Author information

• ¹Department of Infectious Diseases, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom. Electronic address: anna_maria.geretti@kcl.ac.uk.
• ²Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
• ³Department of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, United Kingdom.
• ⁴Institute for Global Health, University College London (UCL), London, United Kingdom.
• ⁵Institute for Global Health, University College London (UCL), London, United Kingdom; NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL, a partnership with UKSHA, London, United Kingdom.
• ⁶Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

Abstract

Objectives: We analyzed hepatitis B surface antigen (HBsAg) screening and seropositivity within a network of 419 general practices representative of all regions of England.

Methods: Information was extracted using pseudonymized registration data. Predictors of HBsAg seropositivity were explored in models that considered age, gender, ethnicity, time at the current practice, practice location and associated deprivation index, and presence of nationally endorsed screen indicators including pregnancy, men who have sex with men (MSM), history of injecting drug use (IDU), close HBV contact or imprisonment, and diagnosis of blood-borne or sexually transmitted infections.

Results: Among 6,975,119 individuals, 192,639 (2.8 %) had a screening record, including 3.6-38.6 % of those with a screen indicator, and 8065 (0.12 %) had a seropositive record. The odds of seropositivity were highest in London, in the most deprived neighborhoods, among minority ethnic groups, and in people with screen indicators. Seroprevalence exceeded 1 % in people from high-prevalence countries, MSM, close HBV contacts, and people with a history of IDU or a recorded diagnosis of HIV, HCV, or syphilis. Overall, 1989/8065 (24.7 %) had a recorded referral to specialist hepatitis care.

Conclusions: In England, HBV infection is associated with poverty. There are unrealized opportunities to promote access to diagnosis and care for those affected.