Medicine (St Vincent's) - Research Publications

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Author: Desmond, Paul × Author: Howell, Jessica × End date: 2021 × Start date: 2020 × Type: Journal Article ×

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    Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C
    Papaluca, T ; Craigie, A ; McDonald, L ; Edwards, A ; MacIsaac, M ; Holmes, JA ; Jarman, M ; Lee, T ; Huang, H ; Chan, A ; Lai, M ; Sundararajan, V ; Doyle, JS ; Hellard, M ; Stoove, M ; Howell, J ; Desmond, P ; Iser, D ; Thompson, AJ ; Liu, C-H (PUBLIC LIBRARY SCIENCE, 2020-11-18)
    BACKGROUND AND AIMS: Prison-based HCV treatment rates remain low due to multiple barriers, including accessing transient elastography for cirrhosis determination. The AST-to-platelet ratio index (APRI) and FIB-4 scores have excellent negative predictive value (NPV) in hospital cohorts to exclude cirrhosis. We investigated their performance in a large cohort of prisoners with HCV infection. METHODS: This was a retrospective cohort study of participants assessed by a prison-based hepatitis program. The sensitivity, specificity, NPV and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis were then analysed, with transient elastography as the reference standard. The utility of age thresholds as a trigger for transient elastography was also explored. RESULTS: Data from 1007 prisoners were included. The median age was 41, 89% were male, and 12% had cirrhosis. An APRI cut-off of 1.0 and FIB-4 cut-off of 1.45 had NPVs for cirrhosis of 96.1% and 96.6%, respectively, and if used to triage prisoners for transient elastography, could reduce the need for this investigation by 71%. The PPVs of APRI and FIB-4 for cirrhosis at these cut-offs were low. Age ≤35 years alone had a NPV for cirrhosis of 96.5%. In those >35 years, the APRI cut-off of 1.0 alone had a high NPV >95%. CONCLUSION: APRI and FIB-4 scores can reliably exclude cirrhosis in prisoners and reduce requirement for transient elastography. This finding will simplify the cascade of care for prisoners living with hepatitis C.
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    A qualitative exploration of enablers for hepatitis B clinical management among ethnic Chinese in Australia
    Xiao, Y ; Wallace, J ; Thompson, A ; Hellard, M ; van Gemert, C ; Holmes, JA ; Croagh, C ; Richmond, J ; Papaluca, T ; Hall, S ; Hong, T ; Demediuk, B ; Iser, D ; Ryan, M ; Desmond, P ; Visvanathan, K ; Howell, J (WILEY, 2021-06)
    An estimated 18% of people living with chronic hepatitis B (CHB) in Australia were born in China. While guideline-based care, including regular clinical monitoring and timely treatment, prevent CHB-related cirrhosis, cancer and deaths, over three-quarters of people with CHB do not receive guideline-based care in Australia. This qualitative study aimed to identify enablers to engagement in CHB clinical management among ethnic Chinese people attending specialist care. Participants self-identified as of Chinese ethnicity and who attended specialist care for CHB clinical management were interviewed in Melbourne in 2019 (n = 30). Semi-structured interviews covered experiences of diagnosis and engagement in clinical management services, and advice for people living with CHB. Interviews were recorded with consent; data were transcribed verbatim and thematically analysed. Receiving clear information about the availability of treatment and/or the necessity of long-term clinical management were the main enablers for participants to engage in CHB clinical management. Additional enablers identified to maintain regular clinical monitoring included understanding CHB increases risks of cirrhosis and liver cancer, using viral load indicators to visualize disease status in patient-doctor communication; expectations from family, peer group and medical professionals; use of a patient recall system; availability of interpreters or multilingual doctors; and largely subsidized healthcare services. In conclusion, to support people attending clinical management for CHB, a holistic response from community, healthcare providers and the public health sector is required. There are needs for public health programmes directed to communicate (i) CHB-related complications; (ii) availability of effective and cheap treatment; and that (iii) long-term engagement with clinical management and its benefits.