: In a tertiary hospital liver clinic population, baseline knowledge about CHB was good, but there were focal deficits concerning transmission and potential for cure. Teach-back was associated with improvement in CHB knowledge and it is a simple communication tool suitable for incorporation into a standard medical consultation.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B Crônica/epidemiologia , Educação de Pacientes como Assunto/métodos , Adulto , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários
3.
Aust J Prim Health ; 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31213224

RESUMO

This inquiry examines health-seeking practices and challenges among South Sudanese people from refugee backgrounds with chronic hepatitis B in Australia. Fifteen semi-structured interviews were conducted. Using interpretative thematic analysis, the results revealed four themes, consisting of barriers and facilitators to clinical follow up, treatment and support-seeking practices and coping responses. Time constraints, having divergent views about treatment decisions and perceived inadequate clinical support were also identified as barriers. Being referred to a specialist, being aware of the risk associated with liver cancer and sending reminders about appointments were identified as facilitators to clinical follow up. Treatment-seeking practices involved both biomedical and alternative therapies. Participants mainly drew on their social networks and supports, religious beliefs and individual resilience as coping strategies. The findings are important for improving access to treatment and care and support for people with chronic hepatitis B from the South Sudanese community.

4.
Hepatol Med Policy ; 3: 1, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30288324

RESUMO

Background: The current model of care for the treatment of chronic hepatitis B (CHB) in Australia is through specialist Hepatology or Infectious Diseases clinics, and limited accredited primary care practices. Capacity is limited, and less than 5% of Australians living with CHB currently access therapy. Increasing treatment uptake is an urgent area of clinical need. Nucleos(t)ide analogue therapy is safe and effective treatment for CHB that is suitable for community prescribing. We have evaluated the success of a community-based model for the management of CHB in primary care clinics using a novel web-based clinical tool. Methods: Using guidelines set out by the Gastroenterological Society of Australia, we developed an interactive online clinical management tool for the shared care of patients with CHB in primary care clinics, with remote oversight from tertiary hospital-based hepatologists and a project officer. We call this model of care the "B in IT" program. Suitable patients were referred from the specialist liver clinic back to primary care for ongoing management. Compliance with recommended appointments, pathology tests and ultrasounds of patients enrolled in "B in IT" was assessed and compared to that of the same patients prior to community discharge, as well as a matched control group of CHB outpatients continuing to attend a specialist clinic. Results: Thirty patients with CHB were enrolled in the "B in IT" program. Compliance with attending scheduled appointments within 1 month of the suggested date was 87% across all 115 visits scheduled. Compliance with completing recommended pathology within 1 month of the suggested date was 94% and compliance with completing recommended liver ultrasounds for cancer screening within 1 month of the suggested date was 89%. The compliance rates for visit attendance and ultrasound completion were significantly higher than the control patient group (p < 0.0001) and the "B in IT" patients prior to community discharge (p = 0.002 and p = 0.039, respectively). Conclusions: The "B in IT" program's novel web-based clinical tool supports primary care physicians to treat and monitor patients with CHB. This program promotes community-based care and increases system capacity for the clinical care of people living with CHB.

5.
PLoS One ; 13(8): e0202647, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30142171

RESUMO

Participation in HIV cure-related clinical trials that involve antiretroviral treatment (ART) interruption may pose substantial individual risks for people living with HIV (PLHIV) without any therapeutic benefit. As such, it is important that the views of PLHIV are considered in the design of HIV cure research trials. Examining the lived experience of PLHIV provides unique and valuable perspectives on the risks and benefits of HIV cure research. In this study, we interviewed 20 PLHIV in Australia about their knowledge and attitudes toward clinical HIV cure research and explored their views regarding participation in HIV cure clinical trials, including those that involve ART interruption. Data were analysed thematically, using both inductive and deductive coding techniques, to identity themes related to perceptions of HIV cure research and PLHIV's assessment of the possible risks and benefits of trial participation. Study findings revealed interviewees were willing to consider participation in HIV cure research for social reasons, most notably the opportunity to help others. Concerns raised about ART interruption related to the social and emotional impact of viral rebound, including fear of onward HIV transmission and anxiety about losing control. These findings reveal the ways in which PLHIV perspectives deepen our understanding of HIV cure research, moving beyond a purely clinical assessment of risks and benefits in order to consider the social context.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Antirretrovirais/uso terapêutico , Austrália/epidemiologia , Feminino , HIV/patogenicidade , Infecções por HIV/virologia , Humanos , Masculino , Percepção , Pesquisa Qualitativa , Meio Social
6.
Aust Fam Physician ; 46(11): 859-864, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29101924

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) surveillance reduces mortality in at-risk people living with chronic hepatitis B (CHB), but is difficult to achieve in practice. The objective of this study was to measure participation and adherence to liver cancer HCC surveillance in eligible patients in a community health centre, following support from the Integrated Hepatitis B Service (IHBS). METHODS: A retrospective analysis of the medical records of patients with CHB who met the indications for HCC surveillance over a 4.5-year period of IHBS involvement was conducted. Data collected included the date of ultrasound examinations and HBV DNA viral load tests. RESULTS: Sixty-seven patients underwent HCC surveillance, representing 213 person years. The participation rate was 75%. Adherence to surveillance was considered good in 18 (27%) patients, suboptimal in 29 (43%) patients and poor in 20 (30%) patients. A greater proportion of patients were receiving HCC surveillance at the final audit (56%) than at baseline (10%; P DISCUSSION: It is difficult to achieve optimal adherence to HCC surveillance, even with additional support.


