Alex Stockdale

There’s a problem with the first chart- the UK’s GDP looks to be less than Russia’s (width of bars) whereas the reverse is true.

@livuninews.bsky.social @livuni-ives.bsky.social

Completely agree. Our review earlier this year in Lancet Gastro Hep also showed low rates of retention in care for HBV across multiple settings. We have a lot to learn from HIV.

Great to collaborate with colleagues in Ethiopia. A decentralised HBV programme achieved some good on-treatment results but half of patients lost to follow up. We need to work out how to better engage and retain patients in care. #idsky #hepsky

www.thelancet.com/journals/lan...

Published today. We found that hepatitis B was the leading cause of cirrhosis and HCC in southern Malawi. HCC is diagnosed at a very late stage. Huge opportunity to prevent liver-related death with community hepatitis B test and treat programmes. #hepsky #idsky

www.thelancet.com/journals/lan...

Hepatitis B care must be overhauled to meet WHO 2030 elimination targets

news.liverpool.ac.uk/2025/08/19/g...

Denial, anger, bargaining, depression and acceptance?

@worldhepalliance.bsky.social

8/ HBV antiviral treatment prevents HCC and improves survival- and is cheap and effective. We need urgent improvements to our service delivery to address a leading cause of liver related death globally.

7/ our care cascade shows huge losses at every step of patient care and we need to learn how to do it better- learning from HIV care. Implementation research, better training and equipping of primary or decentralised care is needed to promote access to care

6/ some innovative community models linked to dedicated research clinics had very good rates of assessment and treatment initiation but the long term outcomes are lacking.

5/ really serious losses observed in linking pregnant women to HBV care after delivery- 56·9% (40·2–72·1; I2=98·8%) linked to care (five cohorts) and when community screening led to self-directed care (without follow up arrangements) 33·2% (23·1–45·1; I2=98·6%)

4/ retention in care is a real problem and especially among patients not started on antiviral treatment - RR 1·72 [95% CI 1·16–2·54]; p=0·019 for retention in care for those on AVT vs not

3/ 12% don’t commence antiviral therapy when eligible, again it is worse in primary or co-managed care

2/ over 15% don’t complete an assessment of their treatment eligibility in specialist care and it is worse in co-managed and primary care.

Service delivery models and care cascade outcomes for people living with chronic hepatitis B: a global systematic review and meta-analysis Considerable attrition was seen across the chronic hepatitis B care cascade, with low rates of retention especially in patients not on antiviral therapy. Assessment for treatment eligibility and initi...

Our review just published in Lancet Gastro Hepatology. We looked at outcomes across the care cascade for people living with hepatitis B and found some serious gaps in care provision. We need to do better #hepsky #idsky #liversky. www.thelancet.com/journals/lan...

Never let excel get anywhere near dates! It’s a menace

Summarise Continuous and Categorical Variables, Check for Duplicates and Missing Data The sumvar package quickly explores continuous and categorical variables. sumvar aims to bring the ease and simplicity of the "sum" and "tab" functions from stata, to R.

Introducing sumvar for R. A package to rapidly summarise and visualise variables with one-line commands, bringing the brilliant tab and sum functions from stata, to R. Install it from cran using install.packages(“sumvar”). #rstats

alstockdale.github.io/sumvar/

They did emphasise shared decision making which is a great idea

Much clearer, simpler and easier to implement in practice. A job well done

But for HBeAg positive young people, no recommendation for treatment, given a lack of strong evidence of benefit

Elevated ALT and HBV DNA >2000, or LSM>8kPa and detectable HBV DNA are the main criteria, liberalising treatment thresholds.

A packed conference room to hear about the new HBV treatment guidelines from #EASL2025

What are the three platforms?

Demonise and Oppress Government Employees

7. Presently the birth dose vaccination coverage in the WHO African region is just 18%. We aim to assess in The Gambia and Malawi the effectiveness, cost-effectiveness, feasibility and safety if tenofovir alone is enough, in settings with low birth dose coverage, in our study starting this year.

6. With enough coverage of birth dose vaccination and maternal antiviral prophylaxis we estimate the we could reduce vertical transmission to <0.1%, achieving the WHO elimination targets. The question is- is tenofovir alone effective when birth dose vaccination coverage is low?

5. We’ll also need antiviral prophylaxis with tenofovir- cheap, effective and safe in pregnancy- for women with high viral loads (>200,000 IU/ml). The challenge is access to viral load testing. New WHO guidelines recommend a treat-all policy in pregnancy when viral load testing is unavailable.

4. Vaccine coverage is an important part of the solution but it’s not enough- data from Cameroon show that even with timely birth dose, over 30% women with high viral loads continue to experience vertical transmission.

3. We found a depressingly slow reduction in vertical transmission events, from a peak of 339,000 (149,000- 634,000) in 2001 to 172,000 (82,000-383,000) in 2022. That’s still 0.4% of live births having hep B vertical transmission almost 40 years after development of an effective vaccine.