Feasibility on Point-of-Care Testing and Knowledge, Attitudes, and Satisfaction of Patients on Chronic Hepatitis B in Primary Healthcare: A Pilot Study in Hong Kong

Feasibility on Point-of-Care Testing and Knowledge, Attitudes, and Satisfaction of Patients on Chronic Hepatitis B in Primary Healthcare: A Pilot Study in Hong Kong | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility on Point-of-Care Testing and Knowledge, Attitudes, and Satisfaction of Patients on Chronic Hepatitis B in Primary Healthcare: A Pilot Study in Hong Kong Marco Tsun Lee, Judy Siu Har Lee, Jeffrey Van Ho Tse, Sally Sin Yi Yung, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7442621/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Chronic hepatitis B (CHB) remains a significant public health challenge in Hong Kong, with an estimated prevalence of 5.6%. Despite effective antiviral therapy, screening uptake remains suboptimal. This study evaluated the feasibility of hepatitis B surface antigen (HBsAg) point-of-care (POC) testing in primary healthcare setting and assessed participants’ knowledge, attitudes, stigma and satisfaction. Methods A cross-sectional study was conducted between September 2024 and May 2025 at the Central and Western District Health Centre Express, a government-initiated primary healthcare facility in Hong Kong. A total of 109 adults received HBsAg POC testing using the Abbott Determine™ HBsAg 2 rapid test kit and completed a structured questionnaire assessing demographics, CHB knowledge, perceived stigma, screening facilitators and barriers, and satisfaction. Regression analyses were performed to identify predictors of knowledge and stigma. Results Participants demonstrated generally good CHB knowledge about CHB (mean score = 11.7 / 16), yet gaps remained in understanding transmission and incurability. Higher knowledge was associated with being born in Hong Kong and knowing someone with CHB. Males had lower knowledge in disease management. Perceived stigma was low overall (mean score = 0.57 / 5). Being married, employed, or living with others were protective factors, whereas having health insurance was linked to higher stigma. Participants expressed high satisfaction with the POC testing process, particularly its convenience and immediacy of results. All participatns were willing to be tested if recommended by doctors, yet only 7.3% reported prior discussion about HBV testing with their physicians. Conclusions Overall knowledge on chronic hepatitis B is satisfactory with some groups having a higher disease knowledge. Misconceptions about transmission and curability remain. HBsAg POC testing was feasible and highly acceptable in primary healthcare setting in Hong Kong. Findings highlight the importance of empowering family doctors to initiate screening discussions and addressing specific knowledge gaps through targeted education. These strategies could improve screening uptake and support Hong Kong’s progress toward CHB elimination goals. Chronic Hepatitis B Hepatitis B Virus Point-of-Care Testing HBsAg Screening Primary Healthcare Knowledge Attitude Stigma Satisfaction Hong Kong Figures Figure 1 Figure 2 Figure 3 Introduction Chronic hepatitis B (CHB) caused by hepatitis B virus (HBV) is a leading cause of liver disease worldwide, contributing to significant morbidity and mortality due to complications such as liver cirrhosis and hepatocellular carcinoma. 1 Despite the availability of effective vaccination and antiviral therapy, CHB remains a major public health concern. Globally, only 14% of the 254 million individuals living with CHB have been diagnosed, and only 8% of those eligible for treatment are receiving it, highlighting a substantial gap in the care cascade. 2 Early detection is crucial, yet many individuals with CHB remain undiagnosed until advanced stages. 3 Hong Kong has a CHB prevalence of approximately 5.6%, translating to an estimated 410,000 affected individuals. 4 According to the Centers for Disease Control and Prevention (CDC), this places Hong Kong within the intermediate prevalence category (2–7%),, for which universal or population-level screening is recommended to enable timely diagnosis and management. 5 While targeted screening is recommended for at-risk populations, universal screening programs remain unavailable and primary healthcare screening is often underutilized. World Health Organization (WHO) recommends that all adults have routine access to hepatitis B surface antigen (HBsAg) serological testing, with appropriate linkage to prevention, care, and treatment services. 1 The WHO further encourages integration of HBV testing into existing community- and facility-based programmes, including antenatal care, human immunodeficiency virus (HIV), or tuberculosis (TB) clinics, to maximize coverage and efficiency. 1 Traditional screening methods require venipuncture, laboratory-based testing, and follow-up visits, which can be barriers to access, particularly for individuals with limited healthcare engagement. 6 Given these challenges, innovative, cost-effective, and convenient screening approaches are needed to improve CHB detection rates in primary healthcare settings. Point-of-care (POC) testing presents a potential solution by enabling rapid and convenient screening in primary healthcare or community settings. HBsAg POC testing has been developed and validated in various international settings, demonstrating high sensitivity and specificity compared to conventional laboratory-based assays. 