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Community-Based Strategies to Improve Screening, Diagnosis and Linkage to Care for Patients with Chronic Hepatitis B

  • Hepatitis B (JK Lim, Section Editor)
  • Published:
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Abstract

Purpose of Review

Chronic hepatitis B (CHB) places 3.5% of the world population at risk of dying from liver failure or liver cancer. Effective antiviral therapies can change disease outcomes, provided that CHB screening and linkage to care can be delivered at population level, to reach the vast numbers of undiagnosed people. We therefore reviewed the experience of community-based CHB screening programs reported in the English literature since 2014.

Recent Findings

Twenty papers met eligibility criteria and only one originated from a low-income country. The two randomised studies found that culturally tailored hepatitis education increased hepatitis testing. Successful linkage to care was facilitated by partnerships with community-based organisations and the use of bilingual patient navigators. Point of care testing and chain referral sampling were successfully tested in two programs.

Summary

These studies demonstrated that community-based interventions can screen large numbers of people and could deliver the population-level outcomes required to meet the WHO targets of hepatitis B elimination.

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References

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  1. World Health Organization, Global Hepatitis Report 2017. https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/ , W.H. Organization, Editor. 2017, World Health Organization: Geneva. Accessed 15 May 2019.

  2. Gellert L, Jalaludin B, Levy M. Hepatocellular carcinoma in Sydney south west: late symptomatic presentation and poor outcome for most. Intern Med J. 2007;37(8):516–22.

    Article  CAS  Google Scholar 

  3. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50(3):661–2.

    Article  Google Scholar 

  4. World Health Organization, Global Health Estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2016. https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html , W.H. Organization, Editor. 2016, World Health Organization: Geneva. Accessed 15 May 2019.

  5. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the global burden of disease study 2013. Lancet. 2016;388(10049):1081–8.

  6. Juon HS, Strong C, Kim F, Park E, Lee S. Lay health worker intervention improved compliance with hepatitis B vaccination in Asian Americans: randomized controlled trial. PLoS One. 2016;11(9):e0162683.

    Article  Google Scholar 

  7. Kwong SL, Stewart SL, Aoki CA, Chen MS. Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007. Cancer Epidemiol Biomark Prev. 2010;19(11):2747–57.

    Article  Google Scholar 

  8. Trinh-Shevrin C, Pollack HJ, Tsang T, Park J, Ramos MR, Islam N, et al. The Asian American hepatitis B program: building a coalition to address hepatitis B health disparities. Prog Community Health Partnersh. 2011;5(3):261–71.

  9. Supramaniam R, et al. Cancer incidence in New South Wales migrants 1991 to 2001. Sydney: The Cancer Council NSW; 2006.

    Google Scholar 

  10. Altekruse S, McGlynn K, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009;27(9):1485–91.

    Article  Google Scholar 

  11. McDermott S, DesMeules M, Lewis R, Gold J, Payne J, Lafrance B, et al. Cancer incidence among Canadian immigrants, 1980-1998: results from a national cohort study. J Immigr Minor Health. 2011;13(1):15–26.

  12. Haworth EA, Soni Raleigh V, Balarajan R. Cirrhosis and primary liver cancer amongst first generation migrants in England and Wales. Ethn Health. 1999;4(1–2):93–9.

    Article  CAS  Google Scholar 

  13. Visser O, van Leeuwen FE. Cancer risk in first generation migrants in North-Holland/Flevoland, the Netherlands, 1995-2004. Eur J Cancer. 2007;43(5):901–8.

    Article  CAS  Google Scholar 

  14. Chang TT, Liaw YF, Wu SS, Schiff E, Han KH, Lai CL, et al. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology. 2010;52(3):886–93.

  15. Papatheodoridis GV, Manolakopoulos S, Touloumi G, Nikolopoulou G, Raptopoulou-Gigi M, Gogos C, et al. Hepatocellular carcinoma risk in HBeAg-negative chronic hepatitis B patients with or without cirrhosis treated with entecavir: HepNet.Greece cohort. J Viral Hepat. 2015;22(2):120–7.

  16. Toy M, Veldhuijzen IK, de Man RA, Richardus JH, Schalm SW. Potential impact of long-term nucleoside therapy on the mortality and morbidity of active chronic hepatitis B. Hepatology. 2009;50(3):743–51.

    Article  CAS  Google Scholar 

  17. Nayagam S, Thursz M, Sicuri E, Conteh L, Wiktor S, Low-Beer D, et al. Requirements for global elimination of hepatitis B: a modelling study. Lancet Infect Dis. 2016;16(12):1399–408.

