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Hepatitis B virus (HBV) care cascade characterisation is important for monitoring HBV elimination progress. This study evaluated care cascade and factors associated with HBV DNA testing and treatment in New South Wales, Australia. HBV care cascade were determined through linkage of HBV notifications (1993-2017) to Medicare and pharmaceutical benefits schemes (2010-2018). Timely HBV DNA testing was within 4 weeks of HBV notification. Multivariate Cox proportional hazards regression evaluated factors associated with HBV DNA testing and treatment. Among 15,202 people with HBV notification, 10,479 (69%) were tested for HBV DNA. A total of 3179 (21%) initiated HBV treatment. HBV DNA testing was more likely among age ≥45 years (adjusted hazard ratio [aHR] 1.07, 95% CI: 1.02, 1.12), hepatocellular carcinoma (HCC) (aHR 1.23, 95% CI: 1.01, 1.50), coinfection (aHR 1.61, 95% CI: 1.23, 2.09), later notification (2014-2017) (aHR 1.21, 95% CI: 1.16, 1.26) and less likely among females (aHR 0.95, 95% CI: 0.91, 0.99), history of alcohol use disorder (AUD) (aHR 0.77, 95% CI: 0.66, 0.89), HCV coinfection (aHR .62, 95% CI: 0.55, 0.70) and Indigenous peoples (aHR 0.84, 95% CI: 0.71, 0.98). HBV treatment was associated with age ≥45 years (aHR 1.35, 95% CI: 1.24, 1.48), decompensated cirrhosis (aHR 2.07, 95% CI: 1.62, 2.65), HCC (aHR 2.96, 95% CI: 2.35, 3.74), HIV coinfection (aHR 4.27, 95% CI: 3.43, 5.31) and later notification (2014-2017) (aHR 1.37, 95% CI: 1.26, 1.47). HBV treatment was less likely among females (aHR 0.68, 95% CI: 0.63, 0.73) and Indigenous peoples (aHR 0.58, 95% CI: 0.42, 0.80). HBV DNA testing and treatment coverage have increased, but remain sub-optimal among some key populations., (© 2023 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

Routinely collected and linked healthcare administrative datasets could be used to monitor mortality among people with hepatitis B (HBV) and C (HCV). This study aimed to evaluate the concordance in records of liver-related mortality among people with an HBV or HCV notification, between data on hospitalization for end-stage liver disease (ESLD) and death certificates. In New South Wales, Australia, HBV and HCV notifications (1993-2017) were linked to hospital admissions (2001-2018), all-cause mortality (1993-2018) and cause-specific mortality (1993-2016) datasets. Hospitalization for ESLD was defined as a first-time hospital admission due to decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC). Consistency of liver death definition of mortality following hospitalization for ESLD was compared with two death certificate-based definitions of liver deaths coded among primary and secondary cause-specific mortality data, including ESLD-related (deaths due to DC and HCC) and all-liver deaths (ESLD-related and other liver-related causes). Of 63,292 and 107,430 individuals with an HBV and HCV notification, there were 4478 (2.6%) post-ESLD hospitalization deaths, 5572 (3.3%) death certificate liver disease deaths and 2910 (1.7%) death certificate ESLD deaths. Between 2001 and 2016, among HBV post-ESLD hospitalization deaths (n = 891), 63% (562) had death certificate ESLD recorded, and 83% (741) had death certificate liver disease recorded. Between 2001 and 2016, among HCV post-ESLD hospitalization deaths (n = 3587), 58% (2082) had death certificate ESLD recorded, and 87% (3135) had death certificate liver disease recorded. At least one-third of death certificates with DC and HCC as cause of death had no mention of HBV, HCV or viral hepatitis. Our study identified limitations in estimating and tracking HBV and HCV liver disease mortality using death certificate-based data only. The optimum data for this purpose is either ESLD hospitalisations with vital status information or a combination of these with cause-specific death certificate data., (© 2023 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