7 Studies conducted in resource-limited settings and primary healthcare environments have shown that POC testing can facilitate timely diagnosis and improve linkage-to-care. 8 , 9 The availability of rapid, finger-prick blood tests offers an alternative to traditional screening methods, potentially increasing patient uptake and reducing delays in diagnosis. Patient satisfaction is a critical factor in the adoption of new healthcare technologies, including POC testing. 10 Despite the potential of HBsAg POC testing, local data on barriers, facilitators and patient satisfaction toward HBsAg POC testing in Hong Kong are limited. This study aims to evaluable the feasibility and acceptability of HBsAg POC testing in primary healthcare settings in Hong Kong. Specifically, we assessed participants’ knowledge of CHB, attitudes toward HBV testing, factors influencing perceived stigma, and satisfaction with the POC process. The findings provide insight into barriers and facilitators to screening, informing future community-based strategies to enhance awareness on HBV testing and uptake of testing. Methods Study Design A cross-sectional feasibility study was conducted from 16 Sep 2024 to 31 May 2025 at the Central and Western District Health Centre Express (C&W DHCE), a community-based primary healthcare provider in Hong Kong. Eligible participants underwent POC testing and completed a structured questionnaire in Traditional Chinese. Participants who screened positive for HBsAg were referred to the Linkage-to-care Clinic (LTCC) at Queen Mary Hospital (QMH) in Hong Kong for further clinical assessment and specialist care by a hepatologist (L.L.Y.M.). Outcomes were tracked via the electronic health record (eHR) system with informed consent. A summary of the study flow is presented in Figure 1. Study Population Adults aged 18 years or above attending C&W DHCE were eligible. Inclusion criteria included the ability to read Chinese and communicate in Cantonese or Mandarin. Exclusion criteria were known CHB infection, current pregnancy, or serious comorbidities. This feasibility study employed a convenience sampling approach, with the sample size determined based on pragmatic considerations including available resources, time frame, and expected daily patient volume at the screening site. Study Procedures All participants provided written informed consent. Participants underwent HBsAg POC testing using the Abbott Diagnostics Determine™ HBsAg 2 rapid test kit, which has a detection limit of 0.1 IU/mL. This assay was prequalified by the WHO in 2019 as one of the most sensitive rapid tests for HBsAg detection. 11 Capillary blood was collected via fingerstick, with results available in 15 minutes. During this time, participants completed the questionnaire. Questionnaire Design The questionnaire comprised five main sections: (1) demographics, (2) HBV-related history, (3) CHB-related knowledge, (4) stigma and attitudes toward CHB and testing, and (5) satisfaction with POC testing. The questionnaire was developed in Chinese and administered in this language, as approved by the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB). Selected items were adapted from previously published instruments, translated into Traditional Chinese and modified for cultural and healthcare context appropriateness in Hong Kong by a bilingual expert panel (M.T.L., L.L.Y.M. and J.V.H.T.). 10,12 An English translation is provided as Supplementary File 1 for transparency and for the benefit of reviewers and readers. The demographics section collected clinical characteristics such as age, sex, education level, employment status, district of residence, birthplace, household composition, and presence of chronic illnesses. The HBV–related history session assessed self-reported vaccination status, health insurance coverage, family doctor access, prior doctor-initiated discussions about HBV testing, whether participants were willing to undergo HBV testing if offered free of charge, and whether participants personally knew someone with CHB. CHB-related knowledge using 16 true/false questions divided into three thematic domains: transmission, management, and progression. Each correct response was awarded one point, while incorrect or unanswered responses were scored as 0. Total scores ranged from 0 to 16, with higher scores indicating greater knowledge. Stigma was assessed using five binary yes/no statements reflecting anticipated emotional or social responses to hypothetical CHB diagnosis, such as anticipated shame, embarrassment, social withdrawal, or perceived burden on family and employment. Attitude to CHB included willingness to test under various scenarios (e.g., if recommended by a physician, or if treatment/vaccination were free). One item assessed willingness to seek treatment if tested positive, which was used as a proxy for linkage-to-care intention. Satisfaction with POC testing was measured using a 0 to 10 visual analogue scale across seven items. These assessed participants’ experience with six domains of the testing process, including the sample collection method, confidence in the procedure, confidence in the test results, perceived