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BackgroundA baseline of hepatitis C virus (HCV) burden and other HCV epidemiological profiles is necessary for HCV micro-elimination in Ho Chi Minh City (HCMC), Viet Nam. This study aimed to determine HCV exposure and prevalence of HCV viremia as well as the proportion of HCV testing and treatment uptake among participants.MethodsFrom 2019 to 2020, the probability proportionate to size sampling method was deployed to representatively invite approximately 20,000 adults (18 or older) throughout HCMC to free screening and linkage to care for HCV.FindingsIn HCMC, the weighted prevalence of anti-HCV was 1·3% (95% CI, 1·1%-1·6%). Individuals born from 1945 to 1964 had the anti-HCV prevalence of 3·6% (95% CI, 3·0%-4·2%) and represented 40·4% of all HCV cases. There were wide variations in anti-HCV prevalence in HCMC, including variations between districts, risk factors, and socioeconomic statuses. A baseline HCV continuum of care for the city demonstrated that only 28·5% (85/298, 95%CI 23·4-33·7%) of persons with anti-HCV (+) were aware of their HCV status, with 77.6% (66/85, 95%CI 68·8-86·5%) diagnosing HCV incidentally, 82·7% (62/75, 95%CI 74·1-91·2%) initiating anti-HCV therapy, and 53.6% (30/56, 95%CI 40·5-66·6%) achieving HCV cures.InterpretationThere remains a considerable disease burden of HCV in HCMC of which a significant proportion was in the age group born between 1945 to 1964. Additionally, there were significant gaps in HCV awareness, screening, and access to care in the community in Viet Nam. Thus, future interventions must have pragmatic targets, be tailored to the local needs, and emphasise screening.FundingThis work was supported by investigator-sponsored research grants from Gilead Sciences Inc. (Grant No: IN-US-987-5382); Roche Diagnostic International Ltd. (Grant No. SUB-000196); and in-kind donations from Abbott Diagnostic Viet Nam; Hepatitis B Foundation; Medic Medical Center, Viet Nam; Johns Hopkins University School of Medicine's Center of Excellence for Liver Disease in Viet Nam; and the Board of Directors, Viet Nam Viral Hepatitis Alliance (V-VHA).

BackgroundAn exploratory study was performed to determine the prevalence of the patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs78409 [G] allele among the Hmong as a risk factor for nonalcoholic fatty liver disease (NAFLD). NAFLD/nonalcoholic steatohepatitis is the world's most common chronic liver disease and is expected to replace viral hepatitis as the leading cause of cirrhosis and potential precursor to hepatocellular carcinoma (HCC). Of all populations in California, the Hmong experience the highest risk of death from HCC and the highest prevalence of metabolic syndrome risk factors among Asians that predispose them to NAFLD. Here a genetic explanation was sought for the high rates of chronic liver disease among the Hmong. The literature pointed to the PNPLA3 rs738409 [G] allele as a potential genetic culprit.MethodsCell-free DNA was isolated from 26 serum samples previously collected in community settings. Quantitative polymerase chain reaction-based single-nucleotide polymorphism (SNP) genotyping was performed with a validated TaqMan SNP genotyping assay, and results were analyzed with TaqMan Genotyper software.ResultsThe PNPLA3 rs738409 [C>G] variant occurred at a frequency of 0.46 (12 of 26; 95% confidence interval, 0.27-0.67). This carrier rate would rank the Hmong as the third highest population in the 1000 Genomes Project.ConclusionsAlthough this small sample size limits the generalizability, the high frequency rates of this allele along with the presence of metabolic syndrome risk factors warrant further studies into the etiology of NAFLD among the Hmong. Cancer 2018;124:1583-9. © 2018 American Cancer Society.

