title: The cascade of care for Australians living with chronic hepatitis B: measuring access to diagnosis, management and treatment.
abstract: OBJECTIVE
  To estimate the level of access to diagnosis, management and treatment for people living with chronic hepatitis B (CHB) in Australia, and to identify the gaps in clinical care for people living with CHB.
  
  
  METHODS
  Analysis of publicly available population level data including infectious disease notifications, Medicare and Pharmaceutical Benefits Scheme utilisation data, census-based estimates of CHB prevalence and burden, and mathematical modelling.
  
  
  RESULTS
  In 2012, of the estimated 218,567 Australians living with CHB, 57% had been diagnosed, 17,367 people (8%) received recommended HBV DNA viral load testing (without treatment) and 10,987 (5%) received antiviral therapy.
  
  
  CONCLUSIONS
  This analysis reveals substantial gaps in the cascade of care for CHB in Australia, most notably in diagnosis (with 43% undiagnosed) and in recommended yearly monitoring (87% not in care). The number receiving therapy represents only one-third of those estimated to require treatment to prevent progressive liver disease and liver cancer.
  
  
  CONCLUSIONS
  These findings demonstrate that the majority of those affected are not receiving guideline-based care; highlight the need for improvements in opportunistic screening, engagement in care, and access to therapy; and provide a method to assess the impact of public health and clinical interventions in response to CHB over time.
authors.affiliation: Epidemiology Unit VIDRL, The Doherty Institute, Victoria.|Department of Medicine, University of Melbourne, Victoria.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Allard
authors.affiliation: Epidemiology Unit VIDRL, The Doherty Institute, Victoria.|Department of Medicine, University of Melbourne, Victoria.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: MacLachlan
authors.affiliation: Epidemiology Unit VIDRL, The Doherty Institute, Victoria.|Department of Medicine, University of Melbourne, Victoria.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Cowie
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000458:organization & administration; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D054625:Healthcare Disparities; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D011634:Public Health / Q000191:economics; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents
keywords: cascade of care; epidemiology; health systems; hepatitis B; liver cancer