convenience, cost-related considerations, and the extent to which the testing facilitated engagement with healthcare providers and disease management. Data Analysis Descriptive statistics summarized participant characteristics and outcome variables. Continuous variables were presented as means ± standard deviations (SD), and categorical variables as frequencies and percentages. CHB Knowledge scores were analyzed as continuous variables (total and domain-specific). Multiple linear regression assessed associations between knowledge and demographic or psychosocial factors. Binary logistic regression identified predictors of stigma. All models included the same independent variables. POC satisfaction was not included in regression, as they were assessed after the intervention and could not influence baseline knowledge. All collected data were complete, with no missing values for the variables analyzed. Statistical analyses were performed using R software (version 3.6.1) and a two-sided p-value of < 0.05 was considered statistically significant. Ethical consideration and approval This study was approved by the HKU/HA HKW IRB under approval number UW 24-542. The study adheres to the principles outlined in the Declaration of Helsinki, ensuring the ethical conduct of research involving human subjects. Written informed consent was obtained from all participants prior to their enrolment. Confidentiality and data privacy were strictly maintained, with all identifiable information anonymized in compliance with data protection regulations. Results Participant Characteristics, Healthcare Access, and HBV-Related History A total of 109 participants were enrolled (response rate: 78.9%). The mean age was 60.5 ± 8.6 years, with 63.3% female and 73.4% married. 83.5% were reported to live with family members. Regarding educational attainment, over half (56.6%) had completed secondary education, while 32.3% had attained tertiary education or above. Most participants were either retired (43.7%) or in full-time employment (33.0%). The majority (75.0%) were born in Hong Kong. Most participants (80.7%) reported no chronic diseases, and 46.8% reported having health insurance. Regarding healthcare access, 57.8% of participants reported having a regular family doctor, yet only 7.3% recalled that HBV screening had ever been discussed. Willingness to undergo HBsAg POC testing was high as 99.1% would accept testing if offered free of charge, and 100% expressed willingness if recommended by a physician. In terms of HBV–related history, 30.3% reported a history of HBV vaccination, primarily due to childhood or school-based programs (64.0%). 24.8% of participants reported that they personally knew someone diagnosed with CHB. Among those unvaccinated, barriers included unclear accessibility of vaccination (36.4%), low perceived need (25.0%), and limited understanding of vaccine benefits (22.7%). These results were presented in Table 1 , Supplementary Table S1 , S2 and S3. Table 1 Summary of Participant Characteristics, Healthcare Access, and Hepatitis B–Related History (n = 109) Value (n = 109) Ages (years) Mean ± SD 60.5 ± 8.6 Gender Male 40 (36.7%) Female 69 (63.3%) Living status Lives alone 18 (16.5%) Lives with others 91 (83.5%) Marriage Single 18 (16.5%) Married 80 (73.4%) Divorced 4 (3.7%) Widowed 7 (6.4%) Education level Below primary school 3 (3.0%) Primary school 8 (8.1%) Secondary school 56 (56.6%) Tertiary or above 32 (32.3%) Occupation Full-time Employment 36 (33.0%) Part-time Employment 10 (9.2%) Student 0 (0%) Unable to Work due to Illness 0 (0%) Housewife/Househusband 9 (8.3%) Retired 47 (43.1%) Currently Job Searching 3 (2.8%) Unemployed 4 (3.7%) Other 0 (0%) District of Residence Hong Kong Island 100 (91.7%) Kowloon 2 (1.8%) New Territories 7 (6.4%) Birthplace Hong Kong 81 (75.0%) Outside Hong Kong 27 (25.0%) Current Chronic Disease None 88 (80.7%) 1 type 19 (17.4%) 2 types 2 (1.8%) 3 types 0 (0%) 4 types or more 0 (0%) Insurance Coverage Insured (Personal or Group Insurance) 51 (46.8%) Not insured 58 (53.2%) Have a family doctor Yes 63 (57.8%) No 46 (42.2%) Duration since last visit to any doctor 20 years 1 (0.9%) Doctor ever mentioned HBsAg POC testing Yes 8 (7.3%) No 97 (89.0%) Not sure 4 (3.7%) Willingness to receive HBsAg POC testing if it is free Yes 108 (99.1%) No 0 (0%) Know someone (family members or friends) with CHB Yes 27 (24.8%) No 55 (50.5%) Not Sure 27 (24.8%) HBV vaccination history Yes 33 (30.3%) No or not sure 43 (40.4%) Not Sure 32 (29.4%) CHB-related Knowledge The overall average knowledge score was 11.7 ± 1.8 out of 16. Domain analysis showed that participants scored highest in the disease progression domain (mean 88.7%). Most of the participant correctly identified that CHB can lead to liver cancer (91.7%), recognized its association with cirrhosis (98.2%), and aware that the disease can be asymptomatic (76.2%). This demonstrated that most participants demonstrated strong understanding of CHB complications and prevention. The disease management domain also showed relatively strong performance (mean 75.5%). Most participants were aware that CHB is preventable (91.7%) and that HBV vaccine is available (94.5%). However, only 41.3% correctly understood that CHB is not curable, revealing a notable gap in understanding of disease treatment and chronicity. Knowledge