​Summary

  • ​Hepatitis B is a vaccine-preventable disease. Individuals at risk of exposure should be vaccinated.
  • Close to half of those living with hepatitis B are undiagnosed and therefore at risk of poor health outcomes.
  • Opportunistic testing for hepatitis B in priority populations presents an opportunity to diagnose, intervene and prevent illness and death.

 

ASHM produces a range of practical resources to support GPs at the time of diagnosis as hepatitis B testing, diagnosis and management can be a complex area of primary care. These cover:

  • Indications for testing
  • Informed consent
  • Conveying a positive hepatitis B test result
  • Vaccination
  • Ongoing management of chronic hepatitis B
  • Support for patients

 

Prevention

Immunisation is provided free of charge, for people at risk, by a number of state and territory governments. The vaccine  can be ordered by GPs through your health department. Provisions vary according to jurisdiction and risk group. 

 

Testing

Opportunistic testing of people at risk, particularly:

  • people born in intermediate and high prevalence countries; and
  • Aboriginal and Torres Strait Islander people

will reduce the number of people with CHB who are undiagnosed and subsequently reduce the mortality and morbidity caused by hepatitis B.

Opportunistic testing for hepatitis B, in a patient from a hepatitis B priority population, aligns with the screening provisions of the Medicare Benefits Schedule2   

When testing for hepatitis B, the tests to be ordered are: 

  • Hepatitis B surface antigen (HBsAg), 
  • Antibody to surface antigen (anti-HBs), and 
  • Antibody to core antigen (anti-HBc). 

 

Diagnosis

ASHM produces a range of practical resources to support GPs when making a new hepatitis B diagnosis. Guidance on hepatitis B testing and vaccination, informed consent and conveying a positive result is available. Information on ongoing management of chronic hepatitis B and resources to support patients are also provided.

  • Positive HBsAg indicates current infection. 
  • Positive anti-HBs indicates immunity (through vaccination or past infection).
  • Positive anti-HBc indicates past or current infection (this test may occasionally give a false-positive result).
  • For information on who and how to test and interpretation of serology information see the B Positive Website​ or the Decision Making in HBV tool.

 

National Hepatitis B Strategy Targets

 ​​The National Hepatitis B Strategy 2014-2017​ set the following targets to be met by 2017:

  • Achieve HBV childhood vaccination coverage of 95%
  • Increase to 80% the proportion of all people living with chronic hepatitis B who are diagnosed.​
  • Increase hepatitis B vaccination coverage of priority populations

 

Testing Portal and Hepatitis B Testing Policy

ASHM plays an important role in the National Hepatitis B Testing Policy development. ASHM facilitates the ongoing review of the National Hepatitis B Testing Policy and manages  National Testing Portal. The portal covers HIV, HBV and HCV testing. Each policy is guided by an Expert Reference Group.

 

Resources​ for General Practice

ASHM develops a comprehensive range of practical resources to support the health professionals working with hepatitis B, as well as a series of profession-based booklets for groups most in contact with BBVs and STIs.  The resources focus on prevention, testing, diagnosis, management and treatment and are available in printed and/or online formats. 

 

HepBHelp

HepBHelp is an independent website which aims to assist GPs in the further investigation and management of patients diagnosed with chronic hepatitis B. HepBHelp was developed by VIDRL, in partnership with Cancer Council Victoria. This initiative was developed in recognition of the increasing burden of hepatitis B related liver cancer in Australia.​​​

 

Hepatitis B and Primary Care Providers

This 12-page booklet outlines hepatitis B virus and provides advice on the important role primary care providers can play in vaccination, diagnosis, management and treatment. 

 

Decision-making in Hepatitis B

This two-page quick reference card provides an overview of the natural history of chronic hepatitis B and can be used when making decisions about hepatitis B management and treatment.

 

B Positive (2nd Edition) - all you wanted to know about hepatitis B - a guide for primary care providers

This manual provides a comprehensive summary of currently available knowledge and practice, reiterating the key role of primary care practitioners in the diagnosis, care and management of people living with chronic hepatitis B. It is intended to be used as a desktop resource by practitioners who require information to direct management or answer questions from patients living with CHB. It covers testing, interpretation of serology, initial assessment, ongoing monitoring, treatment and complex management situations such as pregnancy and advanced liver disease. There is also a website of B Positive

 

The Hepatitis B Story​

An educational tool developed and produced by St Vincent’s Hospital Melbourne. It is designed for health workers to use in a discussion about chronic hepatitis B with clients/patients who have low health literacy levels and are newly diagnosed. Patient resources are also available in Vietnamese, Cantonese and Mandarin and video animations​ are available online in a variety of languages.

