Linkage to Care, Retention in Care and Treatment Uptake Among Patients Diagnosed With Chronic Hepatitis B in Norway, 2008–2022

Abstract

People living with chronic hepatitis B infection (PLWHB) need life-long care to monitor liver health and treatment need. Data on clinical follow-up for PLWHB are essential to monitor the health system response to this infection. We used linked national registry data to calculate the proportion of diagnosed PLWHB in Norway linked to specialist care (LTC), treated and retained in specialist or primary care (RIC) from 2008 to 2022. We described the outcomes by time, age, sex, region of residence, place of birth and residence status. Using log-binomial regression, we explored how these factors were associated with ever being LTC and being RIC during the last 12 months of the study period. Among 10,542 diagnosed PLWHB, 8301 (79%) had ever been LTC and 2454 (23%) had received treatment. In the first 2 years after LTC, 64% were still RIC. At the end of the study period, 4476 (50%) of 8979 PLWHB still resident in Norway had been RIC in the last 12 months. PLWHB born outside Norway had a higher probability of LTC (relative risk [RR]: 1.24; 95% confidence interval [CI] 1.19–1.29) and RIC (RR: 1.67; 95% CI 1.53–1.84). Other significant associations with smaller effect sizes included a higher probability of LTC among PLWHB aged < 25 years and a lower probability of RIC when diagnosed from 2010 to 2013 or aged ≥ 65 years. The management of diagnosed PLWHB in Norway is suboptimal. Our study provides a framework for how key performance indicators can be monitored in ongoing national surveillance.