in the transmission domain was comparatively limited, with an average score of 67.4%, indicating greater variability and misconceptions. While most participants correctly identified blood-borne and mother-to-child transmission routes, only 55.0% recognized sexual contact as a mode of transmission. Encouragingly, 97.2% correctly identified that HBV cannot be transmitted through handshakes. However, fewer than half understood that HBV is not genetically inherited (46.8%) or transmissible via shared food or utensils (55.0%). The lowest correct response (27.5%) was recorded for the misconception that HBV can be transmitted by consuming raw shellfish, likely reflecting disease confusion with hepatitis A or E. While participants had good understanding of CHB complications and some aspects of disease management, knowledge gaps remain, particularly regarding transmission routes and treatment misconceptions. Figure 2 summarizes the correct response rates across all CHB-related knowledge questions answered by participants. Low Stigma Score Participants reported low stigma levels towards CHB (mean score: 0.58 out of 5). Very few participants felt CHB would be associated with shame (0.9%), embarrassment (2.8%), or job loss (5.5%). Figure 3 displays participants’ responses to five CHB-related stigma statements. HBV Screening Facilitators and Linkage-to-Care Intention Participants demonstrated high willingness to undergo HBV screening when certain facilitators were present. 99.1% would receive HBV screening if it were provided for free and all participants reported that they would accept screening if recommended by doctors. All participants indicated willingness to receive treatment if diagnosed or if the treatment is free. This strong intent highlights the feasibility of implementing screening programs with direct linkage to care, especially when combined with point-of-care testing and integrated clinical support. Social context appeared to influence participants’ willingness to undergo HBV screening. When asked whether they would be more likely to be tested if they knew a family member or friend with CHB, 95.4% responded affirmatively. Among the 27 participants who reported knowing someone with CHB, 96.3% indicated increased likelihood of testing, compared to 95.1% among those who did not or were unsure. Participants who knew someone with CHB had higher odds of expressing willingness to undergo screening than those who did not or were unsure, corresponding to an odds ratio of 1.33. While this finding suggests a modest influence of social familiarity with HBV on screening intention, overall willingness remained high across all groups. The details were summarized in Table 2 . Table 2 Willingness to Test if Family or Friend Has CHB Knows Someone with CHB More Likely to Test Not More Likely to Test Total Yes 26 1 27 No/Not Sure 78 4 82 Total 104 5 109 Factors Associated with CHB Knowledge Multiple linear regression analysis showed that participants who were born in Hong Kong demonstrated significantly higher knowledge scores compared to those born elsewhere (β = 0.95, p = 0.029). Similarly, knowing a family member or friend with CHB was positively associated with knowledge (β = 0.74, p = 0.049). Positive trends were also observed among participants who had received the HBV vaccine, those whose doctor had previously discussed HBV screening, and those living alone. No significant associations were observed for age, sex, education level, employment status, marital status, chronic disease status, insurance coverage, family doctor access, recent doctor visits, or stigma score. Details were summarized in Table 3 . Table 3 Multiple Linear Regression Predicting CHB Knowledge Score Predictor β 95% CI p -value (Intercept) 9.48 (5.57, 13.39) < 0.001 *** Age 0.001 (− 0.046, 0.048) 0.977 Sex −0.29 (− 0.97, 0.39) 0.407 Lives alone 1.09 (− 0.15, 2.33) 0.089 † Married 0.56 (− 0.50, 1.62) 0.296 Education level 0.36 (− 0.13, 0.86) 0.154 Employed 0.35 (− 0.40, 1.10) 0.364 Born in Hong Kong 0.95 (0.10, 1.81) 0.029 * Chronic disease 0.27 (− 0.58, 1.12) 0.524 Knows someone with CHB 0.74 (0.01, 1.48) 0.049 * Insured −0.54 (− 1.25, 0.18) 0.133 Has family doctor −0.49 (− 1.15, 0.17) 0.149 Recent doctor visit (< 1 year) −0.25 (− 1.17, 0.66) 0.590 Doctor discussed HBV test 1.26 (− 0.02, 2.54) 0.053 † Vaccinated 0.76 (− 0.01, 1.53) 0.052 † Stigma present (≥ 1) −0.23 (− 0.93, 0.47) 0.513 Model summary : R² = 0.3088, Adjusted R² = 0.1974, F(15, 93) = 2.77, p = 0.001 Note . β represents the unstandardized regression coefficient. CI = confidence interval. A positive β indicates higher knowledge score relative to the reference category. Reference categories: female (sex), not married (marital status), not employed (employment), not born in Hong Kong (birthplace), no chronic disease, not insured, no family doctor, no recent doctor visit (> 1 year), did not discuss HBV testing with doctor, not vaccinated, does not live alone, does not know someone with CHB, and no stigma (score = 0). p < 0.05 (*) was considered statistically significant. p < 0.10 (†) was considered borderline significance and interpreted as a trend. Separate multiple linear regression models were conducted to examine predictors of domain-specific CHB knowledge, including transmission, management, and progression, in which the results were