Introduction: Birth preparedness and complication readiness (BPCR) is a broad system to increase the practice of trained health provision at the time of childbirth and the key interventions to decrease mothers' and newborns' death. However, its status and influencing factors have not been well studied at different levels in the study area. The current study aimed to assess the BPCR status and explore its associated factors influencing BPCR among childbearing age women in Thatta, District of Sindh., Methods: This community-based cross-sectional study was conducted among 770 recently delivered mothers from October 2016 -September 2017, recruited using a multistage cluster sampling technique. A structured validated close-ended questionnaire measuring BPCR knowledge and practices was used for the interviews. The results were analyzed by means of the Chi-square test, and a binary logistic regression model was used to determine the factors influencing BPCR., Results: The overall response rate was 94.6%, with a low BPCR status. Out of 770 participants, only 163 (21.2%) were well prepared, while 607 (78.8%) were not prepared for safe childbirth and its complications. A small proportion of women knew about the serious warning signs of pregnancy, labour, childbirth and the postpartum period (16.2%), (15.3%) and (22.7%) respectively. Antenatal care (ANC) checkup (P < 0.001), cost of ANC checkup (p = 0.016), place of birth (p = 0.014), awareness of serious warning signs during pregnancy (p = 0.001) and awareness of serious warning signs during the postpartum period (p < 0.001) were found to be significant predictors of BPCR., Conclusion: The proportion of women who were well prepared for birth and its complications was low. It is recommended to organize community-based education campaigns and improve the quality of MNCH services at every level to increase BPCR among women in Sindh., Competing Interests: The authors have declared that no competing interests exist.

Background & Aims: Population-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions., Methods: Trends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors., Results: Among 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth <1944, adjusted hazard ratio [aHR] 2.06, 95% CI 1.57-2.69), alcohol use disorder (aHR 4.82, 95% CI 3.96-5.87) and HCV co-infection (aHR 1.88, 95% CI 1.53-2.31). Predictors of HCC diagnosis included older age (birth <1944, aHR 3.94, 95% CI 2.91-5.32) and male sex (aHR 3.79, 95% CI 3.05-4.71)., Conclusion: In an era of improved antiviral therapies, the risk of HBV-related liver morbidity and mortality has declined. HCV co-infection and alcohol use disorder are key modifiable risk factors associated with the burden of HBV., Lay Summary: Rising hepatitis B-related morbidity and mortality is a major public health concern. However, the development of highly effective medicines against hepatitis B virus (HBV) has brought renewed optimism for its elimination by 2030. This study shows a steady decline in HBV-related liver morbidity and mortality in New South Wales, Australia. Moreover, late hepatitis notification has also declined, allowing individuals with HBV to have access to timely antiviral treatment. Despite this, hepatitis C co-infection and alcohol use disorder are key modifiable risk factors associated with HBV disease burden. To attain the desired benefits from highly effective antiviral treatment, managing comorbidities, including hepatitis C and high alcohol use, must improve among individuals with hepatitis B., Competing Interests: ML has received research support from Merck, Bristol-Myers Squibb, Boehringer Ingelheim, Janssen-Cilag, Gilead Sciences, and ViiV HealthCare. ML has received consultancy and workshop fees from Gilead Sciences. ML has received Data Safety Monitoring Board Committee fees from Sirtex Pty Ltd. JG is on the speaker’s bureau for Gilead Sciences, Merck, Janssen, Roche, and Pharmaxis. JG is a member of advisory board for Gilead Sciences, Merck, Janssen, Bristol-Myers Squibb, AbbVie, Roche, GlaxoSmithKline, Pharmaxis and Pfizer. JG has received travel support from Gilead Sciences, Merck, Bristol-Myers Squibb, AbbVie, and Roche. GD has received research support from Gilead Sciences, Merck, and AbbVie. Other authors have no commercial relationships that might pose a conflict of interest in connection with this manuscript. GM has received research support from Gilead Sciences and AbbVie. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2022 The Author(s).)