Impact of a multilevel hospital intervention on hepatitis screening and risk management in neuroinflammatory patients receiving immune therapy.

BACKGROUND

Patients with neuroinflammatory disorders receiving immune therapy are at risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivation, particularly in endemic regions. However, adherence to recommended hepatitis screening prior to immune therapy remains inconsistent in neurological practice. This study evaluated whether a hospital-based intervention could improve hepatitis screening and risk management in this population.

METHODS

We conducted a retrospective-prospective cohort study in the neurology departments of a tertiary medical center and a regional hospital in Taiwan. The intervention included clinician education, electronic medical record-based screening alerts, and periodic feedback on screening adherence. Screening uptake, screening timeliness, and clinical management actions were compared between pre-intervention (December 2018-May 2021) and post-intervention (June 2021-November 2023) cohorts.

RESULTS

A total of 344 patients receiving immune therapy for neuroinflammatory disorders were included. Pre-immune therapy screening rates improved significantly after the intervention for HBsAg (37.1% to 63.3%), anti-HBc (10.1% to 31.8%), and anti-HCV (34.3% to 59.8%) (all p < 0.001). Overall screening rates, including in-therapy testing, also increased substantially. Time-to-screening analysis demonstrated shorter delays for in-therapy screening after the intervention. Clinical responses following HBV identification-including HBV DNA testing, hepatology referral, and antiviral prophylaxis-were significantly more frequent in the post-intervention period. Improved screening also revealed previously unrecognized HBV carriage and reactivation events.

CONCLUSIONS

A structured hospital-based intervention integrating clinician education, electronic reminders, and feedback significantly improved hepatitis screening and downstream clinical management in neuroinflammatory patients receiving immune therapy. These findings support incorporating systematic hepatitis risk assessment into neurological care in HBV/HCV-endemic regions.