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Problem Although most primary hepatocellular cancers (HCCs) are attributable to chronic viral hepatitis and largely preventable, such cancers remain a leading cause of cancer-related mortality wherever chronic hepatitis B is endemic. Approach Many HCCs could be prevented by increasing awareness and knowledge of hepatitis B, optimizing the monitoring of chronic hepatitis B and using antiviral treatments--but there are gaps In the implementation of such strategies. Local setting The 'B Positive' programme, based in Sydney, Australia, Is designed to Improve hepatitis-B-related health outcomes among immigrants from countries with endemic hepatitis B.The programme offers information about disease screening, vaccination and treatment options, as well as optimized access to care. Relevant changes The B Positive programme has been informed by economic modelllng.The programme offers culturally tailored education on chronic hepatitis B to target communities and their health practitioners and regular follow-up through a population- based registry of cases. Lessons learnt As the costs of screening for chronic hepatitis B and follow-up are relatively low and less than one in every four cases may require antiviral drugs, optimizing access to treatment seems an appropriate and cost-effective management option.The Identification and accurate staging of cases and the judicious use of antiviral medications are predicated upon an Informed and educated health workforce. As establishing community trust Is a lengthy process, delaying the Implementation of programmes against chronic hepatitis B until antiviral drugs become cheaper is unwarranted. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Probleme Bien que la majorite des cancers hepatocellulaires primaires (CHC) soient attribuables aux hepatites virales chronlques et qu'ils puissent etre evites en grande partie, ces cancers restent une des principales causes de mortalite liee au cancer partout ou l'hepatite B chronique est endemique. Approche De nombreux CHC pourraient etre evites par une sensibilisation et une connaissance accrues de l'hepatite B, l'optimisation du suivi des hepatites B chroniques et i'utilisation de traitements antiviraux--mais il existe des lacunes dans la mise en ceuvre de ces strategies. Environnement local Le programme <>, base a Sydney en Australie, est concu pour ameliorer l'etat de sante lie a l'hepatite B chez les immigrants venus de pays ou l'hepatite B est endemique. Le programme offre des informations sur le depistage de la maladie, la vaccination et les options de traitement, alnsi qu'un acces optimise aux soins. Changements significatifs Le programme <> a ete elabore par modelisation economique. Le programme offre un enseignement sur l'hepatite B chronique culturellement adapte pour cibler les communautes et leurs professionnels de sante, et un suivi regulier via un registre de cas base sur la population. Lecons tirees Puisque les couts de depistage et de suivi de l'hepatite B chronique sontrelativementfaiblesetquemoinsd'unmaladesurquatre peut avoir besoin de medlcaments antiviraux, l'optimisation de l'acces au traitement semble etre une option de gestion appropriee et rentable. Identification des cas, leur triage precis et l'utilisation judicieuse des medlcaments antiviraux s'appuient sur un effectif de sante informe et eduque. Letablissement de liens de confiance avec les communautes est un processus long. Par consequent, il n'est pas justifie de retarder la mise en ceuvre de programmes de lutte contre l'hepatite B chronique jusqu'a ce que les medicaments antiviraux deviennent plus abordables. [TEXT NOT REPRODUCIBLE IN ASCII] Situacion Aunque la mayoria'de carcinomas hepatocelulares (CHC) primarios se atribuyen a la hepatitis virica cronica y son evitables en gran parte, ese tipo de canceres sigue siendo una de las principales causas de la mortalidad relacionada con el cancer en aquellos lugares en los que la hepatitis B cronica es endemica. Enfoque Muchos CHC podrian evitarse con un aumento de la concienciaclon y el conocimiento sobre la hepatitis B, la optimizacion de la supervision de la hepatitis B cronica y el uso de tratamientos antiviricos, pero existen lagunas en la puesta en practica de estas estrategias. Marco regional El programa'B Positive' con sede en Sidney, Australia, se ha disenado para mejorar los resultados sanitarios relacionados con la hepatitis B entre los inmigrantes procedentes de paises en los que la hepatitis B es endemica, y ofrece Informacion acerca dela deteccion de la enfermedad, la vacunacion y las opciones de tratamiento, asi como un acceso optimizado a la atencion. Cambios importantes El programa 'B Positive' se fundamenta en modelos economicosy ofrece educacion culturalmente adaptada sobrela hepatitis B cronica para llegar a las comunidades y sus medicos, y realizar un seguimiento regular a traves de un registro poblacional de casos. Lecciones aprendidas Puesto que los costes de deteccion y seguimiento de la hepatitis B son relativamente bajos y menos de uno de cada cuatro casos requiere medicamentos antiviricos, la optimizacion del acceso al tratamiento parece ser una opcion de gestion adecuada y rentable. La identificacion y clasificacion correcta de los casos y el uso acertado de los medicamentos antiviricos se apoya en una personal sanitario Informado y formado. El establecimiento de la confianza de la comunidad es un proceso muy largo, por lo que retrasar la ejecucion de programas contra la hepatitis B cronica hasta que los medicamentos antiviricos se abaraten no tiene justificacion alguna., Problem In May 2010, the Sixty-third World Health Assembly adopted a resolution calling for a comprehensive approach to the prevention and control of all forms of viral hepatitis--which kills over [...]