summarized in Supplementary Table S5, Table 4 and Supplementary Table S6 respectively. Male sex was significantly associated with lower knowledge scores in disease management domain (β = − 0.36, p = 0.030). No other variables showed significant associations in this model. Table 4 Multiple Linear Regression Predicting CHB Disease Management Knowledge Score Predictor β 95% CI p -value (Intercept) 2.04 (0.21, 3.87) 0.030 * Age 0.004 (–0.02, 0.03) 0.735 Sex –0.36 (–0.68, − 0.04) 0.030 * Lives alone 0.31 (–0.28, 0.89) 0.302 Married 0.34 (–0.15, 0.84) 0.168 Education level 0.17 (–0.07, 0.41) 0.159 Employed 0.27 (–0.09, 0.63) 0.133 Born in Hong Kong 0.25 (–0.14, 0.65) 0.208 Chronic disease 0.18 (–0.21, 0.58) 0.364 Knows someone with CHB 0.10 (–0.24, 0.44) 0.549 Insured –0.15 (–0.54, 0.20) 0.363 Has family doctor 0.11 (–0.20, 0.43) 0.470 Recent doctor visit (< 1 year) –0.35 (–0.78, 0.08) 0.112 Doctor discussed HBV test 0.28 (–0.31, 0.87) 0.348 Vaccinated 0.22 (–0.14, 0.58) 0.225 Stigma present (≥ 1) –0.26 (–0.60, 0.08) 0.128 Model summary : R² = 0.225, Adjusted R² = 0.100, F(15, 93) = 1.80, p = 0.046 Note . β represents the unstandardized regression coefficient. CI = confidence interval. A positive β indicates a higher CHB disease management knowledge score relative to the reference category. Reference categories: female (sex), not married (marital status), not employed (employment), not born in Hong Kong (birthplace), no chronic disease, not insured, no family doctor, no recent doctor visit (> 1 year), did not discuss HBV testing with doctor, not vaccinated, does not live alone, does not know someone with CHB, and no stigma (score = 0). p < 0.05 (*) was considered statistically significant. p < 0.10 (†) was considered borderline significance and interpreted as a trend. Factors Associated with Stigma towards CHB Binary logistic regression was conducted to identify predictors of perceived CHB–related stigma (defined as a score ≥ 1). Stigma was negatively associated with being married, employed, or living with others, and positively associated with insurance status. Significant predictors included living alone (OR = 0.08, p = 0.012), being married (OR = 0.19, p = 0.037), being employed (OR = 0.28, p = 0.041), being born in Hong Kong (OR = 0.14, p = 0.004), and having health insurance (OR = 3.50, p = 0.018). The results were summarized in Table 5 . Table 5 Logistic Regression Predicting Presence of CHB–Related Stigma Predictor β 95% CI OR p -value (Intercept) –0.55 — — 0.868 Age + 0.058 (0.99, 1.14) 1.06 0.108 Sex –0.03 (0.34, 2.76) 0.97 0.953 Lives alone –2.57 (0.01, 0.53) 0.08 0.012 * Married –1.64 (0.04, 0.87) 0.19 0.037 * Education level –0.07 (0.44, 1.98) 0.93 0.858 Employed –1.27 (0.08, 0.91) 0.28 0.041 * Born in Hong Kong –2.00 (0.03, 0.49) 0.14 0.004 ** Chronic disease + 0.37 (0.44, 4.83) 1.45 0.542 Knows someone with CHB + 0.45 (0.52, 4.78) 1.57 0.421 Insured + 1.25 (1.28, 10.38) 3.50 0.018 * Has family doctor + 0.81 (0.84, 6.28) 2.25 0.110 Recent doctor visit (< 1 year) + 0.69 (0.49, 9.13) 1.99 0.348 Doctor discussed HBV testing –1.32 (0.03, 1.82) 0.27 0.195 Vaccinated + 0.27 (0.41, 4.35) 1.31 0.655 Knowledge score (0 to 16) –0.11 (0.66, 1.22) 0.90 0.484 Model summary : Residual deviance = 116.78 on 93 degrees of freedom, AIC = 148.78 Note . β represents the log odds coefficient from logistic regression. OR = odds ratio, calculated as exp(β). A positive β indicates higher odds of reporting stigma (score ≥ 1) relative to the reference category. Reference categories: female (sex), not married (marital status), not employed (employment), not born in Hong Kong (birthplace), no chronic disease, not insured, no family doctor, no recent doctor visit (> 1 year), doctor has not discussed HBV testing, not vaccinated, does not live alone, does not know someone with CHB. p < 0.05 (*) was considered statistically significant. p < 0.01 (**) was considered highly significant. Satisfaction Toward HBsAg POC Testing Participant satisfaction with the HBsAg POC testing process was high across multiple domains, as summarized in Table 6 . Participants reported particularly strong agreement regarding the convenience of testing (9.4 ± 1.0 out of 10), and the immediacy of test results (9.5 ± 0.8 out of 10). Confidence in the test results was similarly strong (9.1 ± 1.2 out of 10). Participants also agreed that on-site POC testing contributed positively to their relationship with healthcare professionals (8.8 ± 1.5 out of 10). Notably, agreement with the statement that “laboratories have better hygiene standards than point-of-care testing” was relatively low (4.4 ± 3.2 out of 10). This indicates that participants did not perceive a significant difference in hygiene standards between the two settings. Table 6 Summary of HBsAg POC testing satisfaction questionnaire (n = 109) Areas Statements Mean score (± SD) Median score (range) Collection process I would rather have blood taken by finger rick than by needle in my arm 8.6 (± 2.2) 10 (0–10) Confidence in the process Laboratories have better hygiene processes than point-of-care testing 4.4 (± 3.2) 5 (0–10) Confidence in the results I have confidence in the information given the results by my physician or practice regarding my on-site point-of-care HBsAg test result 9.1 (± 1.2) 10 (5–10) Convenience Not having to travel to an outside laboratory