AbstractChronic Hepatitis B (chronic HBV infection) affects 350 million people globally and causes significant morbidity and mortality in the form of cirrhosis and liver cancer. The overall prevalence of chronic HBV infection in Australia is around 1%; however Indigenous Australians are disproportionately affected. In the Northern Territory (NT) exact prevalence rates in Indigenous communities are not known but have been estimated to be between 2.4-14%. Universal vaccination commencing at birth has been in place in the NT since 1990 and effective antiviral treatments are available, however only 2.4% of those living with chronic HBV infection are receiving treatment for it. Low health literacy is one of the multiple barriers preventing access to care particularly in a cross-cultural context.
Following the literature reviews in section A, this thesis covers three major areas of work that have formed my PhD studies (sections B, C and D).
In section B, I present a detailed description of the sero-epidemiology of hepatitis B in the NT based on 20 years of Territory-wide laboratory data. Overall HBsAg prevalence is 3.40%, increasing to 6.08% for Indigenous Australians.
In section C, I present the CHARM (Characterising hepatitis B in northern Australia through molecular epidemiology) cohort. This study identified the unique and universal hepatitis B subgenotype in Indigenous Australians in the NT to be C4. Full genome sequencing has identified C4 to be a recombinant virus with molecular markers associated with rapid progression to cirrhosis and liver cancer.
Section D reports a qualitative participatory action research study looking at hepatitis B-specific health literacy and the provision of patient information. The results of this study have informed and enabled production of a bilingual (English and Yolŋu matha) electronic application to provide information for Indigenous people about hepatitis B. The ‘Hep B Story’ app is freely available through the Apple app store and the Google play app store.
Note: Please note that some published articles in the thesis are available in hard copy only.
|Date of Award||Jul 2015|
|Supervisor||Joshua Davis (Supervisor)|