Barriers to Hepatitis B Treatment: A Multicentre Cross-Sectional Registry and Survey Study by the Canadian Hepatitis B Network.

Authors

Hin Hin Ko, Jordyn Vienneau, Curtis L Cooper, Pam Crotty, Stephen E Congly, Mayur Brahmania, Alnoor Ramji, Erin Kelly, Angela M Crawley, Karen Doucette, Vanessa Meier-Stephenson, Mang Ma, Scott K Fung, David K Wong, Jordan Feld, Nabiha Faisal, Kelly Kaita, Carla Osiowy, Magdy Elkhashab, Edward Tam, Alexander Wong, Robert Bailey, Philip Wong, Giada Sebastiani, Tianyan Chen, Brian Conway, David Truong, Keith Tsoi, Carmine Nudo, Julie Zhu, Sébastien Poulin, Abdel-Aziz Shaheen, Carla S Coffin

Published in

Liver international : official journal of the International Association for the Study of the Liver. Volume 46. Issue 9. Pages e70835.

Abstract

Chronic hepatitis B (CHB) remains a leading cause of cirrhosis and hepatocellular carcinoma (HCC) worldwide, yet treatment uptake is suboptimal even in high-resource settings. This pan-Canadian study aimed to quantify treatment gaps within the Canadian Hepatitis B Network (CanHepB) Registry, compare characteristics of treatment-eligible but untreated patients to those receiving therapy, and assess patient and specialist perspectives on barriers to treatment.
A cross-sectional, retrospective analysis of 1983 adults with CHB followed in 18 Canadian hepatitis B specialty clinics between January 2018 and November 2024. Treatment eligibility was determined using the 2018 Canadian Association for the Study of the Liver guidelines. An anonymous survey captured patient-reported barriers and perspectives (n = 191), while a separate survey evaluated specialist perceptions (n = 54).
Among 881 untreated patients, 46.4% (n = 409) were treatment eligible. Compared with the treatment group (n = 1087), the treatment-eligible but untreated patients were younger (median 47.3 vs. 54.5 years), more frequently female (54.2% vs. 39.7%), and more likely to be of Black/African/Caribbean origin (18.2% vs. 9.7%). They had a lower prevalence of cirrhosis (2.4% vs. 20.3%), HCC (0.7% vs. 9.3%), and hypertension (17.1% vs. 22.9%), but a higher prevalence of steatotic liver disease (36.4% vs. 24.6%) and dyslipidemia (14.7% vs. 10.8%). Among untreated respondents, concerns included side effects, the need for long-term therapy, and lack of curative options. Conversely, specialists identified cost as the primary barrier and side effects as the least concerning.
This nationwide study reveals a significant treatment gap in CHB care, driven by demographic disparities and a mismatch between patient concerns and clinician perceptions.

PMID:
42576655
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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