would be convenient 9.4 (± 1.0) 10 (5–10) Cost Outside pathology laboratories involve extra time and transport costs 8.7 (± 2.0) 10 (0–10) Disease management Having immediate feedback on the test result for my condition was important as it allowed/would allow me to discuss the management of my condition with healthcare professional 9.5 (± 0.8) 10 (6–10) On-site HBsAg point-of care-testing strengthened/would strengthen my relationship with healthcare professional 8.8 (± 1.5) 10 (4–10) The score ranges from 0 (completely disagree) to 10 (completely agree) for all statements. The higher the score the higher. Discussion This study provides important insights in terms of public knowledge, attitudes, stigma, and satisfaction with HBsAg POC testing in a primary healthcare setting in Hong Kong. CHB-Related Knowledge and Associated Factors Participants demonstrated fair overall knowledge of CHB, with better understanding of complications and prevention but notable misconceptions in disease transmission. Many misunderstood sexual transmissions or believed in non-transmissible routes such as food sharing or genetic inheritance, suggesting disease knowledge confusion with hepatitis A or E. Awareness of CHB’s incurability was also limited. Prior studies echo similar knowledge deficits. For example, a United States study among Asians found many believed HBV could be inherited or spread through food, while fewer recognized links to liver cancer or treatability. 12 Multivariable analysis found that being born in Hong Kong and knowing someone with CHB were significant predictors of higher knowledge. Positive trends were also observed among those vaccinated, who had discussed HBV testing with doctors, or lived alone. Interestingly, education and insurance status were not significantly associated with knowledge of CHB. This suggests other contextual or system-level influences may play a greater role in CHB knowledge acquisition in Hong Kong. Males scored lower in disease management, which may reflect fewer encounters with HBV-related care. A 2022 study in Australia also reported high HBV knowledge among recently pregnant women. 13 In Hong Kong, antenatal HBV screening is a standard practice, and new mothers are often required to bring their infants to clinics for the second and third doses of the HBV vaccine. 14 These repeated interactions with the healthcare system may reinforce HBV-related knowledge among women. Leveraging maternal care and reproductive health services to strengthen CHB literacy presents a valuable opportunity. Meanwhile, male-targeted education strategies should be developed to address potential knowledge gaps and ensure more equitable health literacy across genders. These results have clear implications for public health policy. In Hong Kong, as an intermediate endemicity region with a well-developed primary healthcare system, enhancing public knowledge through evidence-based education campaigns is crucial to improving screening uptake and early detection. Multi-channel education efforts including primary healthcare should correct misconceptions and normalize HBV discussions. Frontline providers should be equipped with materials to reinforce awareness, aligning with the Hong Kong Viral Hepatitis Action Plan 2020–2024 . 15 Facilitators of Screening and Linkage to Care Participants demonstrated a strong willingness to undergo screening when tests were free and recommended by doctors. Personal connection with someone with CHB modestly increased screening intention. These findings support embedding free HBV testing in primary healthcare settings to lower structural barriers and enhance screening uptake. Encouragingly, all participants expressed willingness to engage in follow-up care if diagnosed, highlighting the importance of integrating testing with clear referral mechanisms, public subsidy schemes, and patient education to support successful linkage-to-care. The combination of high screening interest and strong intent to seek care reinforces the feasibility of POC-based HBV screening in Hong Kong. These findings support the feasibility of embedding free HBV testing services within primary healthcare settings to lower structural barriers and enhance screening uptake. Notably, the Hong Kong government has announced plans to implement hepatitis B screening in primary healthcare through DHCs, as stated in the 2024 Policy Address. 16 Our data provides timely evidence supporting this policy direction, demonstrating strong public receptivity to testing and identifying key facilitators of successful screening and linkage to care. Influence of Family Doctors Although participants indicated they would follow a doctor’s advice to test, only 7.3% reported previous discussions on HBV testing with their physicians. This reflects a missed opportunity for early case identification and linkage to care in Hong Kong’s primary healthcare system, where 64.9% reported having a regular family doctor. Evidence from international studies reinforces the critical role of primary healthcare providers in driving HBV screening uptake. Studies found doctors were the most common reason for testing among screened individuals, but provider engagement remains suboptimal even in high-risk populations. 