Jhaki Mendoza, MSc

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.