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The majority of Australia's hepatitis B virus (HBV) burden is borne by culturally and linguistically diverse (CALD) populations, and antiviral treatment is the mainstay of intervention. Using modelling, we estimated the impact of targeted antiviral treatment scale-up and changes in migration on HBV-related mortality and HBV elimination in CALD populations in Australia. We fitted a deterministic mathematical model based on the natural history of HBV and the Australian migration effect in four CALD population groups according to country of birth. We used three antiviral treatment scale-up scenarios: baseline (9.3% coverage); intermediate (coverage of 80% of patients eligible for antiviral therapy by 2030); and optimistic (coverage of 20% of all patients living with HBV by 2022). Our model predicted that if the baseline treatment is followed between 2015 and 2030, the number of chronic HBV cases and HBV-related mortality will increase. Following the optimistic scale-up, the number of new HBV cases could be reduced by 78%, 73%, 74% and 83% in people born in Asia-Pacific, Europe, Africa and the Middle East, and Americas, respectively, between 2015 and 2030. An optimistic treatment scale-up could result in a 19.2%-24.5% reduction in HBV-related mortality and a 15%-25% reduction in HCC-related mortality in CALD populations between 2015 and 2030. In conclusion, our findings highlight that targeted antiviral treatment for CALD populations provides significant health system benefits by reducing HBV-related complications from cirrhosis and HCC. Expanded antiviral treatment programmes focusing on high-prevalence CALD populations may be an effective strategy to reduce HBV-related morbidity and mortality.

This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse (CALD) backgrounds attending a community-based general practitioner and specialty hepatology shared-care (HEPREACH) clinic in Brisbane, Australia. Patient-reported data on health literacy and clinical information from adult patients (n = 66) of CALD background recruited from the liver clinic were analyzed. Health literacy was assessed using a 5-question, 12-point scale. Variance weighted multiple linear regression was used to identify factors associated with knowledge about VH. About three-quarters of patients (74.2%) were diagnosed with hepatitis B. The median knowledge score was 7.8 (interquartile range [IQR] 6‒9). One in five patients did not understand the infective nature of VH, 30.3% did not understand mother-to-child transmission risk, and 30–40% of patients thought activities such as kissing, sharing food or mosquito bites could spread VH. Only 6% of patients understood the risk of liver cancer and the need for regular screening. Higher educational level (secondary, β = 4.8, p

Background and Aim Surveillance and early detection and curative treatment of hepatocellular carcinoma (HCC) are the mainstay of improving survival for patients, but there are several barriers to achieving this goal. We reported the impact of remoteness of residence on receipt of treatment, tumor stage, and survival in patients with HCC in Queensland. Methods We conducted a retrospective cohort study of 1651 HCC patients (147 migrants) from 1 January 2007 to 31 December 2016. We used Wilcoxon rank‐sum test to compare the median age at the time of diagnosis and Bayesian Weibull accelerated failure time regression to identify independent predictors of time to death. Results The median survival time after HCC diagnosis was 9.0 months (interquartile range 2.0–24.0). Metropolitan residence (P = 0.02), non‐English language (P, In a cohort study of 1651 patients with hepatocellular carcinoma, we found patients living in rural and remote areas were more likely to present with late stage of tumor, less likely to receive curative treatment such as surgical resection, and experience 25% shorter survival time. In a multivariate analysis, remote residence, preferred language, older age at presentation, poorly differentiated tumor, and presence of medical comorbidity were associated with poorer HCC survival, possibly because of limited access to surveillance and curative treatment.

This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse (CALD) backgrounds attending a community-based general practitioner and specialty hepatology shared-care (HEPREACH) clinic in Brisbane, Australia. Patient-reported data on health literacy and clinical information from adult patients (n = 66) of CALD background recruited from the liver clinic were analyzed. Health literacy was assessed using a 5-question, 12-point scale. Variance weighted multiple linear regression was used to identify factors associated with knowledge about VH. About three-quarters of patients (74.2%) were diagnosed with hepatitis B. The median knowledge score was 7.8 (interquartile range [IQR] 6‒9). One in five patients did not understand the infective nature of VH, 30.3% did not understand mother-to-child transmission risk, and 30-40% of patients thought activities such as kissing, sharing food or mosquito bites could spread VH. Only 6% of patients understood the risk of liver cancer and the need for regular screening. Higher educational level (secondary, β = 4.8, p 0.0001 or tertiary, β = 8.1, p 0.0001 vs. primary) was associated with better knowledge, and transition through a refugee camp (vs. not, β = - 1.2, p = 0.028) and country of diagnosis (overseas vs. Australia, β = - 1.9, p = 0.016) were associated with poorer knowledge. Country of origin, refugee status and opportunities for tertiary education impact patients' understanding of VH. Ensuring delivery of culturally appropriate care and education is critical to improve knowledge, reduce misconceptions to improve care and outcomes for VH in CALD migrant communities.

