Hepatitis B
Olivia C. Welter, PharmD
Over the past several years, public health care partners in the United States have taken action to combat hepatitis B virus (HBV) infection. Pharmacists have various opportunities to participate in HBV prevention and identification due to updated recommendations on screening and vaccination by federal regulatory bodies.
Screening and risk assessment
HBV risk assessment recommendations have historically been a major barrier in diagnosing HBV infection. Published guidelines previously directed clinicians to perform a risk-based screening, which means that only patients deemed at increased risk for HBV infection received screening. According to an article by Garofoli published in the September/October 2024 issue of JAPhA, this approach often failed to identify many individuals with hepatitis B infection. Stigma related to reporting symptoms and risk factors, minimal or ambiguous symptom presentation, and assessment burden for clinicians have all been challenges in properly screening for HBV.
In 2023, CDC introduced universal screening recommendations for HBV. Instead of only screening for HBV if risk factors are present, CDC now recommends every adult should receive HBV screening at least once in their lifetime.
The screening process uses three laboratory tests which detect serologic markers used to determine HBV infection status. These tests include hepatitis B surface antigen, antibody to hepatitis B surface antigen, and antibody to hepatitis B core antigen.
Pharmacists can conduct HBV screenings at their practice site in some jurisdictions. A systematic review by Hayes and colleagues published in eClinicalMedicine in the March 2024 issue found that community pharmacies are an important and acceptable setting for viral hepatitis testing. The authors’ findings also indicate that pharmacies are high-uptake locations for patients seeking viral hepatitis testing.
Pharmacists interested in offering HBV screening can review their state’s laws and rules related to pharmacist scope of practice and collaborative pharmacy practice to determine whether they are permitted to implement a screening service.
Strategies for vaccination
In 2022, ACIP released updated recommendations for HBV vaccination in adult populations. The recommendations include universal HBV vaccination for any patient aged 19 years or older regardless of risk factors present. This is in addition to other populations for whom HBV vaccination was already recommended by ACIP, including all infants and persons younger than 19 years. ACIP notes that the new recommendations are intended to direct clinicians to proactively offer HBV vaccines to patients rather than waiting for a patient to request the vaccine.
Although patients may feel hesitant about receiving the HBV vaccination series, Garofoli notes in her her JAPhA publication that pharmacists can combat vaccine hesitancy by leaning into the benefits of the HBV vaccine. Specifically, Garofoli suggests educating patients on HBV being the leading risk factor for liver cancer and emphasizing that the HBV vaccine can help prevent liver cancer from developing.
In addition to explaining the health benefits of the HBV vaccine, pharmacists can help patients evaluate how much the HBV vaccination series may cost. The HBV vaccine is covered under Medicare parts B and D, making it available at no cost for most Medicare beneficiaries at in-network pharmacies. For younger patients using private insurance, pharmacists can counsel on the benefit of the HBV vaccine compared to the cost. In some cases, there may be no copay for private insurance patients receiving the HBV vaccine at their pharmacy.
Viral hepatitis elimination
Both nationally and internationally, public health care partners have a shared goal to eliminate viral hepatitis as a public health threat by 2030. Specifically, WHO has a global hepatitis strategy that all 194 WHO member states have signed onto. The CDC Division of Viral Hepatitis recognized this strategy in their 2020–2025 strategic plan while noting that U.S. hepatitis B cases continue to rise.
Pharmacy teams have a unique opportunity as accessible health care providers to help work toward this goal. Pharmacies interested in participating in HBV vaccination or screening services can access WHO resources, such as their operational guide for priorities in planning person-centered hepatitis B and C testing services, to direct program initiation. ■