Treatment adherence is a cornerstone of the successful management of patients with chronic hepatitis B (CHB),1 yet it proves challenging for patients and providers alike.

Mimi Chang, MSN, FNP

“Everyone reacts differently when they find out they have CHB. Some are very sad, upset, and most of them feel embarrassed, so it’s very different reactions that I get from patients. You have to approach each patient differently,” said Mimi Chang, MSN, FNP, a nurse practitioner at the Asian Pacific Liver Center, St. Vincent Medical Center in Los Angeles, California. Because of the stigma surrounding CHB within the Asian population, Ms. Chang must customize her approach when interacting with Asian patients. “We try to educate them on how they get it. Usually Asians [contract hepatitis B virus] at birth from their mother or when they’re young, so we explain that they don’t need to feel ashamed because there’s a lot of misconceptions [within the Asian community] that bad behavior causes hepatitis B infection,” she added.

Apps for Treatment Adherence*
App Features Compatible
Mango Health Medication reminders; ability to earn points each day when you take medications properly and on time; points may be redeemed for Mango Gifts (eg, gift cards from stores, charitable donations) iPhone, iPod touch, and iPad
RxmindMe Features 9 different types of reminders (eg, daily, hourly, weekly, etc.); automatic prescription quantity tracker; historical tracking of prescriptions taken iPhone, iPod touch, and iPad (requires iOS 4.0 or later)
PillManager Medication alerts and reminders; automatic refill reminders; connect to personal pharmacy to refill medications iPhone (3GS, 4, 4S, 5), iPod touch (third to fifth generation), iPad (requires iOS 4.3 or later)
* Health care providers may recommend these free apps to patients to support treatment adherence.

After explaining CHB and its common routes of transmission, Ms. Chang discusses an action plan with patients for monitoring and managing their CHB infection. She recommends that patients follow up 2 to 3 times a year, which she finds to be a feasible schedule for patients to follow. She also involves patients in their care and shares lab reports to encourage open discussions.

However, Ms. Chang has encountered patients who have stopped taking their prescribed medication once they have achieved an undetectable viral load and normal liver function. “We don’t start medication until this person commits to taking it as prescribed … but if patients do stop taking their medication, we show them the lab reports and explain ‘You have a detectable viral load and the virus is coming back, and this isn’t good because now not only is the virus coming back, but the virus may mutate. So the same medication won’t work as well, and this is why we don’t want you to stop your medication.’ And that really works,” she said.

Ms. Chang also believes in encouraging a family member or close friend to join in the therapeutic alliance. “For someone who does not understand the language, the disease, or the treatment, we include a family member who can understand and explain it to the patient, especially someone living with that patient. Support is very important for someone who doesn’t really understand,” she added.

Another obstacle to optimal treatment adherence is forgetfulness. Ms. Chang says it is natural for patients to sometimes forget to take their therapy, so she recommends different resources in order for patients to better manage their treatment. “We give out pillboxes and encourage patients to fill the [7-day] medication boxes every week, so they know if they took the medication or not, which really helps. We also give out a tiny pillbox that can be attached to a key chain so patients can carry an extra 1 or 2 pills, and they can take medication on the run if they forget to take it at their house. We try everything,” she explained.

Discussing outcomes with patients can be a complex challenge. “Ultimately, you have to let patients know that CHB is easily managed, and if they need a treatment, there’s very safe and effective medication available. We need to tell them how effective treatment can be,” Ms. Chang said.

Ms. Chang also discusses the importance of lifestyle modifications with patients, such as abstinence from alcohol. “I explain that alcohol will cause a lot of stress on their liver and, because they have CHB, they don’t want to put another stress on the liver, so they need to avoid alcohol. I explain that anything good for their body will be good for their liver, so healthy food and exercise will be good for their liver,” she said.

Although imparting the importance of treatment adherence to patients with CHB can be challenging, it is vital for quality outcomes. Through education and engaging a third party in the therapeutic alliance, this goal becomes more attainable. Creating an open dialogue with patients about their diagnosis and fostering realistic expectations regarding treatment outcomes also improves medication adherence.

“Listen to patients. Everyone has different perceptions and concerns, so we have to be culturally sensitive,” said Ms. Chang.


1. Giang L, Selinger CP, Lee AU. Evaluation of adherence to oral antiviral hepatitis B treatment using structured questionnaire. World J Hepatol. 2012;4(2):43-49.

Pointers for Clinicians
Educate patients on CHB Explain that CHB can be managed, and treatment is available
Involve patients in their care Share lab reports and make patients active partners in treatment
Encourage a therapeutic alliance Enlist help from patients’ family or friends who can offer support
Engage in an open dialogue Actively listen to patients’ concerns and questions, and discuss the importance of adherence
Based on a conversation with Mimi Chang, MSN, FNP.