  18. IOM (Institute of Medicine), Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C., IOM, Editor. 2010, Institute of Medicine: Washington DC.

  19. Cowie, B. and H.Kelly, Outcomes of a complex dynamic mathematical model of hepatitis B virus in Australia. (PP-027), in 20th Conference of the Asian Pacific Association for the Study of the Liver (APASL); . 2010, Hepatology International Beijing, China p. 27.

  20. Hatzakis A, Wait S, Bruix J, Buti M, Carballo M, Cavaleri M, et al. The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference. J Viral Hepat. 2011;18(Suppl 1):1–16.

  21. Cohen C, Holmberg SD, McMahon BJ, Block JM, Brosgart CL, Gish RG, et al. Is chronic hepatitis B being undertreated in the United States? J Viral Hepat. 2011;18(6):377–83.

  22. Hu KQ, Pan CQ, Goodwin D. Barriers to screening for hepatitis B virus infection in Asian Americans. Dig Dis Sci. 2011;56(11):3163–71.

    Article  Google Scholar 

  23. Ma GX, Fang CY, Shive SE, Toubbeh J, Tan Y, Siu P. Risk perceptions and barriers to hepatitis B screening and vaccination among Vietnamese immigrants. J Immigr Minor Health. 2007;9(3):213–20.

    Article  Google Scholar 

  24. Nguyen CT, Lin SY. Hepatitis B screening in Asian and Pacific islanders: new guidelines, old barriers. J Immigr Minor Health. 2015;17(5):1585–7.

    Article  Google Scholar 

  25. Xu K, Watanabe-Galloway S, Rochling FA, Zhang J, Farazi PA, Peng H, et al. Practice, knowledge, and barriers for screening of hepatocellular carcinoma among high-risk Chinese patients. Annals of Global Health. 2017;83(2):281–92.

  26. Zhou K, Fitzpatrick T, Walsh N, Kim JY, Chou R, Lackey M, et al. Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses. Lancet Infect Dis. 2016;16:1409–22.

  27. Ferrante JM, Winston DG, Chen PH, de la Torre AN. Family physicians' knowledge and screening of chronic hepatitis and liver cancer. Fam Med. 2008;40(5):345–51.

    PubMed  Google Scholar 

  28. Lai CJ, Nguyen TT, Hwang J, Stewart SL, Kwan A, McPhee SJ. Provider knowledge and practice regarding hepatitis B screening in Chinese-speaking patients. J Cancer Educ. 2007;22(1):37–41.

    Article  Google Scholar 

  29. Robotin M, Patton Y, George J. Getting it right: the impact of a continuing medical education program on hepatitis B knowledge of Australian primary care providers. Int J Gen Med. 2013;6:115–22.

    Article  Google Scholar 

  30. Status of Vietnamese Health: Santa Clara County, California, 2011, C.o.S.C.P.H. Department, Editor. 2011, Public Health Department Santa Clara.

  31. Robotin MC, George J. Community-based hepatitis B screening: what works? Hepatol Int. 2014;8(4):478–92.

    Article  Google Scholar 

  32. van der Veen YJ, et al. Cultural tailoring to promote hepatitis B screening in Turkish Dutch: a randomized control study. Health Promot Int. 2013;29(4):692–704.

    Article  Google Scholar 

  33. Zuure FR, Bouman J, Martens M, Vanhommerig JW, Urbanus AT, Davidovich U, et al. Screening for hepatitis B and C in first-generation Egyptian migrants living in the Netherlands. Liver Int. 2013;33(5):727–38.

  34. Ma GX, Gao W, Tan Y, Chae WG, Rhee J. A community-based participatory approach to a hepatitis B intervention for Korean Americans. Prog Community Health Partnersh. 2012;6(1):7–16.

    Article  Google Scholar 

  35. Bailey MB, et al. San Francisco Hep B free: a grassroots community coalition to prevent hepatitis B and liver Cancer. J Community Health. 2010;36(4):538–51.

  36. Hwang JP, Mohseni M, Gor BJ, Wen S, Guerrero H, Vierling JM. Hepatitis B and hepatitis C prevalence and treatment referral among Asian Americans undergoing community-based hepatitis screening. Am J Public Health. 2010;100(Suppl 1):S118–24.

    Article  Google Scholar 

  37. Robinson T, Bullen C, Humphries W, Hornell J, Moyes C. The New Zealand hepatitis B screening Programme: screening coverage and prevalence of chronic hepatitis B infection. N Z Med J. 2005;118(1211):U1345.

    PubMed  Google Scholar 

  38. Marineau M, Tice AD, Taylor-Garcia D, Akinaka KT, Lusk H, Ona F. Culturally sensitive strategies designed to target the silent epidemic of hepatitis B in a Filipino community. Hawaii Med J. 2007;66(6):154–6.