 

National Hepatitis B Testing Policy and Testing Portal

The Testing Policy defines appropriate hepatitis B testing pathways using currently available technologies. It is relevant for all health professionals ordering and interpreting tests for hepatitis B. It is not intended to be a resource for people with or at risk of hepatitis B. Key areas of the policy relevant to GPs include:

Indications for hepatitis B testing

Informed consent for testing

Conveying hepatitis B test results

 

General Practitioner Management Plan: Chronic Hepatitis B

​This GPMP enables GPs to plan and coordinate the health care of patients with chronic hepatitis B using the Chronic Disease Management GP services items on the Medicare Benefits Schedule (Medicare items 721 and 723). ​

 

HIV, Viral Hepatitis, STIs: A Guide for Primary Care Providers (4th Edition)

This 2014 review was overseen by an expert reference group comprised of general practitioners, nurses, and specialists, including epidemiology, immunology, hepatology, and gastroenterology. Download the entire handbook or download individual chapters, or order a hardcopy.

 

Preventing Liver Cancer through Diagnosis and Management of Hepatitis B

Preventing liver cancer through diagnosis and management of hepatitis B is a four-part module discusses the role general practitioners can play in the diagnosis and management of hepatitis B. The module can be accessed through RACGP's GP Learning. ​(Duration: Four 15-minute modules; CPD: approved for 2 Category 2 RACGP QI&CPD point​)

 

Resources for Newly Diagnosed Individuals

​​Hepatitis B factsheet for people newly diagnosed (English)

This resource has been written for people who have received a positive hepatitis B test result. It provides a basic overview of hepatitis B and information around disclosure, management, preventing the spread of infection and useful websites. It was developed in collaboration with Cancer Council NSW. It is also available in 12 community languages: Arabic, Burmese, Chinese, Dari, Greek, Indonesian, Italian, Khmer, Korean, Thai, Turkish, Vietnamese.

 

Hepatitis B: It's Family Business

A hepatitis B resource developed specifically for people from culturally and linguistically diverse backgrounds produced by Multicultural HIV and Hepatitis Service, NSW. Available in ArabicChineseIndonesianKhmerKoreanThaiVietnamese and plain English, this booklet covers basic information about hepatitis B, consequences of chronic infection, transmission, testing, treatment, prevention and relevant services.

 

The hepatitis B story

This booklet produced by St Vincent’s Hospital Melbourne explains hepatitis B in plain language using engaging images. Patient resources are available in EnglishVietnameseMandarinKarenArabicBurmese and  Dari and video animations are available online in a variety of languages.

 

​​Hepatitis B – What you need to know

Produced by the Hepatitis Council of Queensland and Hepatitis Australia, this brochure provides simple informative answers to the frequently asked questions about hepatitis B. It is also available in ArabicChinese and Vietnamese.

 

​​​Information about hepatitis B

Produced by the Gastroenterological Society of Australia, this four-page leaflet provides information about hepatitis B transmission and vaccination, plus treatment and monitoring techniques.

 

Hepatitis Australia

Hepatitis Australia is the peak community organisation for viral hepatitis. There are eight state and territory-based hepatitis organisations that form part of Hepatitis Australia.​

 

Education

ASHM develops and delivers national training curricula, face-to-face and online training, as well as webinars that cover prevention, testing and diagnosis. ​

 

National Laboratories: Best Practice Testing and Reporting of Test Results

Interpreting Hepatitis B Serology: Recommended wording for national laboratories to report hepatitis B diagnostic test results

This is a document designed for laboratories performing hepatitis B testing.

Its aim is to promote best practice testing and reporting of test results. This is in order to provide requesting doctors with a better understanding and interpretation of hepatitis serology, which can be confusing. The ultimate aim is to improve diagnosis and management of hepatitis B infection. Download it here 

 

Policy development

As a professional organisation, ASHM has an active program of policy development. ASHM contributes to policy, standards and the development of guidelines in the testing area.

 

​​​​References

  1. MacLachlan JH, Cowie BC and Haynes K. Hepatitis B Mapping Project: Estimates of chronic hepatitis B prevalence, diagnosis, monitoring and treatment by Primary Health Network, 2014/15 - National Report
  2. Medicare Benefits Schedule (MBS). MBS – Note G13.1. 2012​