12 , 17 These findings mirror local observations and suggest a passive HBV screening approach limits the reach and effectiveness of existing control strategies. Integrating HBV screening in primary healthcare settings could greatly expand its reach. Family doctors should be supported to proactively identify high-risk individuals, while community pharmacists and nurses can help raise awareness and improve access. Leveraging these trusted providers through a multidisciplinary approach will be key to enhancing screening uptake, ensuring linkage to care, and advancing HBV elimination goals under the Hong Kong Viral Hepatitis Action Plan 2020–2024 . 15 Low Stigma and Its Role in Facilitating Screening Our cohort reported notably low levels of CHB-related stigma in Hong Kong. This contrasts with findings from the United States and mainland China, where stigma included fears of shame, job loss, and relationship concerns. 18 , 19 In Hong Kong, the more accepting social context may promote greater willingness to screen and disclose infection status. Logistic regression showed that being married, employed, or living with others was associated with lower stigma, while having insurance was linked to higher stigma, possibly due to disclosure concerns. Unlike in some countries such as the United States, where insurance coverage is more widely available or employer-based schemes are common, Hong Kong does not offer universal health insurance. Only 49.7% have employer or self-paid medical insurance. 20 This unique context may influence how individuals perceive stigma and privacy concerns in accessing care. Cultural and social context, rather than education or healthcare access, appeared more predictive of stigma in Hong Kong. These findings support continued stigma reduction efforts through primary healthcare engagement and public education. High Satisfaction with HBsAg POC Testing in Primary Healthcare Setting To our knowledge, this is the first study to evaluate the satisfaction of HBsAg POC testing in HBV screening. Participants reported high levels of satisfaction with HBsAg POC testing, particularly regarding convenience, immediacy, and facilitation of dialogue with providers. This mirrors findings from POC use in chronic disease management, where patients valued speed, confidence, and enhanced provider communication. 10 These results justify broader implementation of HBsAg POC testing in primary healthcare, especially in DHCs and community-based settings such as community pharmacies. By streamlining access and reducing barriers, POC testing could improve early detection and linkage-to-care, supporting HBV elimination targets. Limitations of the study This study was limited by sampling from one district and an older, health-conscious participant pool, limiting generalizability. The absence of a control group precluded direct comparisons with standard care. Additionally, the questionnaire did not explicitly state that CHB treatment is typically long-term or lifelong. As a result, participants’ reported willingness to initiate treatment may not reflect real-world adherence if the chronic nature of therapy were fully understood. Broader sampling across districts and comparative studies are recommended. Future Research Direction Future studies should evaluate long-term clinical outcomes of early detection and linkage-to-care by HBsAg POC testing, its cost-effectiveness, and how best to integrate it into broader screening initiatives. Further investigation into the role of family doctors is crucial. Understanding barriers to discussing HBV screening in routine consultations and developing strategies to enhance their involvement in preventive care could increase screening uptake. Conclusions This study provides valuable insights into the knowledge, attitudes, and satisfaction regarding HBV screening in Hong Kong. While participants demonstrated fair overall knowledge, significant gaps remain, particularly in understanding transmission modes and the incurability of CHB. The study also highlights the positive impact of low stigma in encouraging screening uptake and the crucial role family doctors can play in promoting screening. High satisfaction with HBsAg POC testing, particularly regarding its convenience and rapid results, underscores the potential for integrating POC testing into routine screening programs. In conclusion, addressing knowledge gaps, encouraging family doctor involvement, and expanding access to HBsAg POC testing are essential steps in improving HBV screening and prevention efforts in Hong Kong. These findings provide early real-world evidence supporting the Hong Kong SAR government’s plan to implement HBV screening in primary healthcare and offer insight into how future programs can be optimized for success. Abbreviations Abbreviation Full Term AIC Akaike Information Criterion C&W DHCE Central and Western District Health Centre Express CDC Centers for Disease Control and Prevention CHB Chronic Hepatitis B CI Confidence Interval eHR Electronic Health Record HBV Hepatitis B Virus HBsAg Hepatitis B Surface Antigen HCC Hepatocellular Carcinoma HIV Human Immunodeficiency Virus HKU/HA HKW IRB Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster IRB Institutional Review Board IU/mL International Units per Millilitre LTCC Linkage-to-care Clinic OR Odds Ratio POC Point-of-Care QMH Queen Mary Hospital SD Standard Deviation TB Tuberculosis WHO World Health