Authors: (including presenting author): :
Hui LC, Chen XR Catherine, Leung SH, Ko SH
Affiliation: :
Department of Family Medicine and Primary Healthcare (FM&PHC), Kowloon Central Cluster (KCC)
Keyword 1: :
Chronic Hepatitis B
Keyword 3: :
Primary Healthcare
Keyword 4: :
Health service
Introduction: :
Chronic Hepatitis B (CHB) is associated with serious complications, including liver cirrhosis and hepatocellular carcinoma (HCC). Family physicians are often the first point of contact for CHB patients and play a crucial role in the early identification, management, and surveillance of HCC. Traditionally, CHB monitoring and HCC surveillance are conducted in primary care with regular blood test and imaging. If indicated, the cases will be referred to specialists for antiviral treatment and the waiting time ranges from months to years in the Hospital Authority (HA). In October 2020, the government launched the Hong Kong Viral Hepatitis Action Plan 2020-2024, which sets out a comprehensive strategy and recommendations for managing CHB patients particularly in the community. To enhance CHB management in Kowloon Central Cluster (KCC) catchment area, Family Medicine CHB (FM-CHB) program was established in 2024 in collaboration with QEH & OLMH Medical team.
Objectives: :
The aim of this program is to provide comprehensive assessment for high risk CHB patients and offer antiviral treatment if indicated. This study tries to evaluate the service delivery of FM-CHB clinics in KCC.
Methodology: :
This is a retrospective case series study. High risk CHB patients who had attended the two FM-CHB clinics of KCC of HA from July 1, 2024 to December 31, 2025 were included. The CHB patients are considered as having high risk if they have any of the three conditions: elevated ALT (>35 U/L for male and >25 U/L for female), suspicious of having fibrosis by USG or Fibroscan, or with family history of liver cirrhosis or HCC. Those who fulfill the referral criteria to Medical or Surgical SOPCs were excluded. The patients’ demographic data, use of antiviral treatment, biochemical profile including ALT and HBV DNA level and discharge status were reviewed. The paired student’s t-test was used to determine the significance of the reduction in continuous variables, with statistical significance set at p < 0.05.
Result & Outcome: :
A total of 334 CHB patients were included during the study period. Their average age was 57.6 (±11.2) years, and 186 (55.7%) patients are female. Among them, 21 cases (6.3%) were HBeAg positive and 161 (48.2%) patients were indicated for antiviral therapy. Among the 158 patients who were started on antiviral therapy, both their ALT level and HBV DNA level decreased significantly after 6 months of treatment (p < 0.05) and 94 cases (59.5%) patients achieved HBV DNA levels of less than 10 IU/mL within 6 months. Only 34 cases (10.1%) were referred back to a hepatologist or surgeon for further assessment. This study showed that FM-CHB program was highly effective in offering comprehensive assessment for high risk CHB patients and initiating antiviral treatment timely if indicated. Their biochemical and virology profile were significantly improved with a low referral rate to hepatologists, therefore markedly reduced the disease burden to Medical SOPD in hospital. Future studies should explore the long-term outcome of patients receiving integrated FM-CHB services in primary care.