    PubMed  Google Scholar 

  39. Chen CH, Yang PM, Huang GT, Lee HS, Sung JL, Sheu JC. Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants. J Formos Med Assoc. 2007;106(2):148–55.

    Article  Google Scholar 

  40. Lee J, Lok AS, Chen J. Hepatitis B prevalence among Asian Americans in Michigan: an assessment to guide future education and intervention strategies. J Community Health. 2010;35(5):534–42.

    Article  Google Scholar 

  41. Lin SY, Chang ET, So SK. Why we should routinely screen Asian American adults for hepatitis B: a cross-sectional study of Asians in California. Hepatology. 2007;46(4):1034–40.

    Article  Google Scholar 

  42. Buster EH, et al. Sustained HBeAg and HBsAg loss after long-term follow-up of HBeAg-positive patients treated with peginterferon alpha-2b. Gastroenterology. 2008;135(2):459–67.

    Article  CAS  Google Scholar 

  43. Mostert MC, Richardus JH, de Man RA. Referral of chronic hepatitis B patients from primary to specialist care: making a simple guideline work. J Hepatol. 2004;41(6):1026–30.

    Article  Google Scholar 

  44. Robotin MC, Kansil MQ, Porwal M, Penman AG, George J. Community-based prevention of hepatitis-B-related liver cancer: Australian insights. Bull World Health Organ. 2014;92(5):374–9.

    Article  Google Scholar 

  45. World Health Organization, Global health sector strategy on viral hepatitis, 2016–2021.­­­, in http://apps.who.int/iris/bitstream/10665/246177/1/WHO-HIV-2016.06-eng.pdf?ua=1 , W.H. Organization, Editor. 2016, World Health Organization: Geneva. Accessed 12 Apr 2019.

  46. Ward JW. Strategies for expanding access to HBV and HCV testing and Care in the United States: the CDC hepatitis testing and linkage to care initiative, 2012-2014. Public Health Rep. 2016;131(Suppl 2):1–4.

    Article  Google Scholar 

  47. • Chandrasekar E, et al. A Novel Strategy to Increase Identification of African-Born People With Chronic Hepatitis B Virus Infection in the Chicago Metropolitan Area, 2012–2014. Prev Chronic Dis. 2016;13:E118 Trialled chain referral sampling to encourage testing and engagement in care of uninsured and marginalised African-born people; used patient navigators.

    Article  Google Scholar 

  48. Juon HS, Lee S, Strong C, Rimal R, Kirk GD, Bowie J. Effect of a liver cancer education program on hepatitis B screening among Asian Americans in the Baltimore-Washington metropolitan area, 2009-2010. Prev Chronic Dis. 2014;11:130258.

    Article  Google Scholar 

  49. • Ma GX, et al. A Community-Based Randomized Trial of Hepatitis B Screening Among High-Risk Vietnamese Americans. Am J Public Health. 2017;107(3):433–40 Cluster RCT of multilevel intervention offering interactive in-language education and patient navigators vs. general information; outcomes: screening rates. Used a participatory approach to enhance intervention effects and enhance its sustainability.

    Article  Google Scholar 

  50. Nguyen K, van Nguyen T, Shen D, Xia V, Tran D, Banh K, et al. Prevalence and presentation of hepatitis B and C virus (HBV and HCV) infection in Vietnamese Americans via serial community serologic testing. J Immigr Minor Health. 2015;17(1):13–20.

  51. Strong C, Hur K, Kim F, Pan J, Tran S, Juon HS. Sociodemographic characteristics, knowledge and prevalence of viral hepatitis infection among Vietnamese Americans at community screenings. J Immigr Minor Health. 2015;17(1):298–301.

    Article  Google Scholar 

  52. Barragan NC, et al. A case study of a hepatitis B screening and blood pressure assesment program in Los Angeles County, 2012-2013. Prev Chronic Dis. 2015;12:E19.

    Article  Google Scholar 

  53. Stornaiuolo G, Cuniato V, Cuomo G, Nocera E, Brancaccio G, de Rosa M, et al. Active recruitment strategy in disadvantaged immigrant populations improves the identification of human immunodeficiency but not of hepatitis B or C virus infections. Dig Liver Dis. 2014;46(1):62–6.

  54. Beckett GA, et al. Early identification and linkage to care of persons with chronic hepatitis B virus infection--three U.S. sites,2012-2014. MMWR Morb Mortal Wkly Rep. 2014;63(18):399–401.

