Low adherence of guideline-based monitoring among chronic hepatitis B patients: a mixed quantitative and qualitative study

Abstract

Introduction: Adherence to guideline-based monitoring (GBM) for chronic hepatitis B (CHB) in China remains understudied. This mixed-methods study assessed GBM adherence and explored patient-reported barriers.

Methodology: A mixed study was conducted at the Zhongshan Hospital (Xiamen), Fudan University, China. Patients visiting the outpatient department of the hospital between January 2018 and December 2018 were included for the quantitative component. Clinical and biochemical data were retrieved from the hospital's electronic medical record system. Adherence to GBM was defined as regular monitoring of alanine aminotransferase (ALT), hepatitis B virus DNA (HBV-DNA), alpha-fetoprotein (AFP), and liver imaging; at least annually during the 2-year follow-up period. The qualitative component involved semi-structured interviews with thematic and content analysis.

Results: Among the 402 eligible CHB outpatients, only 103 (25.6%) patients presented good adherence to GBM. Specifically, 171 (42.5%) patients were monitored at least annually for ALT and HBV-DNA, while 107 (26.6%) were monitored for AFP and liver imaging. The factors associated with adherence to GBM included receiving antiviral treatment (OR = 3.54 (1.59–7.86)) and completing initial liver imaging (OR = 4.78 (2.04–9.83)). The reasons for non-adherence included inadequate monitoring tests and health education by healthcare providers, patients' perception of not needing frequent monitoring, forgetfulness, cost concerns, and complex hospital visit procedures.

Conclusions: Adherence to GBM among CHB patients was suboptimal despite guideline recommendations. Enhanced efforts and interventions, such as combining technology-driven tools, targeted education for providers and patients, and primary care integration are essential.