AimTo examine the largest tertiary referral center in southern and central Vietnam from 2010 to 2016, evaluating epidemiological trends of hepatocellular carcinoma (HCC) and viral hepatitis B-C in this resource-limited setting.MethodsWe extracted data of patients receiving care from Cho Ray Hospital (Ho Chi Minh City), the largest oncology referral center in southern and central Vietnam, from 2010 to 2016. We collected information on patient age, gender, geographic distribution, and disease characteristics including disease stage, tumor biomarker levels [serum alpha-fetoprotein (AFP), AFP-L3 isoform percentage, and prothrombin induced by induced by vitamin K absence-II], and serological testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.ResultsData from 24091 HCC patients were extracted, with sample demographics comprising mostly male (81.8%) and older age (however with 8.5% younger than 40 years old). This patient sample included a geographic catchment population of 56 million people (60% of the country's total population of 92.7 million), derived from 38 provinces and municipalities in Vietnam. Chronic HBV infection was found in 62.3% of cases, and chronic HCV infection in 26.0%. HBV and HCV co-infection was seen in 2.7%. Cirrhosis was found in an estimated 30% to 40% of cases. Nine percent of patients were not found to have chronic viral hepatitis. Twenty three point two percent of the patients had a normal AFP level. A total of 2199 patients were tested with AFP-L3 and PIVKA II over two years, with 57.7% having elevated AFP-L3%, and 88.5% with elevated PIVKA II levels. Over this 7-year period, the incidence of HCC increased, with a large proportion of cases (overall 40.8%) presenting initially an advanced stage, not amendable to surgical or locoregional therapy.ConclusionHCC contributes significant health care burden in southern and central Vietnam, with increasing case volume over this seven-year period. Viral hepatitis likely explains this high HCC prevalence.

Background: Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking., Methods: We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components., Findings: 7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference = 27.9% [95% Confidence Interval = 3.4-52.4], I 2  = 99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness., Interpretation: HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets., Funding: Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA., Competing Interests: DYD has received financial support from Mai Dolch for the Center of Excellence for Liver Disease in Vietnam at Johns Hopkins School of Medicine; research grants from the Ludwig Institute for Cancer Research, Gilead Sciences, Fujifilm Medical Systems, and Roche Diagnostics International Ltd.; honoraria and travel support from BMJ Best Practices, Fujifilm Medical Systems, Roche Diagnostics International Ltd., and Techno Orbits; and equipment and materials from Fujifilm Medical Systems and Roche Diagnostics International Ltd. DYD has also served on Data Safety Monitoring Boards (DSMBs) or advisory boards for IQVIA. HN has received payment from A. Menarini Singapore Pte. Ltd. for a presentation on the economic evaluation of tenofovir alafenamide in chronic hepatitis B in Vietnam; financial support from VinHealth for the economic evaluation of tenofovir alafenamide in Vietnam; and financial support from Mahidol University for evaluating strategies to prevent mother-to-child transmission of hepatitis B virus (HBV). PN has received financial support from VinHealth for the economic evaluation of tenofovir alafenamide in chronic hepatitis B in Vietnam. All other authors declare no competing interests., (© 2024 The Author(s).)