    PubMed  PubMed Central  Google Scholar 

  55. Chandrasekar E, Kaur R, Song S, Kim KE. A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings. J Multidiscip Healthc. 2015;8:1–9.

    Article  Google Scholar 

  56. Dang JH, Chen MS Jr. Increasing hepatitis B testing and linkage to Care of Foreign-Born Asians, Sacramento, California, 2012-2013. Public Health Rep. 2016;131(Suppl 2):119–24.

    Article  Google Scholar 

  57. •• Harris AM, et al. Testing and Linking Foreign-Born People with Chronic Hepatitis B Virus Infection to Care at Nine U.S. Programs, 2012–2014. Public Health Rep. 2016;131(Suppl 2):20–8 Summary results from a prospective cohort drawn from population groups with a HBV prevalence>2%, based on their country of birth. Nine pilot sites conducted targeted screening of 23,144 participants; linkage to primary care providers was achieved in 83% of HBsAg+ve people. Data collected using a common dataset. Authors provide insights into success factors and recommendations for how to increase testing uptake.

    Article  Google Scholar 

  58. • Hyun CS, et al. Chronic hepatitis B in Korean Americans: decreased prevalence and poor linkage to care. BMC Infect Dis. 2016;16(1):415 Summarises findings of a large-scale screening and awareness campaign targeting Korean Americans. Through 128 separate community events, tested 7,199 people, with HBV prevalence of 2.4%. Identified role of education and navigation in facilitating linkage to care.

    Article  Google Scholar 

  59. Hyun CS, Ventura WR, Kim SS, Yoon S, Lee S. A community- based hepatitis B linkage-to-care program: a case study on Asian Americans chronically infected with hepatitis B virus. Hepatol Med Policy. 2016;1:6.

    Article  Google Scholar 

  60. Navarro N, Lim N, Kim J, Joo E, Che K, Runyon BA, et al. Lower than expected hepatitis B virus infection prevalence among first generation Koreans in the U.S.: results of HBV screening in the Southern California Inland Empire. BMC Infect Dis. 2014;14:269.

  61. • Shankar H, et al. A Novel Collaborative Community-Based Hepatitis B Screening and Linkage to Care Program for African Immigrants. Clin Infect Dis. 2016;62(Suppl 4):S289–97 Novel partnership involving a community-based organisation, an academic medical center and community health centers to provide comprehensive screening and linkage to care of underserved / unisured people from African countries. Used culturally targeted patient navigators.

    Article  Google Scholar 

  62. Walters J, Sullivan A. Early identification and linkage to Care of Foreign-Born People with chronic hepatitis B virus infection, Multnomah County, Oregon, 2012-2014. Public Health Rep. 2016;131(Suppl 2):105–11.

    Article  Google Scholar 

  63. •• Coenen S, et al. Clinical impact of five large-scale screening projects for chronic hepatitis B in Chinese migrants in the Netherlands. Liver Int. 2016;36(10):1425–32 First large-scale community based screening and treatment intervention in high risk Chinese residents in a European country. Combination of outreach with direct clinic referal ensured high referral and treatment rates.

    Article  CAS  Google Scholar 

  64. Richter C, et al. Screening for chronic hepatitis B and C in migrants from Afghanistan, Iran, Iraq, the former soviet republics, and Vietnam in the Arnhem region. Netherlands Epidemiol Infect. 2014;142(10):2140–6.

    Article  CAS  Google Scholar 

  65. •• Lemoine M, et al. Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study. Lancet Glob Health. 2016;4(8):e559–67 First large-scale screen-and-treat program in the general population in a low-resource country in Africa. Used point-of-care testing and trained fieldworkers and achieved high screening coverage and linkage to care.

  66. •• Robotin MC, et al. Using a chronic hepatitis B Registry to support population-level liver cancer prevention in Sydney, Australia. Clin Epidemiol. 2018;10:41–9 Established a disease Registry enrolling patients with CHB diagnosed in primary care. Specialist referral based upon risks stratification by primary care providers, which reduced unnecessary specialist referrals. Validated assumptions of the economic level, including antiviral treatment in 18% of those enrolled.

  67. Juon HS, Strong C, Oh TH, Castillo T, Tsai G, Oh LDH. Public health model for prevention of liver cancer among Asian Americans. J Community Health. 2008;33(4):199–205.

    Article  Google Scholar 

  68. Richter C, et al. Hepatitis B prevalence in the Turkish population of Arnhem: implications for national screening policy? Epidemiol Infect. 2012;140(4):724–30.

