Methods: We conducted a mixed methods study composed of: 1) HBV-infected veterans followed at the Philadelphia VA Medical Center from 2003-2014; and 2) focus group discussions with primary care, infectious disease (ID) and gastroenterology (GI) providers to explore HCC screening practices and identify strategies to improve surveillance rates. Medical records were reviewed to assess adherence to HCC screening (≥1 abdominal ultrasound/year) and identify HCC cases. Focus groups were held with providers from different specialties (2 primary care; 1 ID; 1 GI) to evaluate if knowledge or logistical challenges were contributors to low HCC screening rates.
Results: 201 HBV-infected patients were identified, of whom 40 (20%), 114 (57%) and 47 (23%) were seen by primary care, GI and ID, respectively, with a median follow-up of 7.5 years. Among those at high risk for HCC (n=99), including those with older age, cirrhosis, or abnormal liver function tests, 15% had ≥1 annual abdomen ultrasound, with no differences in adherence rates by provider group. In the focus groups, we identified barriers to HCC screening that varied among the specialties. Despite awareness of HCC screening guidelines for HBV-infected patients, primary care and ID providers expressed a lack of confidence in the benefit of HCC screening for these patients, thus prioritizing it below other preventive efforts. In contrast, GI providers identified logistical barriers as the main driver of low screening rates.
Conclusion: HCC screening rates were low among all 3 provider groups. However, different explanations for poor adherence were identified among provider groups that warrant tailored interventions to improve screening rates. Potential strategies include highlighting the survival benefit of HCC surveillance in HBV-infected patients.
A. Maier, None
D. Kaplan, None
K. M. Chang, None
V. Lo Re III, None
V. Amorosa, None