Low liver disease screening and treatment rates in Mongolia: results from a physician survey

Abstract

BACKGROUND: According to Globocan, Mongolia has the highest worldwide HCC incidence (78.1/100,000, 3.59 higher than China). It is unclear if screening and linkage to care for HBV, HCV, HDV, and HCC have been optimal. Our goal was to evaluate these screening rates, antiviral therapy utilization and barriers to care in Mongolia. METHODS: We conducted an anonymous survey of physicians from all major provinces who attended a 2-day CME liver symposium in Ulaanbaatar analyzing their demography, practice setting/patterns, perceptions, and proposed solutions. RESULTS: A total of 70–95 out of 121 (58–79 %) physician attendees responded to each question. Most were female (87 %), age50 (79 %), sub-specialists (76 %) and practiced in urban vs. rural areas (61 vs. 39 %). Most ([80 %) noted that50 % who need hepatitis or HCC screening receive it. The main perceived barriers to screening were inability to pay for diagnostic tests, lack of guidelines, and poor patient awareness (Figure 1). The major HCC screening barrier was also cost (37 %). Hepatitis treatment rates were low; 83 % treated HCV in10 patients in the past year and 86 % treated HBV in10 patients/month. Treatment barriers were multifactorial with medication cost as a principal barrier. Top proposed solutions were universal screening policies (46 %), removal of financial barriers (28 %), and provider education (20 %). CONCLUSIONS: Physicians from all major regions of Mongolia noted low screening for viral hepatitis (50 %) and even lower treatment rates ([80 % treated10 patients/year for HCV10 patients/month for HBV), and the need to remove financial barriers and increase educational efforts.