Anti‐Viral Treatment Eligibility and Treatment Uptake Among People With Chronic Hepatitis B in Australia: The REACH ‐B Study

Treatment indication for chronic hepatitis B (CHB) varies across clinical guidelines. This study evaluated treatment eligibility and uptake in a large Australian cohort of people with CHB. The REACH-B study recruited people with CHB managed through a national network of healthcare services. Participants were categorised into three groups: (1) receiving antiviral therapy; (2) untreated despite eligibility; (3) untreated and ineligible. Treatment eligibility was determined using Australian Pharmaceutical Benefits Scheme (PBS) criteria, and by international clinical guidelines. Among 3648 participants (56% male; median age 48 years; 49% born in North-East or South-East Asia; 27% First Nations Australians), 14% were HBeAg positive and 7% had cirrhosis. Overall, 47% (n = 1666) were on antiviral therapy, 45% (n = 1573) were untreated and ineligible and 7% (n = 251) were untreated despite eligibility based on Australian PBS criteria. In adjusted analysis, the likelihood of remaining untreated despite eligibility was higher among women (aOR 1.59, 95% CI 1.34, 1.88) and younger participants (age 41-60 vs. > 60 years: aOR 1.51, 95% CI 1.01-2.28; ≤ 40 vs. > 60 years: aOR 2.65, 95% CI 1.60, 4.40). The proportion untreated despite eligibility increased to 13% when applying 2024 World Health Organisation guidelines and ranged 2%-44% based on other guidelines, highlighting the variability across the guidelines. In conclusion, among REACH-B participants, most eligible individuals receive treatment. Lower treatment uptake among women and younger people despite eligibility partly reflects lower threshold for elevated ALT in women, and clinician determination of non-CHB related ALT elevation. As treatment guidelines evolve and eligibility criteria broaden, monitoring treatment patterns is important.