Authors (including presenting author) :
YY Lam (1), Lawrence SW Lai(1), CY Lam(1), WH Yuen(1)
Affiliation :
(1) Medicine & Geriatrics, Pok Oi Hospital
Introduction :
Chronic Hepatitis B (CHB) infection represents a significant public health concern, with an estimated 6-7% of females in Hong Kong being HBV carriers. In alignment with the World Health Organization (WHO) 2030 objectives, a specialized Hepatitis Nurse Clinic has been implemented in public hospitals. At Pok Oi Hospital, around 1,000 CHB patients receive care through this clinic.
Objectives :
- To demonstrate that the Nurse Hepatitis B Clinic can provide safe and effective care for selected low-risk CHB patients, regardless of anti-viral medication status
- To empower patients with knowledge regarding CHB management
- To assess liver stiffness annually using FibroScan®
- To utilize liver stiffness results as an indicator for optimal timing of CHB treatment
Methodology :
Patients meeting specific intake criteria (non-cirrhotic and low risk for hepatocellular carcinoma - HCC) are referred to the nurse clinic by gastroenterology specialists. A trained specialty nurse conducts standardized management, which includes liver biochemistry tests, alpha-fetoprotein tests, HBV DNA tests, liver ultrasounds, and FibroScan examinations. Patients with suspicious symptoms or abnormal findings are discussed in case conferences for further evaluation or earlier medical follow-up.
Result & Outcome :
From April 2023 to March 2024, a total of 1,045 patients attended the Hepatitis Nurse Clinic. During consultations, patients received education on the necessity of Hepatitis A vaccination, family screening for CHB, and the importance of annual liver ultrasounds, enhancing patient compliance with disease management. Approximately 70% of attendees were on anti-viral medication, while the remaining 30% were not. Notably, 94% of clinic clients achieved targeted symptom control as indicated by their liver biochemistry, HBV DNA levels, alpha-fetoprotein levels, and FibroScan® results, demonstrating no cirrhotic changes. Out of 1,000 patients who underwent annual FibroScan®, 6% presented with signs of cirrhosis (i.e., liver stiffness over 12 kPa). Among the 300 CHB patients who were not on anti-viral drugs, 20 (6.5%) showed liver stiffness exceeding 9 kPa (indicative of F3 fibrosis), prompting further discussions with gastroenterology physicians. Over 95% of patients required some form of treatment for CHB.