Abstract Background Australians born in countries where hepatitis B infection is endemic are 6-12 times more likely to develop hepatocellular cancer (HCC) than Australian-born individuals. However, a program of screening, surveillance and treatment of chronic hepatitis B (CHB) in high risk populations could significantly reduce disease progression and death related to end-stage liver disease and HCC. Consequently we are implementing the B Positive pilot project, aiming to optimise the management of CHB in at-risk populations in south-west Sydney. Program participants receive routine care, enhanced disease surveillance or specialist referral, according to their stage of CHB infection, level of viral load and extent of liver injury. In this paper we examine the program's potential impact on health services utilisation in the study area. Methods Estimated numbers of CHB infections were derived from Australian Bureau of Statistics data and applying estimates of HBV prevalence rates from migrants' countries of birth. These figures were entered into a Markov model of disease progression, constructing a hypothetical cohort of Asian-born adults with CHB infection. We calculated the number of participants in different CHB disease states and estimated the numbers of GP and specialist consultations and liver ultrasound examinations the cohort would require annually over the life of the program. Results Assuming a 25% participation rate among the 5,800 local residents estimated to have chronic hepatitis B infection, approximately 750 people would require routine follow up, 260 enhanced disease surveillance and 210 specialist care during the first year after recruitment is completed. This translates into 5 additional appointments per year for each local GP, 25 for each specialist and 420 additional liver ultrasound examinations. Conclusions While the program will not greatly affect the volume of local GP consultations, it will lead to a significant increase in demand for specialist services. New models of CHB care may be required to aid program implementation and up scaling the program will need to factor in additional demands on health care utilisation in areas of high hepatitis B sero-prevalence.

Background: Australians born in countries where hepatitis B infection is endemic are 6-12 times more likely to develop hepatocellular cancer (HCC) than Australian-born individuals. However, a program of screening, surveillance and treatment of chronic hepatitis B (CHB) in high risk populations could significantly reduce disease progression and death related to end-stage liver disease and HCC. Consequently we are implementing the B Positive pilot project, aiming to optimise the management of CHB in at-risk populations in south-west Sydney. Program participants receive routine care, enhanced disease surveillance or specialist referral, according to their stage of CHB infection, level of viral load and extent of liver injury. In this paper we examine the program's potential impact on health services utilisation in the study area. Methods: Estimated numbers of CHB infections were derived from Australian Bureau of Statistics data and applying estimates of HBV prevalence rates from migrants' countries of birth. These figures were entered into a Markov model of disease progression, constructing a hypothetical cohort of Asian-born adults with CHB infection. We calculated the number of participants in different CHB disease states and estimated the numbers of GP and specialist consultations and liver ultrasound examinations the cohort would require annually over the life of the program. Results: Assuming a 25% participation rate among the 5,800 local residents estimated to have chronic hepatitis B infection, approximately 750 people would require routine follow up, 260 enhanced disease surveillance and 210 specialist care during the first year after recruitment is completed. This translates into 5 additional appointments per year for each local GP, 25 for each specialist and 420 additional liver ultrasound examinations. Conclusions: While the program will not greatly affect the volume of local GP consultations, it will lead to a significant increase in demand for specialist services. New models of CHB care may be required to aid program implementation and up scaling the program will need to factor in additional demands on health care utilisation in areas of high hepatitis B sero-prevalence. [ABSTRACT FROM AUTHOR]