title: Markers of hepatitis B infection and immunity in patients attending Aboriginal community controlled health services.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality in Aboriginal and Torres Strait Islander people, who have high rates of infection compared with non-Indigenous Australians. We aimed to increase the evidence base around HBV in Aboriginal and Torres Strait Islander people through an analysis of routine clinical encounter data.
  
  
  METHODS
  A cross-sectional study of de-identified records from electronic patient systems over 5 years (8 January 2009 to 11 July 2013).
  
  
  METHODS
  Four Aboriginal community controlled health services.
  
  
  METHODS
  All patients attending for a clinical visit were included in the study. Hepatitis B testing records were included if at least one serological test for HBV was done.
  
  
  METHODS
  Percentage of clinical patients tested for hepatitis B, compliance with guidelines and serological status.
  
  
  RESULTS
  A total of 2959 people aged 15-54 years were screened for HBV, representing 17.2% of all people with a clinical visit in the study period. A total of 865 Aboriginal patients were tested concurrently for hepatitis B surface antigen (HBsAg), hepatitis B core antibody and hepatitis B surface antibody. Of those, 352 (40.7%) were susceptible to HBV infection (95% CI, 37.4%-43.9%) and 34 (3.9%) had either an acute or chronic infection indicated by a positive HBsAg result (95% CI, 2.6%-5.2%). In 329 women with antenatal screening, six (1.8%) returned a positive HBsAg result (95% CI, 0.37%-3.28%).
  
  
  CONCLUSIONS
  A substantial proportion of patients tested were susceptible to HBV, with a high percentage potentially infectious compared with the general population. High levels of active infection and susceptibility to infection suggest many opportunities for transmission and indicate the potential benefit of routine HBV testing and vaccination in this population.
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, NSW, Australia. mharrod@kirby.unsw.edu.au.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Harrod
authors.affiliation: General Practice and Rural Medicine, James Cook University, Townsville, QLD, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Couzos
authors.affiliation: Public Health Unit, Aboriginal Medical Service Western Sydney, Sydney, NSW, Australia.
authors.forename: Dea
authors.initials: D
authors.lastname: Delaney-Thiele
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore
authors.affiliation: Quality, Safety and Reporting, Nunkuwarrin Yunti of South Australia Inc, Adelaide, SA, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Hammond
authors.affiliation: National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Saunders
authors.affiliation: Victorian Aboriginal Health Service, Melbourne, VIC, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Belfrage
authors.affiliation: Goondir Health Services, Dalby, QLD, Australia.
authors.forename: Sidney
authors.initials: S
authors.lastname: Williams
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
authors.affiliation: Baker IDI Central Australia, Alice Springs, NT, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D015415:Biomarkers / Q000097:blood; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D006303:Health Services, Indigenous; D006509:Hepatitis B / Q000097:blood* / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006511:Hepatitis B Antigens / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006510:Hepatitis B Antibodies; D006511:Hepatitis B Antigens