Anti‐Viral Treatment Eligibility and Treatment Uptake Among People With Chronic Hepatitis B in Australia: The
REACH
‐B Study
Behzad Hajarizadeh, Renjy Nelson, Jacob George, Josh Hanson, Jane Davies, Marianne Martinello, Tracey Brown, Ian Wong, Tasnim Hasan, Lester Mascarenhas, James O'Beirne, Amanda Wade, Marilou Capati, Georgina Trotter, Sarah Thomas, Lloyd Nash, Benjamin Cowie, Nicole Allard, Thomas Tu, Lien Tran, Stephanie Howard, Robert Monaghan, Jessica Carter, Elise Tu, Amanda Erratt, Joanne Carson, Gregory J. Dore, Gail V. Matthews, ABSTRACT
Treatment indication for chronic hepatitis B (CHB) varies across clinical guidelines. This study evaluated treatment eligibility and uptake in a large Australian cohort of people with CHB. The REACH‐B study recruited people with CHB managed through a national network of healthcare services. Participants were categorised into three groups: (1) receiving antiviral therapy; (2) untreated despite eligibility; (3) untreated and ineligible. Treatment eligibility was determined using Australian Pharmaceutical Benefits Scheme (PBS) criteria, and by international clinical guidelines. Among 3648 participants (56% male; median age 48 years; 49% born in North‐East or South‐East Asia; 27% First Nations Australians), 14% were HBeAg positive and 7% had cirrhosis. Overall, 47% ( n = 1666) were on antiviral therapy, 45% ( n = 1573) were untreated and ineligible and 7% ( n = 251) were untreated despite eligibility based on Australian PBS criteria. In adjusted analysis, the likelihood of remaining untreated despite eligibility was higher among women (aOR 1.59, 95% CI 1.34, 1.88) and younger participants (age 41–60 vs. > 60 years: aOR 1.51, 95% CI 1.01–2.28; ≤ 40 vs. > 60 years: aOR 2.65, 95% CI 1.60, 4.40). The proportion untreated despite eligibility increased to 13% when applying 2024 World Health Organisation guidelines and ranged 2%–44% based on other guidelines, highlighting the variability across the guidelines. In conclusion, among REACH‐B participants, most eligible individuals receive treatment. Lower treatment uptake among women and younger people despite eligibility partly reflects lower threshold for elevated ALT in women, and clinician determination of non‐CHB related ALT elevation. As treatment guidelines evolve and eligibility criteria broaden, monitoring treatment patterns is important.