Gaps and Disparities in the Hepatitis B Cascade of Care Among a National Cohort of U.S. Veterans with Chronic Hepatitis B Infection.

[OBJECTIVE] Timely antiviral therapy in chronic hepatitis B (CHB) significantly reduces risk of cirrhosis, hepatocellular carcinoma, and mortality. Gaps in CHB have been reported, but reasons contributing to these persistently low treatment rates are unclear. We aim to evaluate gaps and disparities in the CHB cascade of care spanning from clinical and laboratory monitoring, assessment of treatment eligibility, and receipt of antiviral therapy.

[METHODS] Adult Veterans with CHB receiving care within Veteran Affairs (VA) healthcare facilities were identified from 1/1/2010-6/30/2024 (with follow-up through 7/30/2025). CHB monitoring (GI/Hepatology clinic visit and ALT and HBV DNA testing), CHB treatment-eligibility, and receipt of CHB treatment were compared between groups using univariable chi-square tests and adjusted multivariable logistic regression models.

[RESULTS] Among 25,845 Veterans with CHB (92.8% men, 7.8% Asian, mean age 57.2 ± 11.9y), 50.2% had >1 GI/Hepatology clinic and 47.8% had >1 ALT and >1 HBV DNA within 12 months in non-cirrhotics. Among patients who became treatment-eligible during median 7.7y of follow-up, 32.3% received CHB treatment. Greater odds of treatment were observed among men, Asians, those with higher FIB-4 scores, and patients who had routine CHB laboratory monitoring and GI/Hepatology specialty clinic follow-up.

[CONCLUSIONS] Less than one-third of Veterans with CHB eligible for treatment received antiviral therapy. A major contributor to gaps in treatment are due to lack of routine laboratory monitoring and GI/Hepatology clinic follow-up. Efforts aimed at improving timely CHB treatment should focus resources to ensure appropriate linkage and retention to specialty care with routine CHB monitoring.