Impact of Programs to Manage Alaska Native Patients with Chronic Hepatitis B and C in Urban and Remote Rural Areas Using a Data Base Registry
Methods: We have developed Alaska Statewide Computerized Registries to aid management of hepatitis B since 1982 and hepatitis C since 2000. All persons with HBV (1560) and HCV (1323) infections receive letters every 6 months reminding them to go to their village clinic or hospital for blood draw for liver function (LFT) and alpha-fetoprotein testing (AFP). Sera are sent to the Alaska Native Medical Center for testing and review. For HBV infection, persons with AFP > 10 mg/ml are referred to the nearest facility for liver ultrasound (US); persons with elevated LFT have HBV DNA testing performed and if both LFT and HBV DNA are elevated, they are evaluated for liver biopsy and potential treatment.
Results: Since the year 1982-2013, 1367 persons with HBV infection have had 40,385 laboratory visits that yielded 53 cases of hepatocellular carcinoma. Sixty-eight percent of tumors were found at a resectable stage and 5-year survival was significantly better than historical controls (40% vs 0; p=.0.012). In addition, 102 patients with HBV infection were started on antiviral therapy. For patients with HCV infection, 176 received antiviral therapy and 92 experienced a sustained virologic response (SVR). The advent of new drugs for hepatitis C will make it easier to treat and cure persons living in rural areas.
Conclusions: This program demonstrates that care and treatment of hepatitis B and C as recommended by evidenced-based Practice Guidelines can be carried out for infected persons living in both urban and isolated communities via electronic based registries.