Management of chronic hepatitis B in the Torres Strait Islands: an identified need for a comprehensive public health approach to chronic hepatitis B in remote Australian Indigenous communitiesJack Wallace A C , Marian Pitts A , James Ward B and Stephen McNally A
A Australian Research Centre in Sex, Health and Society, La Trobe University, Level 2, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
B Baker IDI Institute, Alice Springs, NT 0841, Australia.
C Corresponding author. Email: email@example.com
Australian Journal of Primary Health 20(3) 273-277 https://doi.org/10.1071/PY12130
Submitted: 8 October 2012 Accepted: 25 April 2013 Published: 20 May 2013
We aimed to document how health service providers in the Torres Strait Island region of northern Australia respond to chronic hepatitis B, and to identify priorities for the effective clinical management of the infection. Semi-structured qualitative interviews with 61 health service providers were conducted in 2011 in the Torres Strait and north Queensland region to explore issues affecting chronic hepatitis B management. Two critical issues were identified affecting the health service response to chronic hepatitis B: (i) the absence of a systems-based approach to clinically managing the infection; and (ii) variable knowledge about the infection by the health workforce. Other issues identified were competing and more urgent health priorities, the silent nature of chronic hepatitis B infection at an individual and systems level, inadequate resources and the transient health workforce. While people living in the Torres Strait region are screened, diagnosed and informed that they are infected with chronic hepatitis B, there is an ad hoc approach to its clinical management. An effective and coordinated public health response to this infection in remote and isolated Australian Indigenous communities needs to be developed and resourced. Critical elements of this response will include the development of clinical guidelines and workforce development.
Additional keywords: chronic disease, health service provision, remote communities.
ReferencesAmin J, Dore GJ, O’Connell DL, Bartlett M, Tracey E, Kaldor JM, Law MG (2006) Cancer incidence in people with hepatitis B or C infection: a large community-based linkage study. Journal of Hepatology 45, 197–203.
| Cancer incidence in people with hepatitis B or C infection: a large community-based linkage study.CrossRef | 16684579PubMed |
Australian Bureau of Statistics (2006) Population distribution, Aboriginal and Torres Strait Islander Australians. 4705.0 Available at http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/377284127F903297CA25733700241AC0/$File/47050_2006.pdf [Verified 1 March 2013]
Australian Government, Department of Health and Ageing (2010a) National hepatitis B strategy 2010–2013. Commonwealth of Australia. Available at http://www.health.gov.au/internet/publications/publishing.nsf/Content/ohp-national-strategies-2010-hepb-l [Verified 1 March 2013]
Australian Government, Department of Health and Ageing (2010b) Third national Aboriginal and Torres Strait Islander blood borne viruses and sexually transmissible infections strategy 2010–2013. Commonwealth of Australia. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010-atsi-bbv/$File/atsi.pdf [Verified 1 March 2013]
Butler J, Korda R, Watson K, Watson A (2009) ‘The impact of chronic hepatitis B in Australia: projecting mortality, morbidity and economic impact.’ (Australian Centre for Economic Research on Health: Canberra)
Carville K, MacLachlan J, Cowie B (2012) ‘Liver cancer in Victoria, 1982–2007: epidemiological determinants and secular and geographical trends.’ (Melbourne Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory: Melbourne)
Cross V, Larkins S (2011) Management of chronic hepatitis B infection in the remote primary health care setting: the search for a suitable guideline. The Australian Journal of Rural Health 19, 95–100.
| Management of chronic hepatitis B infection in the remote primary health care setting: the search for a suitable guideline.CrossRef | 21438952PubMed |
Fisher DA, Huffam SE (2003) Management of chronic hepatitis B virus infection in remote-dwelling Aboriginals and Torres Strait Islanders: an update for primary healthcare providers. The Medical Journal of Australia 178, 82–85.
Gastroenterological Society of Australia (2010) ‘Australian and New Zealand chronic hepatitis B (CHB) recommendations.’ 2nd edn. (Digestive Health Foundation: Melbourne)
Hanna JN, Malcolm RL, Vlack SA, Andrews DE (1998) The vaccination status of Aboriginal and Torres Strait Islander children in Far North Queensland. Australian and New Zealand Journal of Public Health 22, 664–668.
| The vaccination status of Aboriginal and Torres Strait Islander children in Far North Queensland.CrossRef | 1:STN:280:DyaK1M%2FmsFyjug%3D%3D&md5=fcdbadbd45c2533bb07a37623dc579d4CAS | 9848960PubMed |
Homewood J, Coory M, Dinh B (2005) ‘Cancer among people living in rural and remote Indigenous communities in Queensland; an update 1997–2002.’ (Queensland Government, Queensland Health: Brisbane)
Lok ASF, McMahon BJ (2009) American Association for the Study of the Liver (AASLD) practice guidelines; chronic hepatitis B: update 2009. Hepatology (Baltimore, Md.) 50, 661–662.
| American Association for the Study of the Liver (AASLD) practice guidelines; chronic hepatitis B: update 2009.CrossRef |
MacLachlan J, Cowie B (2012) ‘Estimates of chronic hepatitis distribution in Australia.’ (Victorian Infectious Diseases Reference Laboratory, Epidemiology Unit: Melbourne)
MacLachlan JH, Allard N, Towell V, Cowie B (2013) The burden of chronic hepatitis B infection in Australia, 2011. Australian and New Zealand Journal of Public Health
| The burden of chronic hepatitis B infection in Australia, 2011.CrossRef |
Menzies R, Turnour C, Chiu C, McIntyre P (2008) Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2003 to 2006. Communicable Diseases Intelligence 32, S2–S67.
QSR International Pty Ltd (2010) NVivo qualitative data analysis software, version 9. Melbourne. Available at http://www.qsrinternational.com [Verified 6 May 2013]
Sheridan J, Donald K, Jarneson J (1989) The Queensland hepatitis B program. Aboriginal Health Information Bulletin 12, 19–23.
Smith J (1995) Semi-structured interviewing and qualitative analysis. In ‘Rethinking methods in psychology.’ (Eds Smith J, Harré R, Langenhove L) pp. 9–26. (Sage: London)
Tracey E, Kerr T, Dobrovic A, Currow D (2010) ‘Cancer in New South Wales: incidence and mortality report 2008.’ (Cancer Institute NSW: Sydney)
World Health Organization (2012) Prevention and control of viral hepatitis infection: framework for global action. World Health Organization, Geneva. Available at http://www.who.int/csr/disease/hepatitis/GHP_Framework_En.pdf [Verified 14 May 2013]