Publications

Authors: R. Sarmiento, A. Amoranto, W. Lim, J. Mendoza, A. Viray, J. Ong

Objectives: This systematic review examines existing liver disease registries, focusing on their structure, data management, quality monitoring, and long-term sustainability. It aims to provide practical recommendations for designing a liver disease registry in low-resource settings, with a focus on enhancing healthcare for liver disease cases in the Philippines. Materials and Methods: We conducted a systematic review for full-text papers published in English across PubMed, Cochrane Library, Web of Science, and Scopus, following PRISMA guidelines. Studies were included if they described a liver disease registry's design, data collection, maintenance, or quality assurance strategies. Key data extracted included registry characteristics, disease scope, governance, and funding sources. Results: We identified 62 liver disease registries across 139 publications. Most (72.6%) focused on a single liver disease, with viral hepatitis (31.5%) and hepatocellular carcinoma (21.6%) being the most commonly documented. Registries were primarily found in high-income countries, with national-level implementation (50.0%) being the most common. Only 33.9% had a designated governing body, and while half of the registries (50%) employed quality monitoring measures, data security practices were often unclear. Registry sustainability was a key challenge, with 46.8% of registries lacked long-term funding plans. Conclusion: Liver disease registries play a crucial role in improving patient care, research, and public health strategies, yet significant gaps remain, particularly in resource-limited settings. Strengthening governance, standardizing data collection, and securing long-term funding are essential for maximizing their impact. The insights from this review will help guide the development of a liver disease registry in the Philippines.

Authors: A. Amoranto, R. Sarmiento, A. Viray, J. Mendoza, J. Ong

Objectives: To achieve expert consensus on the core variables and structure of a liver disease registry relevant to the Philippine context, ensuring alignment with local clinical practice and policy priorities. Materials and Methods: A three-round modified Delphi process was conducted to identify key data elements for six priority liver diseases: Hepatitis B, Hepatitis C, Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), Alcohol-Related Liver Disease (ALD), Liver Cirrhosis, and Hepatocellular Carcinoma. An initial list of 764 variables was developed from local guidelines, policies, and a systematic review of liver disease registries. Fifteen expert panelists - selected based on predefined inclusion criteria such as clinical experience, research, policy involvement, or leadership roles - represented public and private hospitals, professional societies, and registries. Variables were grouped into seven domains and evaluated through three rounds of email questionnaires. Final results were presented and validated in a face-to-face workshop. Results: By the end of Round 3, 551 data elements reached consensus for inclusion. Of these, 257 (46.64%) were categorized as Required and 294 (53.36%) as Optional. The number of variables per disease ranged from 263 (Hepatitis C) to 340 (MASLD), with the majority designated for collection at the initial consult. A common set of 218 variables was identified for collection across all six diseases, and approximately 150 variables per disease were marked as Required. Conclusion: This Delphi study produced a consensus-based, contextually grounded dataset to guide liver disease registry development in the Philippines. The final variable set supports routine clinical documentation, disease surveillance, and future research efforts.

Authors: Martin Louis Fernandez, Hoang Nguyen, Dang Nguyen, Bethany Holt, Duong Doan, Manu Gaspar, Geohari Hamoy, Jhaki Mendoza, Timothy Bill Mercado, Daniel Joy Cabauatan, Huyen Nguyen, My Dang, Vy Nguyen, Janus Ong, Joseph Michael Manlutac, Yen Nguyen, Hoa Nguyen, Dung Vu, Jan Philip Florendo, Danica Delima, Mary Cris Rombaoa, Jose Mateo Dela Cruz, Rosanna Buccahan, Hjordis Marushka Celis, Jeanette Lazatin, Pham Nam Thai, Pham Xuan Truong, Tran Khanh Thu, Thuy Pham, David Duong, Todd Pollack

A mixed-methods health facility assessment evaluating the readiness of primary healthcare systems in Viet Nam and the Philippines to deliver hepatitis B and C services, identifying critical gaps in diagnostics, workforce capacity, treatment access, and health financing.

Authors: Bethany Holt, Jhaki Mendoza, Hoang Nguyen, Duong Doan, Thu Huyen Nguyen, Timothy Bill Mercado, Lam Dam Duy, Martin Fernandez, Manu Gaspar, Geohari Hamoy, Bao Ngoc Le, Boon-Leong Neo, Vy Nguyen, Thuy Pham, Janus Ong, Todd M Pollack, Jae-Ann Sumalo, Pham Thai, David B Duong

BACKGROUND: To ensure that health services are high-quality, trusted and used by the population, their design and improvement should start from the perspective of what matters to people. Patient journey mapping (PJM) is one research method that centers the experiences of individuals living with health conditions and follows their pathways through care and recovery. This paper describes a novel, qualitative PJM methodology used in Vietnam and the Philippines to inform the co-design of a people-centered viral hepatitis screening, care and treatment pathway for individuals living with chronic hepatitis, which is a significant public health concern in the Asia-Pacific region. METHODS: Data collection involved in-depth interviews with a purposive sample of 63 people living with hepatitis (demand-side) and focus group discussions with healthcare providers working in the same geographical areas (supply-side). Rapid deductive qualitative analysis was used to identify typical journeys, and related barriers and enablers. The methodology was implemented over 8 weeks, adapting the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: This paper demonstrates how a PJM methodology that incorporates patient and HCP perspectives can be feasibly implemented in two LMIC contexts, while fulfilling many of the criteria identified by the COREQ guidelines. Sharing such methods and associated instruments may help to enable broader uptake and application in other LMIC settings, providing health systems practitioners with a critical tool to identify and overcome barriers in and promote the delivery of people-centered health services globally. CONCLUSION: Despite limited uptake, especially in resource-limited contexts and at the primary healthcare level, PJM is a novel research method with the potential to make promising contributions to people-centered health service design.