Background: We conducted a community-based seroprevalence study using three HBV seromarkers (HBsAg, anti-HBs, anti-HBc) in Ho Chi Minh City (HCMC), Vietnam, to (1) determine the prevalence of HBV serologic profiles; (2) document factors associated with HBV infection or susceptibility; and (3) propose strategies toward HBV elimination by 2030., Methods: During 2019-2020, we deployed a multistage cluster design with probability proportionate to size, to recruit 20,000 adults for an HBV screening and linkage to care program citywide. Screening results with interpretation, recommendations, and health education materials were returned to participants. Post-study surveys were conducted within three months to identify gaps in linkage to care., Findings: Of the 17,600 adults invited, 15,275 (86.7%) participated in the study, 14,674 (96.1%) completing all data for final analyses. The prevalence of HBsAg (+) and HBV-naïve were 7.5% and 37.7%, respectively. HBV vaccination rates were 18.7% and about 50% of HCMC population had been exposed to HBV. Of the persons with HBsAg (+), 27.1% linked to care (76% used health insurance). There were wide variations in HBsAg (+) and HBV vaccination rates between districts, risk factors, and socio-economic statuses., Interpretation: The significant disease burden of and gaps in the continuum of care highlight the need and urgency to address the HBV public health problem in Vietnam. Using three screening seromarkers that tailor interventions to the needs of HBV micro-populations could be an effective strategy to pursue HBV elimination goals., Funding: Gilead Sciences Inc; Roche Diagnostic International Ltd; Roche Diagnostics-Vietnam; Abbott Diagnostics-Vietnam; Hepatitis B Foundation; Medic MedicalCenter, Vietnam; Center of Excellence for Liver Disease in Vietnam, Johns Hopkins University School of Medicine., Competing Interests: MC.Jr received consulting fees from the Vietnam Viral Hepatitis Alliance. RGG has received grants or research support in last two years from Gilead. RGG has also performed as a consultant or advisor in the past two years to Abbott, AbbVie, Altimunne, Antios, Arrow head, Dynavax, Eiger, Eisai, Enyo, Genentech, Genlantis, Gerson Lehrman Group, Gilead Sciences, Helios, HepaTX, HepQuant, Intercept, Janssen, Merck, Pfizer, Topography Health, and Venatorx. RGG is on scientific or clinical advisory boards for AbbVie, Antios, Dynavax, Enyo, Genentech, Genlantis, Gilead, Helios, HepaTX, HepQuant, Intercept, Janssen, Merck, Pfizer, and Prodigy. RGG is a member of Topography Health clinical trials alliance. RGG is chair of the clinical advisory board for Prodigy. RGG is an advisory consultant for Fibronostics, Fujifilm/Wako, Perspectum, Quest, and Sonic Incytes. RGG is on data safety monitoring boards for Altimmune, Arrowhead, CymaBay Therapeutics, and Durect. RGG currently has consulting confidentiality agreements with Abbvie, Abbott, Access Biologicals, Active Genome Expressed Diagnostics, ADMA Biologics, AEC Partners, Aligos Therapeutics, Arena Pharma ceuticals Inc, Ark Biopharmaceutical Co Ltd, Arrowhead, Arterys Inc, Alexion, Altimmune, Antios Therapeutics, AprosTx, Audentes Therapeutics, Bayer, Bausch/Salix, Cirina, Consumer Health Products Assoc, CymaBay Therapeutics Inc, DiaSorin Inc, Dova Pharmaceuticals, DRG Abacus, DURECT Corporation, Dynavax, Echosens, Eiger, Eisai, Enyo, Exelixis, Fibronostics Inc, Forty-Seven Inc, Fujifilm Wako Diagnostics, Gilead, HepQuant, HepaTx, IDLogiq, Intellia, Intercept, Inotek, Iqvia, Janssen/J&J, KannaLife, Kezar Life Sciences Inc, LabCorp, Laboratory for Advanced Medicine, Labyrinth Holdings, Life Line Screening, Lilly, MedImmune, Merck, New Enterprise Associates, Ogilvy CommonHealth, Organovo, Patient Connect, Perspectum, Pfizer, Pharmaceutical Research Associates, ProdigY Biotech, Prometheus Laboratories, Refuah Solutions, Regulus Therapeutics, Sagimet Inc, Salix, Saol Bermuda Ltd, Shenzhen HEC Industrial Develop ment, Shionogi Inc, Spring Bank, Tonghua Anrate Biopharmaceutical, Topography Health, Trimaran, Venatorx, and Viravaxx AG. RGG reports activities for Speakers Bureau, focusing on HBV, HCV, HDV and liver cancer; specifically, epidemiology, diagnosis, and treatment. In addition, program presentations on vaccination for HBV and management of complications of cirrhosis. RGG has speaker's contracts to do promotional talks for AbbVie, BMS, Eisai, Genentech, Gilead Sciences Inc., and Intercept. RGG is a minor stock shareholder (liver space noted only) for RiboSciences and CoCrystal. RGG holds stock options in Eiger, Gen lantis, HepQuant, AngioCrine, and HepaTx, outside the submitted work. The rest of the authors declare no competing interests., (© 2022 The Author(s).)