BEAT-B Study (Behavior, Aspirations, and Treatment Needs): A Mixed-Methods Study of Patient Values, Preferences, and Barriers to Care Among People Living With Chronic Hepatitis B in South and Southeast Asia

Background: Chronic hepatitis B (HBV) infections have significant challenges in treatment uptake and adherence due to sociocultural barriers, healthcare system inefficiencies, and economic constraints. The evidence to decision framework highlights the importance of understanding patient values and preferences to align evidence-based policies with the “treat all” approach. Methods: This mixed-methods study included a cross-sectional survey in five South Asian countries and qualitative data collection through focus group discussions and interviews. Qualitative data explored patient perceptions, barriers, and facilitators in the care continuum, employing thematic analysis. Quantitative data analyzed demographic, socioeconomic, and clinical determinants of treatment uptake and adherence. Findings: Qualitative analysis identified key themes, such as the psychological burden of living with HBV, the aspiration for treatment to protect loved ones, and the critical role of clear guidance and social support in facilitating care. Quantitative findings revealed that higher education levels (OR: 2.0; 95% CI: 1.3–3.1), family support (OR: 1.9; 95% CI: 1.3–2.8), and urban residence (OR: 1.7; 95% CI: 1.1–2.5) were significant predictors of treatment uptake. A significant gap in the knowledge and understanding of the chronic nature of HBV among patients, with only 20.5% recognizing it as a long-term condition and need for family counseling, was noted. Interpretation: These findings highlight the importance of incorporating patient values and lived experiences into HBV care models and policy development. Simplified care pathways, strengthened counseling, enhanced family engagement, and improved affordability may help address barriers to treatment uptake and retention in care.