Authors: Naeema Hopkins-Kotb, Jhaki Mendoza, Manu Gaspar, Martin Fernandez, Jae-Ann Sumalo, Timothy Mercado, Jovein Alcantara, Joshua Bartolome, Diana Rose de Silva, Janus P Ong, Todd M Pollack, David B Duong, Bethany Holt

BACKGROUND: Stigma is a key barrier to compassionate primary health care delivery and people-centered care (PCC), but is understudied among primary care providers (PCPs). Hepatitis B and C have a significant burden of disease in the Philippines, where there is limited awareness of and access to screening and treatment. Patient-reported stigma has been identified as a significant barrier to hepatitis care in the Philippines, but PCP stigma-related attitudes and behaviors have not been explored in this context. METHODS: In this study, we assessed primary PCP-reported stigma-related attitudes and behaviors toward patients with hepatitis B and C. We surveyed primary PCPs in Tarlac, Philippines working within a network of healthcare facilities that have been part of an initiative to decentralize hepatitis care to the primary care level and prioritize PCC. RESULTS: We found that PCPs' self-reported attitudes toward patients with hepatitis B and C reflect a strong sense of responsibility to provide care, and comfort with sensitive history-taking, but also pervasive attitudes of pity and blame. PCPs' self-reported behaviors showed commitment to providing equal care, but variation in infection control practices suggesting misconceptions about transmission risk. CONCLUSIONS: Our results provide essential insight into PCPs' stigma-related attitudes and behaviors that will serve as a baseline for future comparison with patient-reported experiences. These findings underscore the critical role of primary care in addressing stigma and improving hepatitis care in the Philippines, highlighting the importance of training, resource allocation, and people-centered care strategies.

Authors: Bethany Holt, Jhaki Mendoza, Hoang Nguyen, Duong Doan, Vy H Nguyen, Daniel Joy Cabauatan, Lam Dam Duy, Martin Fernandez, Manu Gaspar, Geohari Hamoy, Joseph Michael D Manlutac, Sinit Mehtsun, Timothy Bill Mercado, Boon-Leong Neo, Bao Ngoc Le, Hoa Nguyen, Huyen Thu Nguyen, Yen Nguyen, Thuy Pham, Todd Pollack, Mary Cris Rombaoa, Pham Thai, Tran Khanh Thu, Pham Xuan Truong, Dung Vu, Janus Ong, David Duong

In Vietnam and the Philippines, viral hepatitis is the leading cause of cirrhosis and liver cancer. This study aims to understand the barriers and enablers of people receiving care for hepatitis B and C to support both countries' efforts to eliminate viral hepatitis as a public health threat by 2030. Retrospective, semi-structured interviews were conducted with a purposive, quota-based sample of 63 people living with hepatitis B or C in one province of Vietnam and one region of the Philippines. A rapid deductive approach to thematic analysis produced key findings among the three phases of care: (1) pre-awareness and testing, (2) linkage and treatment initiation and (3) ongoing treatment and recovery. The research found that participants followed five typical journeys, from a variety of entry points. Barriers during the pre-awareness and testing phase included limited awareness about hepatitis and its management, stigma and psychological impacts. Enablers included being familiar with the health system and/or patients benefiting from social connections within the health systems. During the linkage and treatment initiation phase, barriers included difficult physical access, complex navigation and inadequate counselling. In this phase, family support emerged as a critical enabler. During the ongoing treatment and recovery phase, the cost of care and socially and culturally informed perceptions of the disease and medication use were both barriers and enablers. Exploring peoples' journeys with hepatitis B and C in Vietnam and the Philippines revealed many similarities despite the different cultural and health system contexts. Insights from this study may help generate a contextualized, people-centred evidence base to inform the design and improvement of primary care services for hepatitis in both research sites.

Authors: Bethany Holt, Martin Fernandez, Dang Nguyen, Danica Delima, Lam Dam Duy, Manu Gaspar, Geohari Hamoy, Bao Ngoc Le, Jan Llevado, Joseph Michael D Manlutac, Jhaki Mendoza, Timothy Mercado, Hoang Nguyen, Huyen Thu Nguyen, Janus Ong, Mary Cris Rombaoa, Jan Florendo, Jose Mateo Dela Cruz, Thuy Pham, Pham Nam Thai, Pham Xuan Truong, Todd Pollack, David Duong

Chronic viral hepatitis is a significant public health concern in the Western Pacific, including in Vietnam and the Philippines. To accelerate progress toward meeting the 2030 elimination goals, the World Health Organization (WHO) encourages countries to adopt an integrated, people-centered health sector response to hepatitis, grounded in Primary Health Care (PHC). A review of the academic and grey literature, along with policy documents, was conducted to describe the national health system and PHC response to hepatitis B and C in Vietnam and the Philippines. Information was analyzed against the four strategic levers of the WHO Operational Framework for PHC to identify challenges and opportunities. The findings suggest that both countries have relatively robust policy frameworks, with some room for improvement. Vietnam may have stronger political commitment and funding than the Philippines, while the Philippines appears to be stronger in community engagement. Both countries share challenges and opportunities for learning to actualize viral hepatitis elimination utilizing a PHC approach.