Advertisement
Research Article|Articles in Press

Hepatitis B virus infection in general practice across England: An analysis of the Royal College of General Practitioners Research and Surveillance Centre real-world database

Published:March 09, 2023DOI:https://doi.org/10.1016/j.jinf.2023.03.001

      Summary

      Objectives

      We analysed hepatitis B surface antigen (HBsAg) screening and seropositivity within a network of 419 general practices representative of all regions of England.

      Methods

      Information was extracted using pseudonymised registration data. Predictors of HBsAg seropositivity were explored in models that considered age, gender, ethnicity, time at the current practice, practice location and associated deprivation index, and presence of nationally endorsed screen indicators including pregnancy, men who have sex with men (MSM), history of injecting drug use (IDU), close HBV contact or imprisonment, and diagnosis of blood-borne or sexually transmitted infections.

      Results

      Among 6,975,119 individuals, 192,639 (2.8%) had a screening record, including 3.6- 38.6% of those with a screen indicator, and 8065 (0.12%) had a seropositive record. The odds of seropositivity were highest in London, in the most deprived neighbourhoods, among minority ethnic groups, and in people with screen indicators. Seroprevalence exceeded 1% in people from high prevalence countries, MSM, close HBV contacts, and people with a history of IDU or HIV, HCV, or syphilis diagnosis. Overall, 1989/8065 (24.7%) had a recorded referral to specialist hepatitis care.

      Conclusions

      In England, HBV infection is associated with poverty. There are unrealised opportunities to promote access to diagnosis and care for those affected.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organization. Hepatitis B Fact Sheet. 24 June 2022 . 〈https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-b〉 (accessed 09/08/2022).

        • GBD
        Hepatitis B Collaborators. Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet.
        Gastroenterol Hepatol. 2019; 2022: 796-829
        • Nayagam S.
        • Thursz M.
        • Sicuri E.
        • et al.
        Requirements for global elimination of hepatitis B: a modelling study.
        Lancet Infect Dis. 2016; 16: 1399-1408
      2. World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030 . 〈https://www.who.int/publications/i/item/9789240053779〉 (accessed 09/08/2022).

      3. Health and Safety Executive. Hepatitis B virus (HBV). 〈https://www.hse.gov.uk/biosafety/blood-borne-viruses/hepatitis-b.htm〉 (accessed 09/08/ 2022 ).

        • Razavi-Shearer D.
        • Gamkrelidze I.
        • Nguyen M.H.
        • et al.
        Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study.
        Lancet Gastroenterol Hepatol. 2018; 3: 383-403
        • Williams R.
        • Alexander G.
        • Armstrong I.
        • et al.
        Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK.
        Lancet. 2018; 391: 1097-1107
        • Martin N.K.
        • Vickerman P.
        • Khakoo S.
        • et al.
        Chronic hepatitis B virus case-finding in UK populations born abroad in intermediate or high endemicity countries: an economic evaluation.
        BMJ Open. 2019; 9e030183
        • Evlampidou I.
        • Hickman M.
        • Irish C.
        • et al.
        Low hepatitis B testing among migrants: a cross-sectional study in a UK city.
        Brit J Gen Pract. 2016; 66: e382-e391
      4. Public Health England. Antenatal screening standards: data report 2019 to 2020. 27 July 2021 . 〈https://www.gov.uk/government/statistics/antenatal-screening-standards-data-report-2019-to2020#:~:text=coverage%20for%20antenatal%20SCT%20screening〉, screening%20in%202019%20to%202020 (accessed 09/08/2022).

      5. National Institutes for Care and Health Excellence. Hepatitis B and C testing: people at risk of infection. 01 March 2013 . 〈https://www.nice.org.uk/guidance/ph43〉 (accessed 09/08/2022).

      6. Health Protection Agency. Annual Review 2011 : Supplementary tables. 〈https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/363847/Sentinel_Surveillance_Annual_Review_2011_SuppTables.pdf〉 (accessed 14/08/2022).

      7. Health Protection Agency. Infection reports. 26 July 2013 . 〈https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.411.8077&rep=rep1&type=pdf〉 (accessed 14/08/2022).

