Effectiveness and implementation of decentralized, community- and primary care-based strategies in promoting hepatitis B testing uptake: a systematic review and meta-analysis.
| Title: | Effectiveness and implementation of decentralized, community- and primary care-based strategies in promoting hepatitis B testing uptake: a systematic review and meta-analysis. |
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| Authors: | Kim TV; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Epidemiology, Pham Ngoc Thach University of Medicine, Viet Nam.; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Pham TND; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.; Phan P; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Le MHN; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.; Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan.; Le Q; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Nguyen PT; University of Health Sciences, Vietnam National University Ho Chi Minh City (VNUHCM-UHS), Binh Duong, Viet Nam.; Nguyen HT; University of Health Sciences, Vietnam National University Ho Chi Minh City (VNUHCM-UHS), Binh Duong, Viet Nam.; Nguyen DX; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Boston University School of Public Health, Boston, MA, USA.; Trang B; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Cao C; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Gurakar A; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Hoffmann CJ; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Dao DY; Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. |
| Source: | EClinicalMedicine [EClinicalMedicine] 2024 Sep 12; Vol. 76, pp. 102818. Date of Electronic Publication: 2024 Sep 12 (Print Publication: 2024). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: The Lancet Country of Publication: England NLM ID: 101733727 Publication Model: eCollection Cited Medium: Internet ISSN: 2589-5370 (Electronic) Linking ISSN: 25895370 NLM ISO Abbreviation: EClinicalMedicine Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [London] : The Lancet, [2018]- |
| Abstract: | Background: Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking.; Methods: We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components.; Findings: 7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference = 27.9% [95% Confidence Interval = 3.4-52.4], I2 = 99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness.; Interpretation: HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets.; Funding: Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA.; (© 2024 The Author(s).) |
| Competing Interests: | DYD has received financial support from Mai Dolch for the Center of Excellence for Liver Disease in Vietnam at Johns Hopkins School of Medicine; research grants from the Ludwig Institute for Cancer Research, Gilead Sciences, Fujifilm Medical Systems, and Roche Diagnostics International Ltd.; honoraria and travel support from BMJ Best Practices, Fujifilm Medical Systems, Roche Diagnostics International Ltd., and Techno Orbits; and equipment and materials from Fujifilm Medical Systems and Roche Diagnostics International Ltd. DYD has also served on Data Safety Monitoring Boards (DSMBs) or advisory boards for IQVIA. HN has received payment from A. Menarini Singapore Pte. Ltd. for a presentation on the economic evaluation of tenofovir alafenamide in chronic hepatitis B in Vietnam; financial support from VinHealth for the economic evaluation of tenofovir alafenamide in Vietnam; and financial support from Mahidol University for evaluating strategies to prevent mother-to-child transmission of hepatitis B virus (HBV). PN has received financial support from VinHealth for the economic evaluation of tenofovir alafenamide in chronic hepatitis B in Vietnam. All other authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Decentralization; Effectiveness; Elimination; Hepatitis B; Implementation; Primary care; Testing |
| Entry Date(s): | Date Created: 20240923 Latest Revision: 20240924 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11416547 |
| DOI: | 10.1016/j.eclinm.2024.102818 |
| PMID: | 39309722 |
| Database: | MEDLINE |
Journal Article