title: Regional challenges: evaluation of a hepatitis outreach programme using transient elastography (FibroScan) in Victoria.
abstract: BACKGROUND
  Evaluation of an outreach programme using a mobile transient elastography (TE) device (FibroScan) to improve liver disease assessment in different clinical settings.
  
  
  OBJECTIVE
  To evaluate a programme of liver fibrosis assessment by TE and to compare fibrosis scores between different sites and patient groups.
  
  
  METHODS
  Prospective cohort study. TE was conducted at a tertiary hospital and during outreach clinics in three different settings: community clinics, clinics for people who use drugs (PWUD) and regional clinics in rural Victoria. All patients referred for TE at the participating locations were eligible during the study period.
  
  
  RESULTS
  A total of 200 of 623 patients was assessed and evaluated during outreach sessions (regional 100; PWUD 18; community 82). While the majority of patients in community centres were infected with hepatitis B (68%), most patients in regional clinics and in PWUD settings had hepatitis C virus (HCV) (81 and 100%, respectively). Significantly more patients assessed at regional clinics and PWUD settings presented with severe fibrosis (F3-F4, F4): regional clinics 39%; PWUD 31%; tertiary 11%; community 7%, (P <0.001). Multivariable logistic regression analysis revealed that older age, alcohol consumption, male sex, increased alanine transferase levels, HCV infection and importantly, evaluation at regional sites were independently associated with severe fibrosis.
  
  
  CONCLUSIONS
  A TE-based outreach programme allows for assessment of liver fibrosis in varied and regional populations. The finding that patients in regional settings and PWUD presented with more advanced fibrosis should prompt improvements in healthcare to improve access for these populations.
authors.affiliation: Victorian Infectious Diseases Service, Melbourne, Victoria, Australia.
authors.forename: M C
authors.initials: MC
authors.lastname: Thurnheer
authors.affiliation: Victorian Infectious Diseases Service, Melbourne, Victoria, Australia.|Department of Medicine, Melbourne, Victoria, Australia.
authors.forename: T R
authors.initials: TR
authors.lastname: Schulz
authors.affiliation: Victorian Infectious Diseases Service, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Doherty Institute, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: MacLachlan
authors.affiliation: Victorian Infectious Diseases Service, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Sasadeusz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003159:Community-Institutional Relations; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006505:Hepatitis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: hepatitis B; hepatitis C; liver fibrosis; outreach programme; rural; transient elastography