Digestive Diseases and Sciences

, Volume 59, Issue 1, pp 46–56 | Cite as

Hepatitis B Management in Vulnerable Populations: Gaps in Disease Monitoring and Opportunities for Improved Care

  • Blaire E. Burman
  • Nizar A. Mukhtar
  • Brian C. Toy
  • Tung T. Nguyen
  • Alice Hm Chen
  • Albert Yu
  • Peter Berman
  • Hali Hammer
  • Daniel Chan
  • Charles E. McCulloch
  • Mandana Khalili
Original Article



Hepatitis B (HBV) is prevalent in certain US populations and regular HBV disease monitoring is critical to reducing associated morbidity and mortality. Adherence to established HBV monitoring guidelines among primary care providers is unknown.


The purpose of this study was to evaluate HBV disease monitoring patterns and factors associated with adherence to HBV management guidelines in the primary care setting.


Primary providers within the San Francisco safety net healthcare system were surveyed for HBV management practices, knowledge, attitudes, and barriers to HBV care. Medical records from 1,727 HBV-infected patients were also reviewed retrospectively.


Of 148 (45 %) responding providers, 79 % reported ALT and 44 % reported HBV viral load testing every 6–12 months. Most providers were knowledgeable about HBV but 43 % were unfamiliar with HBV management guidelines. Patient characteristics included: mean age 51 years, 54 % male and 67 % Asian. Within the past year, 75 % had ALT, 24 % viral load, 21 % HBeAg tested, and 40 % of at-risk patients had abdominal imaging for HCC. Provider familiarity with guidelines (OR 1.02, 95 % CI 1.00–1.03), Asian patient race (OR 4.18, 95 % CI 2.40–7.27), and patient age were associated with recommended HBV monitoring. Provider HBV knowledge and attitudes were positively associated, while provider age and perceived barriers were negatively associated with HCC surveillance.


Comprehensive HBV disease monitoring including HCC screening with imaging were suboptimal. While familiarity with AASLD guidelines and patient factors were associated with HBV monitoring, only provider and practice factors were associated with HCC surveillance. These findings highlight the importance of targeted provider education to improve HBV care.


Hepatitis B Hepatocellular carcinoma Primary care Provider education Practice guidelines Health disparities 



Alanine aminotransferase


Hepatitis B virus


Hepatitis B surface antigen


Hepatitis B e antigen


Hepatitis A virus


Hepatitis C virus


Human immunodeficiency virus


Hepatocellular carcinoma


American Association for the Study of Liver Diseases



This work was in part supported by Hepatology Training Grant DK060414 (B.B.), San Francisco General Hospital Foundation Grant (M.K.), K24AA022523 (M.K.) and P30 DK026743 (UCSF Liver Center).

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Blaire E. Burman
    • 1
  • Nizar A. Mukhtar
    • 1
  • Brian C. Toy
    • 1
  • Tung T. Nguyen
    • 1
  • Alice Hm Chen
    • 1
  • Albert Yu
    • 2
  • Peter Berman
    • 2
  • Hali Hammer
    • 2
  • Daniel Chan
    • 3
  • Charles E. McCulloch
    • 4
  • Mandana Khalili
    • 5
    • 6
  1. 1.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Family and Community MedicineUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.North East Medical ServicesSan FranciscoUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  6. 6.Liver CenterUniversity of California, San FranciscoSan FranciscoUSA

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