Abstract Background/Aims Patients with chronic or resolved hepatitis B virus (HBV) infection receiving immunosuppressive therapy risk reactivation, especially with B-cell-depleting agents, with rates exceeding 10% without antiviral prophylaxis. Rheumatologists usually rely on hepatology-led monitoring, leading to fragmented care. We developed a distinct rheumatology-led hepatitis B monitoring clinic (RHBC) to improve monitoring and evaluated safety, effectiveness, and patient acceptability. Methods Trust HBV monitoring guidelines reflecting national guidance were used to identify patients requiring monitoring. We retrospectively evaluated 96 rheumatology patients with positive HBV receiving immunosuppressive therapy and compared 12-month periods before and after implementation of the rheumatology CNS and rheumatology biologics coordinator-led RHBC. The clinic monitored HBV DNA and liver function testing six-monthly, reviewed prescriptions, and contacted patients to ensure they were informed of results. Data were collected on review frequency, monitoring adherence, treatment gaps, missed appointments (DNAs), and reactivation events. Patient experience was assessed using a satisfaction survey. Results Following RHBC implementation, six-monthly HBV blood monitoring improved from 44% (29/66) to 71% (49/69), demonstrating enhanced surveillance adherence. Treatment gaps decreased from 44% (27/62) to 26% (15/58), reflecting better continuity. HBV reactivation reduced from 2% (1/66) to none post-intervention; the single pre-intervention occurrence was in a patient on methotrexate. The proportion reviewed at least every six months remained similar (48% vs 43%), as did DNAs (21% vs 28%). Treatment distribution by drug class is summarised in Table 1.Survey findings completed by 39 patients were very positive: 70% preferred rheumatology-based HBV monitoring, 78% agreed the integrated model saved time and reduced appointments, and 66% reported receiving regular HBV tests. However, 56% were unsure who to contact for HBV-related issues, indicating a need for clearer communication. Conclusion The RHBC model proved safe, effective, and patient-centred, reducing treatment gaps and reactivation risk while maintaining review frequency. Patients valued the integrated model for convenience and coordinated care. Challenges included documentation consistency and role clarity, prompting the introduction of HBV education materials and drug-specific information sheets. Despite single-centre and survey-response limitations, RHBC supports WHO (2022-2030) and UKHSA HBV-elimination goals, offering a model to enhance viral monitoring and reduce fragmented care in immunosuppressed Rheumatology populations. Disclosure G. Sukhija: None. N. Heyer: None. D. Hill: None. A. Kaul: None.
Sukhija et al. (2026) studied this question.