This collaborative project between Burnet Institute and Cancer Council Victoria seeks to identify and evaluate strategies to increase testing for hepatitis B virus in priority populations in Victoria.

Liver cancer is the fastest increasing cause of cancer death in Australia and has among the lowest of survival rates for all cancers, with only 16 percent of people still alive five years after diagnosis.

Viral hepatitis (hepatitis caused by a virus such as hepatitis B or hepatitis C) is responsible for 80 percent of liver cancers and a significant proportion are caused by chronic hepatitis B infection.

There are an estimated 180,000 people living in Australia with chronic hepatitis B (CHB). The majority of these people were infected at birth or in childhood, with over half having been born in a highly endemic area such as China, Southeast Asia, the Pacific Islands and sub-Saharan Africa, as well as Aboriginal and Torres Strait Islanders. In Australia, migrants from the Asia-Pacific region comprise nearly 40 percent of all chronic CHB cases despite comprising only five percent of Australia’s population.

Without treatment, one in four people living with chronic hepatitis B infection will die from liver cirrhosis or liver cancer. Nationally the number of people dying from hepatitis B infection is predicted to increase from 450 per year (2008) to 1,550 per year in 2017. It is therefore paramount that people with chronic hepatitis B are identified so that they are monitored and/or treated.

For most people that receive treatment, it is very effective at reducing the progression to liver damage and liver cancer. A vaccine against hepatitis B has been available since 1982 and is nearly 100 percent effective in preventing infection. Where someone is susceptible to infection, such as living with a person who is infected, it is important they are vaccinated.

The timely detection of hepatitis B by regular testing (screening) is key; it can prevent hepatitis B infection (through vaccination) and reduce people with hepatitis B infection getting liver cancer (through monitoring and /or treatment). However screening levels are too low. It is estimated that half of the 180,000 infections in Australia are undiagnosed. The aim of hepatitis screening is to identify people at high risk of developing liver cancer. Screening will also identify people who are at risk of hepatitis B infection, such as those not vaccinated and not immune.

General practitioners (GPs) are the first point of contact for most people using Australia’s health care system and are ideally placed to screen people at high risk of HBV. However, studies have shown that this does not happen or happens too late with the vast majority of GPs not regularly testing high risk people for hepatitis B. Barriers to hepatitis B screening include limited knowledge of GPs about hepatitis B virus, language and cultural barriers and lack of awareness in the community.

This project seeks to remove the barriers to hepatitis B screening through addressing patient, doctor and structural barriers.

We will develop strategies that aim to increase testing for hepatitis B in general practice, and use the results to develop a larger intervention to reduce the proportion of undiagnosed hepatitis B infection in Victoria.