Development of an intervention system for linkage-to-care and follow-up for hepatitis B and C virus carriers

Minami Kikuchi, Motoji Sawabe, Haruyo Aoyagi, Kosho Wakae, Koichi Watashi, Satoru Hattori, Naoto Kawabe, Kentaro Yoshioka, Junko Tanaka, Masamichi Muramatsu, Takaji Wakita, Hideki Aizaki

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Poor connections in the cascade of viral hepatitis care have been discussed around the world. In 2011 in Japan, 500,000 to 1.25 million hepatitis B and C virus carriers needed to consult with hepatologists, so linkage-to-care (LTC) needs to be promoted. Therefore, in this study, to improve LTC and care-seeking behaviors, we attempted to establish a community-based intervention system and evaluate its effectiveness by analyzing behavior modifications. Methods: In a model city, Okazaki (population: 387,887 as of 2019), LTC was encouraged among HBV and HCV carriers by annually mailed brochures, and their care-seeking behaviors were followed up through questionnaires for 8 years (2012–2019). Their behavior modifications and demographic characteristics were analyzed anonymously in cooperation with community health workers, hepatologists, and researchers. Results: Through regional HBsAg and anti-HCV screening, 333 HBV and 208 HCV carriers were identified. Before the intervention, only 34.7% (25/72) of HBV- and 34.3% (24/70) of HCV-positive individuals had consulted with hepatologists. However, in 2019, after the intervention, these proportions increased to 79.8% (91/114) and 91.2% (52/57), respectively. Access to outpatient care and treatment uptake also continuously improved. However, individuals over 70 years of age were significantly less likely to engage in care-seeking behaviors (p < 0.05), and significantly fewer HCV-positive females received treatment (p = 0.03). Conclusions: A paper-based reiterative intervention encouraging LTC and follow-up successfully improved the care-seeking behaviors of hepatitis virus-positive individuals and enabled their behavior modifications to be monitored. Further trials are required to advance the system by age- and gender-specific interventions. Graphical Abstract: [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)68-80
Number of pages13
JournalHepatology International
Issue number1
Publication statusPublished - 02-2022

All Science Journal Classification (ASJC) codes

  • Hepatology


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