      8. Public Health England. Sentinel surveillance of blood borne virus testing in England. 〈https://www.gov.uk/search/research-and-statistics?parent=/health-and-social-care/health-protection-services-health-surveillance-and-reporting-programmes&keywords=sentinel%20&content_store_document_type=all_research_and_statistics&topic=7d55894e-5ba5-4495-8962-e7650e9a0559&order=relevance〉 (accessed 14/08/2022 ).

      9. Burton A. , Kumar V. , Cullen K. , et al. The landscape of hepatocellular carcinoma in the UK in the past 20 years: the HCCUK/NCRAS partnership. National Cancer Research Institute Conference 2019 . 〈https://abstracts.ncri.org.uk/abstract/the-landscape-of-hepatocellular-carcinoma-in-the-uk-in-the-past-20-years-the-hccuk-ncras-partnership/〉 (accessed 09/08/2022 ).

        • Flanagan S.
        • Kunkel J.
        • Appleby V.
        • et al.
        Case finding and therapy for chronic viral hepatitis in primary care (HepFREE): a cluster-randomised controlled trial.
        Lancet Gastroenterology Hepatology. 2019; 4: 32-44
      10. Campbell C. , Wang T. , Burrow R. , et al. Estimating the epidemiology of chronic Hepatitis B Virus (HBV) infection in the UK: what do we know and what are we missing? [version 1]. Wellcome Open Research. 08 Aug 2022 , 7:203. 〈https://wellcomeopenresearch.org/articles/7-203/v1〉 (accessed 16/08/2022).

        • de Lusignan S.
        • Correa A.
        • Smith G.E.
        • et al.
        RCGP Research and Surveillance Centre: 50 years' surveillance of influenza, infections, and respiratory conditions.
        Br J Gen Pract. 2017; 67: 440-441
      11. NHS Digital. Read Codes: Terminology and classification. 〈https://digital.nhs.uk/services/terminology-and-classifications/read-codes〉. (accessed 09/08/2022 ).

        • Liyanage H.
        • Williams J.
        • Byford R.
        • de Lusignan S.
        Ontology to identify pregnant women in electronic health records: primary care sentinel network database study.
        BMJ Health Care Inform. 2019; 26e100013
      12. Department for Communities and Local Government. The English index of multiple deprivation (IMD) 2015 – Guidance. 2015 . 〈https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/464430/English_Index_of_Multiple_Deprivation_2015_-_Guidance.pdf〉 (accessed 09/08/2022).

      13. Office for National Statistics. Local authority districts (December 2016) - names and codes in the United Kingdom. 12 June 2017 . 〈https://data.gov.uk/dataset/9b9e026f-02e7-4481-ab2b-cf19e3b9ea61/local-authority-districts-december-2016-names-and-codes-in-the-united-kingdom〉 (accessed 10/08/2022).

      14. World Health Organization. Global hepatitis report, 2017 . 19 April 2017. 〈https://www.who.int/publications/i/item/9789241565455〉 (accessed 10/08/2022).

        • Sweeney L.
        • Owiti J.A.
        • Beharry A.
        • et al.
        Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals.
        BMC Health Serv Res. 2015; 15: 97
        • Roche R.
        • Simmons R.
        • Crawshaw A.F.
        • et al.
        What do primary care staff know and do about blood borne virus testing and care for migrant patients? A national survey.
        BMC Public Health. 2021; 21: 336
        • Richmond J.A.
        • Sasadeusz J.
        • Temple-Smith M.
        The role of primary health care in hepatitis B testing and management: A case study.
        J Community Health. 2018; 43: 38-47
      15. British Association for Sexual Health and HIV (BASHH). 2017 Interim update of the 2015 BASHH national guidelines for the management of the viral hepatitides. 〈https://www.bashhguidelines.org/media/1161/viral-hepatitides-2017-update-18-12-17.pdf〉 (accessed 10/08/2022).

        • Roche R.
        • Simmons R.
        • Logan L.
        • et al.
        Prevalence of hepatitis B immunity and infection in home self-sampling HIV service users.
        Sex Transm Infect. 2022; 98: 286-292
        • Brooks H.
        • Llewellyn C.D.
        • Nadarzynski T.
        • et al.
        Sexual orientation disclosure in health care: a systematic review.
        British Journal of General Practice. 2018; 68: e187-e196
      16. Office for National Statistics. Sexual orientation, UK: 2020. 25 May 2022. 〈https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/sexuality/bulletins/sexualidentityuk/2020〉 (accessed 10/08/2022).

