A pilot programme of community volunteers to improve hepatitis B medication adherence, Kiribati, 2025.

Abstract

Problem: Antiviral therapy for chronic hepatitis B (CHB) reduces morbidity and mortality and improves quality of life. Achieving high levels of adherence is challenging due to multiple barriers, including medication fatigue, stigma, transportation and limited health literacy.

Context: Suboptimal adherence to antiviral therapy for CHB is problematic in Kiribati, particularly among high-risk groups including pregnant women and individuals with cirrhosis.

Action: During January-August 2025, a community volunteer intervention was initiated on Kiritimati, a remote island of Kiribati, to address adherence to CHB antiviral therapy. Community volunteers were assigned to patients positive for hepatitis B surface antigen who were commencing antiviral therapy and were pregnant or had cirrhosis. During home visits, volunteers provided education and encouraged medication adherence and clinic follow-up. Adherence in the intervention group was compared with adherence in positive patients being treated on other remote islands without the intervention.

Outcome: Adherence was measured by medication bottle counts. Outcomes were assessed by overall group adherence and individual adherence > 80%. Group adherence was 77.4% (240.5/310.75) in the volunteer intervention group compared with 52.5% (700/1333) in the group without it (P < 0.001). Overall adherence among pregnant women in the intervention group was 89.7% (52/58). Individual adherence > 80% was met in 58.8% (30/51) of the intervention group and 34.1% (70/205) in the control group (P = 0.0012).

Discussion: Although findings are preliminary and the intervention and control groups were not matched, this pilot suggests community volunteers are a promising intervention to improve CHB treatment adherence in a high-prevalence Pacific island setting. This strategy could also be explored for other chronic conditions where adherence is important.