    Article  CAS  Google Scholar 

  69. Perumalswami PV, Factor SH, Kapelusznik L, Friedman SL, Pan CQ, Chang C, et al. Hepatitis outreach network: a practical strategy for hepatitis screening with linkage to care in foreign-born communities. J Hepatol. 2013;58(5):890–7.

  70. Veldhuijzen IK, Wolter R, Rijckborst V, Mostert M, Voeten HA, Cheung Y, et al. Identification and treatment of chronic hepatitis B in Chinese migrants: results of a project offering on-site testing in Rotterdam The Netherlands. J Hepatol. 2012;57(6):1171–6.

  71. Robotin M, et al. Characteristics of chronic hepatitis B infection in SW Sydney: clinical correlates and policy implications. In: in 9th Australasian Viral Hepatitis Conference. Australia: Alice Springs; 2014.

    Google Scholar 

  72. World Health Organization, Guidelines on hepatitis B and C testing. 2017, World Health Organization Geneva.

  73. Hutton DW, Tan D, So SK, Brandeau ML. Cost-effectiveness of screening and vaccinating Asian and Pacific islander adults for hepatitis B. Ann Intern Med. 2007;147(7):460–9.

    Article  Google Scholar 

  74. Veldhuijzen IK, Toy M, Hahné SJM, de Wit GA, Schalm SW, de Man RA, et al. Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology. 2010;138(2):522–30.

  75. Robotin MC, Kansil M, Howard K, George J, Tipper S, Dore GJ, et al. Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening. J Hepatol. 2009;50(5):990–8.

  76. Lemoine M, Nayagam S, Thursz M. Viral hepatitis in resource-limited countries and access to antiviral therapies: current and future challenges. Futur Virol. 2013;8(4):371–80.

    Article  CAS  Google Scholar 

  77. Zhou K, Fitzpatrick T, Walsh N, Kim JY, Chou R, Lackey M, et al. Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses. Lancet Infect Dis. 2016;16(12):1409–22.

  78. Shapiro AE, et al. Completion of the tuberculosis care cascade in a community-based HIV linkage-to-care study in South Africa and Uganda. J Int AIDS Soc. 2018;21(1):e25065.

    Article  Google Scholar 

  79. Hermann K, van Damme W, Pariyo GW, Schouten E, Assefa Y, Cirera A, et al. Community health workers for ART in sub-Saharan Africa: learning from experience--capitalizing on new opportunities. Hum Resour Health. 2009;7:31.

  80. Dunbar EL, Wroe EB, Nhlema B, Kachimanga C, Gupta R, Taylor C, et al. Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial. BMJ Open. 2018;8(7):e019473.

  81. Busza J, Dauya E, Bandason T, Simms V, Chikwari CD, Makamba M, et al. The role of community health workers in improving HIV treatment outcomes in children: lessons learned from the ZENITH trial in Zimbabwe. Health Policy Plan. 2018;33(3):328–34.

  82. Nayagam S, Conteh L, Sicuri E, Shimakawa Y, Suso P, Tamba S, et al. Cost-effectiveness of community-based screening and treatment for chronic hepatitis B in the Gambia: an economic modelling analysis. Lancet Glob Health. 2016;4(8):e568–78.

  83. Allain JP. Screen-and-treat for chronic hepatitis B: an overdue issue for sub-Saharan Africa. Lancet Glob Health. 2016;4(8):e507–8.

    Article  Google Scholar 

  84. Glasgow RE, Askew S, Purcell P, Levine E, Warner ET, Stange KC, et al. Use of RE-AIM to address health inequities: application in a low-income community health center based weight loss and hypertension self-management program. Transl Behav Med. 2013;3(2):200–10.

  85. Glasgow RE, Estabrooks PE. Pragmatic applications of RE-AIM for health care initiatives in community and clinical settings. Prev Chronic Dis. 2018;15:E02.

    Article  Google Scholar 

  86. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006;21(5):688–94.

    Article  Google Scholar 

  87. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.

    Article  CAS  Google Scholar 

  88. Forman J, Heisler M, Damschroder LJ, Kaselitz E, Kerr EA. Development and application of the RE-AIM QuEST mixed methods framework for program evaluation. Prev Med Rep. 2017;6:322–8.

    Article  Google Scholar 

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  1. University of Notre Dame Australia, School of Medicine, Sydney, Australia

    Monica Robotin

  2. University of Sydney, School of Public Health, Sydney, Australia

    Monica Robotin

  3. Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, Australia

    Jacob George

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Robotin, M., George, J. Community-Based Strategies to Improve Screening, Diagnosis and Linkage to Care for Patients with Chronic Hepatitis B. Curr Hepatology Rep 18, 342–356 (2019). https://doi.org/10.1007/s11901-019-00485-x

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