Liver cancer prevention strategies in high risk Australian populations: challenges and opportunities : Is population-level liver cancer prevention feasible in an Australian setting?

Abstract

This thesis sought to ascertain the feasibility of population-level liver cancer prevention in people with chronic hepatitis B (CHB) infection. This followed on from our group’s economic modelling work, showing that improved CHB management delivers better and more cost-effective hepatocellular cancer (HCC) outcomes, compared to HCC screening. Establishing the B Positive program in South West Sydney allowed us to test a primary care-based HCC prevention intervention in a high CHB prevalence area. We found that local General Practitioners (GPs) could accommodate additional appointments for CHB management, but not the local specialist services. Consequently we developed a CHB management algorithm stratifying patients by level of HCC risk, with high-risk patients referred for antiviral treatment and primary care-level management for the rest. As antiviral treatments accounts for 75% of program costs, lowering drug costs is critical to make HCC prevention affordable in low-resource settings. We addressed local health practitioners’ information needs about CHB and offered additional practice support. We established a CHB disease Registry, currently enrolling approximately 25% of our target population, with antiviral treatment uptake 6-fold higher than the national average. This thesis demonstrated that clinical-Public Health collaborations can deliver successful HCC prevention at primary care level, endorsed by the local community.