Assuntos
Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/fisiopatologia , Sistemas de Alerta/normas , Adulto , Idoso , Austrália/epidemiologia , Detecção Precoce de Câncer/métodos , Feminino , Medicina Geral/métodos , Hepatite B Crônica/complicações , Humanos , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estudos Retrospectivos , Ultrassonografia/métodos
7.
Hepat Mon ; 16(6): e35566, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27630722

RESUMO

BACKGROUND: The psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB. OBJECTIVES: This study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties. PATIENTS AND METHODS: Using convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B. RESULTS: Ninety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them. CONCLUSIONS: Hepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.

8.
Aust N Z J Public Health ; 39(6): 563-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26095536

RESUMO

OBJECTIVE: To assess hepatitis B knowledge among people with chronic hepatitis B (CHB) in Australia. METHODS: People with CHB in three Australian jurisdictions completed a self-administered questionaire, including 24 hepatitis B knowledge questions across four domains: transmission; natural history; epidemiology and prevention; and clinical management. RESULTS: Ninety-three people completed the survey. Mean age was 45 years, 43% were women and 93% were born overseas (75% from Asia). Mean total knowledge score was 55 out of 100 with 17 participants (18%) scoring ≥75 (defined as a high knowledge). Clinical management scored the lowest (median: 25) and natural history scored the highest (median: 80). In adjusted linear regression, tertiary education (vs. secondary and under) was associated with higher knowledge score (ß: 11.95; 95%CI: 2.45, 21.44; p=0.01). In adjusted logistic regression, very good English proficiency (vs. limited/no proficiency) was associated with high knowledge (OR: 7.65; 95%CI: 1.94, 30.19; p<0.01). Participants reporting hepatitis B-related anxiety demonstrated a significantly higher knowledge score compared to those reporting no such anxiety (ß: 15.11; 95%CI: 4.40, 25.81; p<0.01). CONCLUSIONS AND IMPLICATIONS: Hepatitis B-related knowledge gaps were identified among people with CHB. Interventions to improve knowledge should focus on people with low levels of academic education and limited English proficiency.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Hepatite B Crônica/prevenção & controle , Idoso , Austrália/epidemiologia , Escolaridade , Feminino , Inquéritos Epidemiológicos , Hepatite B , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/transmissão , Humanos , Pessoa de Meia-Idade , Classe Social , Inquéritos e Questionários
9.
Aust N Z J Public Health ; 37(5): 405-10, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24090321

RESUMO

OBJECTIVE: General Practitioners (GPs) are essential to reducing the impact of chronic hepatitis B (CHB) given their clinical management role where only 56% of people with the infection in Australia have been diagnosed. This qualitative study aimed to identify the challenges GPs face in effectively responding to CHB. METHODS: Semi-structured interviews were conducted with 26 GPs self-identifying as having a 'high caseload' of patients and/or a particular interest in CHB. Participants were recruited from five jurisdictions and came from diverse ethnicities, clinical experience and practice profile. Interview data were analysed according to the principles of grounded theory. RESULTS: Patient and GP knowledge, a lack of community awareness, and language and cultural diversity impeded the GP response to CHB. Communication with specialists was reported as challenging with unclear referral pathways, limited feedback from specialists after referral, and poor liaison and support for managing people living with CHB. Regulations restricting GPs capacity to respond included the lack of prescribing opportunities, fear of Medicare auditing for screening the populations most at risk, and inadequate financial support given the complexity of CHB and the communities most affected by the infection. CONCLUSIONS: General Practitioners require additional skills and resources to support the effective management of people with CHB. These include improved awareness and knowledge about the infection, adequate financial resources to support patient management, and effective referral pathways and support.


Assuntos
Gerenciamento Clínico , Clínicos Gerais , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/terapia , Adulto , Atitude do Pessoal de Saúde , Austrália , Comunicação , Competência Cultural , Diversidade Cultural , Feminino , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Encaminhamento e Consulta
10.
Sex Health ; 9(2): 131-7, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22498156

RESUMO

BACKGROUND: The complexity of the hepatitis B natural history and its prevalence in specific populations in Australia challenges the capacity of the health system to deliver health care effectively to affected people. This study explores the challenges in delivering health care to people with chronic hepatitis B (CHB) in Australia. METHODS: We conducted a grounded theory based qualitative study in which data were gathered from 70 in-depth interviews with government program officers, clinicians and health and community workers across Australia, and four focus group discussions with 40 health and community workers from the communities most at risk of CHB. RESULTS: A systematic approach to screening populations at risk, including people born in countries with intermediate or high prevalence of CHB; consensus on clinical guidelines; development of a shared care framework for CHB involving general practitioners; and effective communication between patients and health professionals were identified as essential. Workforce development, particularly for primary health care professionals, and developing the knowledge and capacity of health professionals to communicate effectively with people with HBV were described as other major factors in reducing the barriers to CHB treatment in Australia. CONCLUSION: To improve the clinical management of people with CHB in Australia, the health system needs to encourage the screening of people at risk, improve access to clinical services, and the knowledge and communication skills of primary health care and community health service providers. This study supported developing a shared care model and related infrastructures including training programs, referral pathways and clinical guidelines.