SummaryBackgroundTobacco smoking and hepatitis C virus (HCV) infection cause many diseases independently. The interaction of these conditions on health effects has not been widely studied. There is a paucity of information on addressing tobacco smoking in HCV treatment settings. This review examines the relationship between tobacco smoking and HCV infection and health outcomes and discusses opportunities for treating both conditions.MethodsA systematic review was conducted following the PRISMA 2009 guidelines (Registration No.: CRD42019127771). We searched PubMed, EMBASE, Web of Science, and CINAHL on the health effects of tobacco smoking and HCV infection using keywords and MeSH terms for hepatitis C, tobacco smoking, hepatocellular carcinoma (HCC), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), cardiovascular diseases (CVD), and chronic kidney disease (CKD). We used the Newcastle-Ottawa Scale, a measurement tool to assess systematic reviews (AMSTAR-2), and international narrative systematic assessment (INSA) tools to assess the methodological quality of the included studies.FindingsTobacco smoking and HCV infection share similar underlying risk factors and hence it is unsurprising that tobacco smoking prevalence is higher in people living with HCV (PLHCV) than in the general population. Tobacco smoking and HCV infection have additive or multiplicative interaction to cause HCC, COPD, DM, CVD, and CKD. Anti-HCV direct-acting antiviral (DAA) treatment is highly efficacious and widely accessible in many countries, but untreated tobacco smoking addiction may undermine the achievement of optimal health outcomes possible from HCV treatment.InterpretationThe scale-up of DAA treatment programs globally is an opportunity to address the high prevalence of tobacco smoking in PLHCV by concurrently offering tobacco smoking cessation treatment. Simultaneous initiation of smoking cessation therapy at HCV treatment centres is likely to be cost-effective at maximizing the health gains afforded by DAA treatment. Studies are needed to evaluate the effect of tobacco smoking cessation on the sustained virologic response in DAA treated patients.

Background Culturally and linguistically diverse communities face several challenges to receiving screening and curative treatment of hepatocellular carcinoma (HCC). We reported the predictors of receipt of treatment and survival in a cohort of patients diagnosed with HCC in Southeast Queensland. Methods Data from 1651 HCC patients (147 migrants) followed between January 1, 2007, and December 31, 2016 were analyzed using chi-square statistic to test for the association between socio-economic variables and receipt of treatment. Bayesian Weibull Accelerated Failure Time regression was used to identify predictors of time to death, and we reported time ratios. Results Receipt of surgical resection for HCC was associated with non-metropolitan residence (P=0.02), non-English language (P Conclusions Improving access to HCC surveillance and uptake of timely curative treatment for persons living in remote areas and having socioeconomic disadvantage may help patients present to clinic with early stage tumor and provide better survival. Key messages Remoteness of residence is associated with late presentation, low rate of receipt of treatment and predicts survival of patients with HCC.

Background Antiviral treatment gap in culturally and linguistically diverse (CALD) populations may be a barrier progress in national elimination. Using modelling, we estimated and predicted the impact of antiviral treatment and migration on HBV burden, and HBV-related mortality in CALD populations in Australia. Methods We developed a dynamic, deterministic mathematical model using three antiviral treatment scale-up scenarios - the baseline treatment, intermediate treatment scale-up (80% of eligible by 2030), and optimistic scale-up (20% of all HBV by 2022) to predict the incidence of HBV infection, liver cirrhosis, hepatocellular carcinoma, and HBV-related mortality in four groups of people according to their country of birth. Results The number of chronic HBV cases will remain similar, and HBV-related morbidity and mortality will increase if the baseline approach is followed to 2030. Implementing an optimistic treatment scale-up could reduce the number of new cases of liver cirrhosis (30% in European-born, and 40% in Asia-Pacific-born) by 2030. Following the optimistic scale-up approach, the incidence of HCC decreased by 30% and a 15%-25% reduction in HCC-related mortality could be achieved in the four population subgroups by 2030. Conclusions Following the current antiviral treatment coverage, HBV elimination targets in migrants may not be achieved. A rapid treatment scale-up approach reduces HBV incidence, liver cirrhosis and HCC. Key messages Targeted antiviral treatment for migrants with HBV using rapid scale-up reduces HBV-related disease and mortality and contributes to achievement of national elimination targets.

