Authors (including presenting author) :
Wong SN, Luk MHM, Lai KPL, Fung HT, Chan PFWong SN, Luk MHM, Lai KPL, Fung HT, Chan PF
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
Keyword 1: :
Chronic Hepatitis B infection
Keyword 2: :
Family Medicine and Primary Health Care
Introduction :
Chronic Hepatitis B (CHB) infection remains a significant public health concern, with a prevalence of 6.2% among those aged 15 to 84 in Hong Kong. Effective management of CHB infection necessitates a comprehensive approach which includes screening, disease monitoring, hepatocellular carcinoma (HCC) surveillance and treatment. KEC Family Medicine Clinics (FMCs) all along provided opportunistic screening of hepatitis B in patients with unknown hepatitis B status and deranged liver function. FMCs would then provide disease monitoring to patients with CHB. To align with the HKSAR Government commitment in enhancing care for CHB patients, pilot CHB Family Medicine Specialist Clinics (FMSCs) were established in KEC in 2023 with an aim to provide comprehensive management including antiviral treatment and complication assessment to CHB patients in primary care.
Objectives :
To provide an overview about the management of CHB infection in public primary care settings, and to review the clinical outcomes of patients attending the pilot CHB FMSCs.
Methodology :
All patients attended the pilot CHB FMSCs between 1st February 2023 and 31st May 2025 were included. Relevant clinical data were retrieved from Clinical Data Analysis and Reporting System (CDARS).
Result & Outcome :
Results:
The CHB FMSCs mainly received referrals from Family Medicine Clinics (FMCs) for CHB patients with deranged liver functions. The clinics also received downloading of stable patients receiving antiviral from Medical Hepatology Clinics. Enhanced investigations including blood tests for HBV DNA and liver elastography by FibroScan were available for disease monitoring and complication assessment respectively; ultrasonography (USG) was also available in the Central Government-Aided Emergency Hospital for clinically indicated patients who were not affordable for earlier private USG. Antiviral treatment was initiated according to established clinical recommendations. Between 1st February 2023 and 31st May 2025, a total of 1,246 patients attended the CHB FMSCs. Among them, 49% were receiving antiviral therapy (66.2% were initiated in FMSCs and 33.8% were continued from Hepatology Clinics). FibroScan were performed in 156 patients since its availability in May 2024. Stages of liver fibrosis were classified into F0-F1 (Insignificant fibrosis) which accounted for 56.4% of the patients, F2 (Borderline fibrosis) which accounted for 29.5% of the patients, F3 (Probably advanced fibrosis) which accounted for 9.6% of the patients and F4 (Probable cirrhosis) which account for 4.5% of the patients. 43.6% of patients were found to have liver steatosis by the Controlled Attenuation Parameter (CAP). Only 6.5% of cases required referral to hepatologists for further assessment and management. Conclusion:
Screening for CHB infections among high-risk population enables early disease detection and facilities timely linkage to comprehensive clinical management. With the implementation of risk-based screening of CHB infections in FMCs and District Health Centres in 2026, more patients with hepatitis B will be detected. The pilot CHB FMSCs demonstrated successful outcomes in delivering timely and comprehensive management for CHB patients in primary care settings and effective management of CHB patients would reduce various long-term CHB complications. A Family Medicine led CHB model could help reduce the burden in secondary care.