Assuntos
Assistência à Saúde/organização & administração , Educação em Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/terapia , Programas de Rastreamento/organização & administração , Atenção Primária à Saúde/organização & administração , Austrália/epidemiologia , Centros Comunitários de Saúde/organização & administração , Serviços de Saúde Comunitária/organização & administração , Gerenciamento Clínico , Grupos Focais , Humanos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
11.
BMC Res Notes ; 4: 45, 2011 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-21371332

RESUMO

BACKGROUND: The implementation of a comprehensive public health response to hepatitis B in Australia is urgently required to reduce the increasing burden of hepatitis B infection on the health system and the community. A significant gap in the public health response to hepatitis B is an understanding of how people with chronic hepatitis B (CHB) respond to CHB. FINDINGS: A qualitative study involving semi-structured interviews and focus group discussions was conducted. Interviews were held with 20 people with CHB from three states of Australia. In addition, four focus group discussions were held with a total of 40 community and health workers from culturally and linguistically diverse communities in four Australian states.People with CHB reported no formal or informal pre or post test discussion with little information about hepatitis B provided at the point of diagnosis. Knowledge deficits about hepatitis B were found among most participants. Few resources are available for people with CHB or their families to assist them in understanding the infection and promoting their health and well-being. A lack of confidence in the professional knowledge of service providers was noted throughout interviews. CONCLUSIONS: People with CHB need culturally and linguistically appropriate education and information, particularly at the point of diagnosis. Primary health care professionals need the knowledge, skills and motivation to provide appropriate information to people with CHB, to ensure they have the capacity to better manage their infection.

12.
Res Nurs Health ; 33(5): 465-73, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20730869

RESUMO

We identified trajectories of illness uncertainty in chronic hepatitis C patients and examined their association with fatigue levels during 12 months of disease monitoring without treatment (watchful waiting). Sixty-two men and 63 women completed uncertainty and fatigue measures. Groups were formed by uncertainty scores (high, medium, and low) at baseline. Baseline fatigue levels were higher in the high uncertainty group than in the medium and low groups. Over time, uncertainty levels did not change. Fatigue levels in the low uncertainty group remained constant, increased in the medium, and decreased in the high groups. Findings suggest that uncertainty and fatigue do not remit spontaneously. Being aware of this may help nurses identify those patients needing support for these two concerns.


Assuntos
Atitude Frente a Saúde , Fadiga/psicologia , Hepatite C Crônica/psicologia , Incerteza , Adaptação Psicológica , Adulto , Idoso , Comorbidade , Fadiga/diagnóstico , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Pesquisa Metodológica em Enfermagem , Observação , Fatores de Risco , Índice de Gravidade de Doença , Sudeste dos Estados Unidos/epidemiologia
13.
Australas Psychiatry ; 14(4): 374-8, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17116075

RESUMO

OBJECTIVE: To review the evidence available on best practice care of people with both hepatitis C and mental illness and its application in a mental health service. METHODS: A literature search was conducted for publications dealing with screening, referral for specialist review and antiviral treatment for this population group. RESULTS: A small number of studies was identified that specifically dealt with screening and treatment for hepatitis C in people with mental illness. CONCLUSIONS: Screening, referral and treatment for hepatitis C in people with mental illness is worthwhile and achievable.


Assuntos
Hepatite C Crônica/epidemiologia , Hepatite C Crônica/terapia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Austrália/epidemiologia , Comorbidade , Aconselhamento , Guias como Assunto , Educação em Saúde , Hepatite C Crônica/prevenção & controle , Humanos , Estilo de Vida , Serviços de Saúde Mental/organização & administração , Prevalência , Encaminhamento e Consulta
14.
Aust Nurs J ; 12(1): 23-5, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19149457

RESUMO

Hepatitis C has reached epidemic proportions in Australia. Because of its association with injecting drug use, which is a main transmission mode, hepatitis C is a highly stigmatising health condition. In fact, the stigma attached to hepatitis C means hepatitis C is not just a medical diagnosis, but also a social diagnosis. The limited available research indicates hepatitis C-related discrimination is most likely to occur in health care settings. A strategic and evidenced-based approach is required to combat the social impact of hepatitis C.


Assuntos
Hepatite C/diagnóstico , Hepatite C/enfermagem , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Hepatite C/epidemiologia , Humanos , Preconceito , Problemas Sociais
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