Background Treatment seeking for people with alcohol use disorders (AUD), injecting drug use and viral hepatitis is low, and has worsened during the coronavirus disease 2019 (COVID-19) pandemic. Deferring clinical care and increasing drug and alcohol use exacerbate the risks of progression for individuals with chronic liver disease from viral hepatitis and/or alcohol-related liver disease (ALD). We explored the impact COVID-19 epidemic may have on patients with chronic liver disease and suggested mechanisms to protect this at-risk population during and after the pandemic. # Methods We searched PubMed, EMBASE, and Google Scholar for published articles and grey literature and synthesized information about the impact COVID-19 has on patients with chronic liver disease, specifically related to impacts and opportunities to prevent viral hepatitis and ALD. # Results The COVID-19 pandemic has caused significant disruption of clinical management of patients with liver disease, but also to alcohol and drug services, needle and syringe programs (NSP), hepatitis B (HBV) screening, and treatment efforts. Social isolation and pandemic-related anxiety have caused an increase in alcohol and drug use. COVID-19 pandemic disruptions may lead to an increase in the incidence of viral hepatitis and ALD, but also cause patients to undertake risky behaviours. The pandemic impacts people with chronic conditions such as HBV to defer medical visits or undertake screening tests. These factors may worsen rates of decompensation for patients with cirrhosis, for whom these deleterious impacts are believed to stay for some time after the pandemic. Interruption in screening, treatment, and monitoring services during the period disrupts chronic disease management of viral hepatitis and ALD and increases the risk of worsening the clinical course of liver disease and delayed diagnosis of hepatocellular carcinoma. # Conclusions Successful mitigation of the impact of COVID-19 on the incidence of viral hepatitis and alcoholic liver disease requires adaptive approaches to reach people with injecting drug use and AUD including community-based networks, fixed site and mobile NSP, mail delivery systems, the use of telehealth, and other digital media for promoting and implementing alcohol harm reduction during and after the COVID-19 pandemic.

Background This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse (CALD) backgrounds attending a community-based general practitioner and specialty hepatology shared-care (HEPREACH) clinic in Brisbane, Australia.Methods Self-reported data on health literacy and clinical information from adult patients (n=66) of CALD background recruited from the liver clinic were analyzed. Health literacy was assessed using a 5-question, 12-point scale. Variance weighted multiple linear regression was used to identify factors associated with knowledge about VH.Results About three-quarters of patients (74.2%) were diagnosed with hepatitis B. The median knowledge score was 7.8 (interquartile range(IQR) 6‒9). One in five patients did not understand the infective nature of VH, 30.3% did not understand mother-to-child transmission risk, and 30%‒40% of patients thought activities such as kissing, sharing food or mosquito bites could spread VH. Only 6% of patients understood the risk of liver cancer and the need for regular screening. Higher educational level (secondary, β=4.8, pDiscussion Country of origin, refugee status and opportunities for tertiary education impact patients’ understanding of VH. Ensuring delivery of culturally appropriate care and education is critical to improve knowledge, reduce misconceptions to improve care and outcomes for viral hepatitis in CALD migrant communities.

Background Ethiopia has been implementing a community health extension program (HEP) since 2003. We aimed to assess the successes and challenges of the HEP over time, and develop a framework that may assist the implementation of the program toward universal primary healthcare services. Methods We conducted a systematic review and synthesis of the literature on the HEP in Ethiopia between 2003 and 2018. Literature search was accomplished in PubMed, Embase and Google scholar databases. Literature search strategies were developed using medical subject headings (MeSH) and text words related to the aim of the review. We used a three-stage screening process to select the publications. Data extraction was conducted by three reviewers using pre-prepared data extraction form. We conducted an interpretive (not aggregative) synthesis of studies. Findings The HEP enabled Ethiopia to achieve significant improvements in maternal and child health, communicable diseases, hygiene and sanitation, knowledge and health care seeking. The HEP has been a learning organization that adapts itself to community demands. The program is also dynamic enough to shift tasks between health centers and community. The community has been a key player in the successful implementation of the HEP. In spite of these successes, the program is currently facing challenges that remain to be addressed. These challenges are related to productivity and efficiency of health extension workers (HEWs); working and living conditions of HEWs; capacity of health posts; and, social determinants of health. These require a systemic approach that involves the wider health system, community, and sectors responsible for social determinants of health. We developed a framework that may assist in the implementation of the HEP. Conclusion The HEP has enabled Ethiopia to achieve significant improvements. However, several challenges remain to be addressed. The framework can be utilized to improve community health programs toward universal coverage for primary healthcare services.