Press Releases

Union Hospital today released study findings, revealing that only approximately 48% of individuals who tested positive for hepatitis B surface antigen (HBsAg) during health check programs were referred for hepatology specialist follow-up. This highlights a significant gap in the linkage from diagnosis to care for hepatitis B patients in Hong Kong. The study further analyzed factors influencing physicians' referral decisions and identified that individuals with high hepatitis B (HBV) viral load (HBV DNA ≥ 2000 IU/mL) had a 21 times higher referral rate compared to those not tested, demonstrating HBV DNA as the most critical independent factor determining referral.

From Diagnosis to Treatment: Referral is the First and Most Critical Step in Linkage to Care 

A study titled "Evaluation of Factors Influencing Specialist Referral Among Individuals Tested Positive for HBsAg in Health Check Programs in Hong Kong" was conducted by a research team led by Prof. Henry Chan Lik-yuen, Deputy Chief Hospital Manager of Union Hospital and Clinical Professor (Honorary) at the Faculty of Medicine, The Chinese University of Hong Kong. The study analyzed data from individuals who underwent health checks with HBsAg testing at the Union Health Maintenance Centre and Union Healthcheck Centre between 2014 and 2023. Among these, 673 individuals tested positive for HBsAg, yet less than half of these cases were referred for specialist follow-up, a situation falling short of expectations.

Prof. Chan stated, "Referral is the first and most critical step in the cascade of care. If physicians cannot clearly determine which patients need specialist referral at the screening stage, patients may remain in a state of 'HBV diagnosis' without ever entering the treatment pathway. Therefore, we aimed to identify the key factors influencing referral decisions and find ways to improve timely referral rates."

The study found that among the 673 HBsAg-positive individuals, only 31% underwent HBV DNA testing. Of those with viral load ≥ 2000 IU/mL, 93% were referred to specialist care. This rate was significantly higher compared to those with detectable HBV DNA < 2000 IU/mL (58%) and those who did not undergo HBV DNA testing (38%). The study also analyzed other potential factors influencing referral, such as liver enzyme levels and the presence of comorbidities like hypertension and diabetes. Multivariable analysis ultimately confirmed that HBV DNA ≥ 2000 IU/mL was the most significant indicator prompting physicians to refer patients to specialists. 

Union Hospital Implements Reflex HBV DNA Testing to Streamline HBV Referral Process 

Prof. Chan further noted, "The study results clearly demonstrate that relying solely on a positive HBsAg result or traditional liver function tests is insufficient to assist most primary care physicians in making referral decisions. The HBV DNA ≥ 2000 IU/mL threshold is a key indicator recommended by international guidelines for initiating antiviral therapy. It effectively guides referrals, ensuring that patients with high viral load receive timely specialist evaluation."

In response to the study's findings, the Union Health Maintenance Centre and Union Healthcheck Centre have implemented "reflex HBV DNA testing" in their health check programs effective January 1, 2026. This means that for all individuals undergoing health checks who test positive for HBsAg, the laboratory automatically performs HBV DNA testing without requiring an additional blood sample or incurring extra charges. All test results will be provided together to the attending physician and the individual for reference, aiming to enhance the accuracy of referral decisions and improve the linkage from HBV diagnosis to care. 

Public and Private Screening Complement Each Other to Expand HBV Screening Coverage

Liver cancer is the fifth most common cancer and the third leading cause of cancer death in Hong Kong. According to the Department of Health's "Population Health Survey 2020-22", approximately 5.6% of Hong Kong's population has chronic hepatitis B, and 80% of primary liver cancers are attributable to hepatitis B infection. This underscores the critical importance of early screening and treatment for hepatitis B prevention and control.

Currently, the government's "Hepatitis B Co-care Scheme" primarily targets higher-risk groups. Eligible participants are Hong Kong residents born in or before 1988 (i.e., before the universal childhood hepatitis B vaccination was introduced), whose family members or sexual partners are chronic hepatitis B patients, and who have not been previously diagnosed with hepatitis B. This helps identify hidden cases with familial transmission risk. 
 

Advocating Reflex HBV DNA Testing in Health Checks, Aligning with WHO 2030 Hepatitis Elimination Goal 

This research has been published in the Journal of Gastroenterology and Hepatology, an international journal in gastroenterology and hepatology. By sharing these research findings, Union Hospital hopes to advocate for the adoption of "reflex HBV DNA testing" in health check programs across Hong Kong. This aims to improve referral rates and enhance the linkage of hepatitis B prevention, care, and treatment services, actively supporting the Government's "Hong Kong Viral Hepatitis Action Plan 2025–2030" and aligning with the World Health Organization’s (WHO) global goal of eliminating viral hepatitis as a public health threat by 2030, helping Hong Kong progress towards the milestone of hepatitis elimination. 

About Union Hospital 

Established in 1995, Union Hospital is a private hospital located in Tai Wai, Sha Tin. Building on the core values of ‘Caring. Reliable. Empathetic.’, Union Hospital is dedicated to providing easily accessible, personalised and quality healthcare services, earning recognition from multiple local and international accrediting bodies. The Hospital provides a wide range of comprehensive medical services, including family medicine, specialist out-patient clinics, surgery, medical imaging, in-patient hospital care, as well as the first private 24-hour Emergency Medicine Centre in Hong Kong. In 2025, the Hospital officially opened its Extension Block, featuring two floors of semi-private single rooms, a dedicated obstetrics and gynaecologyi in recent years, catering to different medical needs with its high-quality medical care and state-of-the-art facilities. In 2025, the Hospital officially opened its Extension Block, featuring two floors of semi-private single rooms, a dedicated obstetrics and gynaecology floor, a laboratory and a hospital restaurant, among other new facilities.