ArticleFrontiers in health services2026
Healthcare system complexity of hepatitis B and C related liver disease: service mapping in New South Wales, Australia.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Early detection and treatment of hepatitis B and C virus (HBV/HCV) infection, along with regular monitoring for hepatocellular carcinoma (HCC), are critical strategies for improving health outcomes and reducing disease burden. An integrated care pathway should encompass person-centred approaches to prevention, diagnosis, treatment, and surveillance for HCC. Despite global efforts in hepatitis control, how hepatitis and liver cancer services connect at a population level remains unclear. Methods: Semi-structured interviews were conducted with 42 public health staff, nurses, and medical specialists (February 2023 to December 2024). Participants represented hepatitis and hepatology/gastroenterology clinical services across all 15 Local Health Districts in New South Wales (NSW), Australia. Inductive thematic analysis explored perceptions of service integration and person-centred care for hepatitis and HCC. A service mapping exercise was conducted to explore the population-level landscape of hepatitis-HCC service delivery, identifying key stakeholders, resources, care pathways, and models of care. Results: The study identified nine strategic/system-level stakeholders, including HIV and Related Program units, Public Health Units, Specialist Liver Services, primary care and community services. Participants described hepatitis-HCC care journeys and pathways that were adapted to varied local level contexts, populations and resources. Three dominant service models emerged: (1) rural service model, (2) integrated care model, (3) integrated multidisciplinary partnership model. Despite fragmented pathways, complex care needs, and ongoing resource constraints, notable innovations were described, including nurse-led outreach clinics in the community, and multidisciplinary liver cancer teams offering tele-mentoring to rural clinicians. Five interrelated system-level challenges emerged: (1) inadequate and insecure workforce, (2) fragmented care pathways, (3) misaligned funding, (4) inconsistent data and information systems, and (5) stigma and limited community awareness. Conclusions: This is the first jurisdiction-wide mapping of hepatitis-HCC service pathways in NSW. The findings offer actionable insights to strengthen service integration, promote person-centred care continuity, and inform strategic planning for hepatitis and liver cancer services. Supporting these efforts can transform isolated innovations into cohesive, equitable liver health services, accelerating progress toward World Health Organization's hepatitis elimination targets and serving as a scalable model for integrated liver care globally.
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