        • Delpech V.
        The HIV epidemic: global and United Kingdom trends.
        Medicine. 2022; 50: 202-204
      17. UK Health Security Agency. Hepatitis C in England 2022 . 〈https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1057271/HCV-in-England-2022-full-report.pdf〉 (accessed 10/08/2022)

        • Parry S.
        • Bundle N.
        • Ullah S.
        • et al.
        Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg?.
        Epidemiol Infect. 2018; 146: 1026-1035
      18. Public Health England. Liver Disease Profiles: Statistical Commentary, April 2018. Public Health England; 2018 . 〈https://www.gov.uk/government/statistics/liver-disease-profiles-april-2018-update/liver-disease-profiles-statistical-commentary-april-2018〉 (accessed 10/08/2022).

        • Price H.
        • Salimee S.
        • Coelho D.
        Prevalence of hepatitis B and hepatitis C in a UK genitourinary medicine clinic.
        Int J STD & AIDS. 2017; 28: 238-241
      19. Public Health England. Shooting Up: Infections among People Who Inject Drugs in the UK. 〈https://webarchive.nationalarchives.gov.uk/ukgwa/20181111221221/https://www.gov.uk/government/publications/shooting-up-infections-among-people-who-inject-drugs-in-the-uk#history〉 (accessed 14/08/2022 )

      20. Public Health England. Shooting Up: Infections among People Who Inject Drugs in the UK 2019 . 〈https://webarchive.nationalarchives.gov.uk/ukgwa/20220121093137/https://www.gov.uk/government/publications/shooting-up-infections-among-people-who-inject-drugs-in-the-uk〉 (accessed 14/08/2022).

        • Hahné S.
        • Ramsay M.
        • Balogun K.
        • Edmunds W.J.
        • Mortimer P.
        Incidence and routes of transmission of hepatitis B virus in England and Wales, 1995-2000: implications for immunisation policy.
        J Clin Virol. 2004; 29: 211-220
        • Konstantinou D.
        • Deutsch M.
        The spectrum of HBV/HCV coinfection: epidemiology, clinical characteristics, viral interactions and management.
        Ann Gastroenterol. 2015; 28: 221-228
        • Ireland G.
        • Simmons R.
        • Balogun K.
        • et al.
        HIV coinfection among persons diagnosed with hepatitis B in England in 2008-2014.
        HIV Med. 2019; 20: 255-263
        • Marseille E.
        • Harris A.M.
        • Horvath H.
        • et al.
        Hepatitis B prevalence association with sexually transmitted infections: a systematic review and meta-analysis.
        J Sex Health. 2021; 18: 269-279
      21. Public Health England. Tracking the syphilis epidemic in England: 2010 to 2019 . 〈https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/956716/Syphilis_Action_Plan_Metrics_2010_to_2019_report.pdf〉 (accessed 16/08/2022)

      22. Public Health England. Acute Hepatitis B: Annual report for 2018. April 2020 . 〈https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877344/hpr3019_ct-hbv18_V3.pdf〉 (accessed 09/08/2022).

        • Hinton R.C.A.
        • McGovern A W.
        • et al.
        Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) sentinel network: a cohort profile.
        BMJ Open. 2016; 6e011092
        • Tippu Z.
        • Correa A.
        • Liyanage H.
        • et al.
        Ethnicity recording in primary care computerised medical record systems: an ontological approach.
        J Innov Health Inform. 2017; 23: 920
        • Ciftci Y.
        • Blane D.N.
        Improving GP registration and access for migrant health.
        Brit J Gen Pract. 2022; 72: 56-57
        • Allsopp Sigona N.
        • Phillimore J.J.
        Poverty among refugees and asylum seekers in the UK: An evidence and policy review. IRiS Working Paper Series.
        1/2. 2014; : 014
      23. Sustainable Development Goals. Indicator 3.3.4. Hepatitis B incidence per 100,000 population. 〈https://sdgdata.gov.uk/3-3-4/〉 (accessed 16/08/2022 ).

        • Mohammed M.S.
        • Ferrier G.
        • Abouda G.
        • Corless L.
        Socio-economic deprivation significantly impacts clinical management and survival in hepatocellular carcinoma.
        J Hepatology. 2018; 68: 623-625