HBV Knowledge, Stigma Impact Medication Adherence in High-Risk Patients

Hee-Soon Juon, MSN, PhD

Credit: Thomas Jefferson University

Findings from a recent study suggest both individual and healthcare factors play a critical role in influencing medication adherence among Korean American patients living with chronic hepatitis B virus (HBV) in the United States, a high-risk group known to be disproportionately affected by HBV.¹

Leveraging data for Korean American patients with chronic HBV seen at Thomas Jefferson University Hospital and the Asian Pacific Liver Center, the study found younger patients and those with low knowledge of HBV sequelae and high perceived HBV stigma may require targeted educational interventions to improve antiviral medication adherence.¹

According to the World Health Organization (WHO), an estimated 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections occurring each year.² Updated HBV guidelines released in 2024 expanded treatment eligibility to include a larger proportion of HBV-infected individuals.³

Given these broadened treatment recommendations, addressing medication adherence is crucial, especially for patients who are of Asian, Pacific Islander, or African descent, as these individuals comprise more than 50% of the population living with chronic hepatitis B in the US.⁴

“Given the critical role of medication adherence in improving CHB patient outcomes, it is crucial to identify the underlying factors that contribute to medication adherence in Asian American Communities,” Hee-Soon Juon, MSN, PhD, a professor in the department of medical oncology at Thomas Jefferson University, and colleagues wrote.¹ “There is limited research specifically examining medication adherence factors for CHB in Asian American populations, particularly the Korean American community.”

To explore the psychosocial and clinical factors affecting medication adherence in Korean American patients with chronic hepatitis B, investigators recruited a cohort of 365 patients from 2 clinics in Philadelphia and Los Angeles: Thomas Jefferson University Hospital and the Asian Pacific Liver Center.¹

Participants completed baseline surveys from August 2022 to January 2023. Their adherence to medication was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8), with higher scores indicating better adherence. Investigators additionally considered patient factors, including age; gender; knowledge of HBV transmission; sequelae of CHB and perceived HBV stigma; and social support, sociodemographic factors including education, and healthcare system factors as measured by possession of a pharmacy plan.¹

Among the study cohort (n = 365), the average age was 60 (range, 19–84; standard deviation [SD], 10.7) years and the majority of patients were male (56%), born in South Korea (97%), and had some form of health insurance (92%).¹

After medical chart review, investigators noted 283 (78%) study participants were on HBV medication, the most common being tenofovir alafenamide (32.5%) and tenofovir disoproxil fumarate (30.4%). The majority (69%) of participants on antiviral medication reported medium to high adherence levels, as indicated by an MMAS-8 score of 6–8.¹

In the multivariable logistic regression analysis, age, knowledge of sequelae of CHB, perceived HBV stigma, and possession of a pharmacy plan were significantly associated with medication adherence (all P <.05).¹

Specifically, older participants had higher medication adherence than younger participants (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01–1.07). Additionally, those with high knowledge of chronic HBV sequelae were more likely to have medication adherence than those with low scores (aOR, 2.04; 95% CI, 1.11–3.78).¹

Investigators pointed out participants with medium perceived HBV stigma had lower medication adherence than those with low stigma (aOR, 0.47; 95% CI, 0.24–0.91). They also noted participants with pharmacy plans were more likely to adhere to antiviral therapy (aOR, 1.94; 95% CI, 1.01–3.74).¹

“These results suggest that culturally tailored educational interventions that address personal—and healthcare system—factors are essential for improving medication adherence among Korean Americans living with CHB in the United States,” investigators concluded.¹ “Improving patient awareness through educational intervention, medication management, and patient navigation may promote better antiviral medication adherence, especially among younger patients and those with low knowledge of HBV sequelae and high perceived HBV stigma."

References

1. ^{Juon HS, Yang D, Fang CX, et al. Perceived HBV-Related Stigma Is Associated With Lower Antiviral Medication Adherence in Patients With Chronic Hepatitis B. J Viral Hepat. doi:10.1111/jvh.70010.}

2. ^{World Health Organization. Hepatitis B. April 9, 2024. Accessed February 17, 2025. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b}

3. ^{Brooks A. WHO Releases New Hepatitis B Guidelines. HCPLive. April 5, 2024. Accessed February 17, 2025. https://www.hcplive.com/view/who-releases-new-hepatitis-b-guidelines}

4. ^{Hepatitis B Foundation. Hepatitis B Facts and Figures. Accessed February 17, 2025. https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/facts-and-figures/}