Adherence to antiviral treatment among people living with chronic hepatitis B: A global survey

Table 1 Survey questions on dimensions of treatment adherence

Q: In order to better understand the medical challenges that you may face as a person living with chronic hepatitis B, please rate the following statements from (not at all challenging, a little bit challenging, somewhat challenging, very challenging, and extremely challenging)	Cost of blood tests and ultrasounds
	Cost of doctor visits every 6 months
	Cost of medication to control my hepatitis B
	Lack of health insurance or a prescription plan
	Finding a doctor who knows how to manage my hepatitis B
	Going for medical check-ups every 6 months
Q: Please rate the following statements from (not at all challenging, a little bit challenging, somewhat challenging, very challenging, and extremely challenging); because of my chronic hepatitis B diagnosis	I feel less productive
	Managing fatigue is a challenge
	I worry that my relationships with family and friends are negatively affected
	I worry that my ability to do my job is negatively affected
	I worry that I will transmit the virus to someone else
	I fear that I will face discrimination (for example, lose my job or not get accepted into a school)
	I fear that I could develop liver cancer
	I fear that I will live a shorter life
	I feel shame
	I feel like avoiding others
	I feel that others avoid me
	I feel life is less enjoyable
	I feel shame
	I feel like avoiding others
	I feel that others avoid me
	I feel life is less enjoyable
Q: What challenges do you face regarding your hepatitis B medication?	Not wanting to take a pill every day because it reminds me of my chronic condition

Table 2 Treatment adherence indices

Affordability (alpha: 0.80)	Cost of blood tests and ultrasounds
	Cost of doctor visits every 6 months
	Cost of medication to control my hepatitis B
	Lack of health insurance or a prescription plan
Service Acceptability (alpha: 0.71)	Finding a doctor who knows how to manage my hepatitis B
	Going for medical check-ups every 6 months
	Individual functioning (physical, psychological, emotional)
Physical (alpha: 0.72)	I feel tired a lot (for example, more tired than other people I know)
	I feel less productive
	Because of my hepatitis B, managing fatigue is a challenge
Psychological (alpha: 0.83)	I worry that my relationships with family and friends are negatively affected
	I worry that my ability to do my job is negatively affected
	I worry that I will transmit the virus to someone else
	I fear that I will face discrimination (for example, lose my job or not get accepted into a school)
	I fear that I could develop liver cancer
	I fear that I will live a shorter life
Emotional (alpha: 0.74)	I feel shame
	I feel like avoiding others
	I feel that others avoid me
	I feel life is less enjoyable
	Not wanting to take a pill every day because it reminds me of my chronic condition

Table 3 Sociodemographic characteristics of survey respondents based on treatment adherence, n (%)¹

Characteristics	Overall	High adherence	Low adherence	P value (χ2)
n	614 (100.0)	496 (80.8)	118 (19.2)
Age (years)				0.099
18-30	180 (29.3)	147 (81.7)	33 (18.3)
31-45	290 (47.2)	225 (77.6)	65 (22.4)
46 and above	144 (23.5)	124 (86.1)	20 (13.9)
Gender				0.58
Male	480 (78.2)	390 (81.3)	90 (18.8)
Female	134 (21.8)	106 (79.1)	28 (20.9)
Ethnicity				0.008
White/Other	109 (17.8)	94 (86.2)	15 (13.8)
African/African American	322 (52.4)	245 (76.1)	77 (23.9)
AANHPI2	183 (29.8)	157 (85.8)	26 (14.2)
WHO region				0.16
Africa	295 (48.5)	231 (78.3)	64 (21.7)
Western Pacific	42 (6.9)	32 (78.2)	10 (23.8)
Southeast Asia	76 (12.5)	67 (88.2)	9 (11.8)
Middle East	34 (5.6)	26 (76.5)	8 (23.5)
Europe	32 (5.3)	29 (90.6)	3 (9.4)
North America/Americas3	129 (21.2)	109 (84.5)	20 (15.5)
Education				0.17
High school or less	64 (10.4)	55 (85.9)	9 (14.1)
Technical/vocational/some college	64 (10.4)	55 (85.9)	9 (14.1)
College graduate	250 (40.7)	192 (76.8)	58 (23.2)
Postgraduate	236 (38.4)	194 (82.2)	42 (17.8)
Lives in a large city				0.42
No	234 (47.4)	183 (78.2)	51 (21.8)
Yes	260 (52.6)	211 (81.2)	49 (18.9)

¹Treatment adherence is defined by participant reports of how often they miss their hepatitis B medication. Missing medication every other day or once a week were categorized as low treatment adherence and missing medications once a month, a few times a year, and never were categorized as high treatment adherence.

²AANHPI (Asian, Asian American, Native Hawaiian, and Pacific Islanders).

³North America and South America combined due to small South American sample size (1% of sample).

WHO: World Health Organization.

Table 4 Survey respondent treatment adherence and healthcare access indices, n (%)

Indices	Overall	High adherence	Low adherence	P value (χ2)
n	614	496	118
Affordability				0.068
Challenging	319 (52.7)	249 (50.9)	70 (60.3)
Not challenging	286 (47.3)	240 (49.1)	46 (39.7)
Service acceptability				0.040
Challenging	270 (44.5)	209 (42.5)	61 (53.0)
Not challenging	337 (55.5)	283 (57.5)	54 (47.0)
Physical functioning				0.002
Challenging	404 (67.3)	312 (64.5)	92 (79.3)
Not challenging	196 (32.7)	172 (35.5)	24 (20.7)
Psychological functioning				0.55
Challenging	229 (38.1)	182 (37.5)	47 (40.5)
Not challenging	372 (61.9)	303 (62.5)	69 (59.5)
Emotional functioning				0.65
Challenging	221 (36.7)	176 (36.2)	45 (38.5)
Not challenging	382 (63.3)	310 (63.8)	72 (61.5)