Organization Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) under approval number UW 24-542. The study adheres to the principles outlined in the Declaration of Helsinki, ensuring the ethical conduct of research involving human subjects. Written informed consent was obtained from all participants prior to their enrolment. Confidentiality and data privacy were strictly maintained, with all identifiable information anonymized in compliance with data protection regulations. Consent for publication Not applicable. This manuscript does not contain any individual person’s data in any form. Availability of data and materials De-identified individual participant data that underlie the findings of this study (including text, tables, and figures), along with the data dictionary and study protocol, will be made available from the corresponding author upon reasonable request. Data will be available beginning at the time of publication with no set end date. Access will be granted to researchers with a methodologically sound proposal, subject to approval and a signed data access agreement. Competing Interest declaration M.T.L. is a member of the Task Group on Guideline Formulation for Community Pharmacy under the Primary Healthcare Commission, Health Bureau, Hong Kong SAR Government, representing The University of Hong Kong. The Task Group contributes to setting guidelines and standards for community pharmacy services, including hepatitis B management in primary care. This role is unpaid and does not pose any financial conflict. All other authors declare that they have no competing interests. Funding This study received no external funding. Authors’ contributions M.T.L. conceptualized the study, designed the methodology, coordinated the project, and led the investigation. M.F.Y., C.L.C. and L.L.Y.M. provided academic supervision and oversight throughout the project. J.S.H.L. and S.S.Y.Y. coordinated and supervised the implementation of point-of-care HBsAg testing at the Central and Western District Health Centre Express. M.T.L. and J.V.H.T. conducted the literature search and contributed to questionnaire development and manuscript drafting. M.T.L. and V.K.C.C. were responsible for data curation and acquisition. M.T.L. and L.L.Y.M. wrote the original draft. All authors contributed to writing by review and editing. M.T.L. and S.S.Y.Y. had full access to and verified the underlying data reported in the manuscript. All authors approved the final version of the manuscript. Acknowledgements The authors would like to express their sincere gratitude to the C&W DHCE for their support in patient recruitment and provision of HBsAg POC testing kits. Special thanks to Professor Anna S.F. Lok and her team for sharing the validated Chinese-language questionnaire used in previous studies. Written consent has been obtained from them to be acknowledged. The author used ChatGPT (GPT-4, OpenAI, accessed via ChatGPT Plus on web) to assist with improving readability and language clarity in the manuscript. All AI-generated content was reviewed and edited by the authors to ensure accuracy and appropriateness. Authors' information M.T.L.: Senior Pharmacist, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China J.S.H.L.: Project Coordinator, Central and Western District Health Centre Express, operated by The Hong Kong Society for Rehabilitation, Hong Kong SAR, China J.V.H.T.: Senior Research Assistant, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China S.S.Y.Y.: Care Coordinator, Central and Western District Health Centre Express, operated by The Hong Kong Society for Rehabilitation, Hong Kong SAR, China V.K.C.C.: Research Assistant, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China M.F.Y.: Chair Professor and Chief of Division of Gastroenterology and Hepatology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China C.L.C.: Associate Professor, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China L.L.Y.M.: Clinical Assistant Professor, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. L.L.Y.M. is the corresponding author and her email is [email protected] References World Health Organization. Global Hepatitis Report 2024 . Geneva, Switzerland: World Health Organization; 2024. Accessed April 19, 2025. https://www.who.int/publications/i/item/9789240085886. Cornberg M, Sandmann L, Jaroszewicz J, et al. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol . 2025. doi:10.1016/j.jhep.2025.03.018. World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection . Geneva, Switzerland: World Health Organization; 2024. Department of Health. Thematic Report on Viral Hepatitis (Population Health Survey 2020–22) . Hong Kong SAR: Government of the Hong Kong Special Administrative Region; 2023. Accessed April 19, 2025. https://www.hepatitis.gov.hk/english/health_professionals/thematic_report_on_viral_hepatitis.html. Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations - United States, 2023. MMWR Recomm Rep . 2023;72(1):1-25. doi:10.15585/mmwr.rr7201a1 Kaewdech A, Charatcharoenwitthaya P, Piratvisuth T. Asian Perspective on Hepatitis B Virus and Hepatitis C Virus Elimination. Viruses . 2024;17(1):34. Published 2024 Dec 29. doi:10.3390/v17010034 Khuroo MS, Khuroo NS, Khuroo MS. Accuracy of Rapid Point-of-Care Diagnostic Tests for Hepatitis B Surface Antigen-A Systematic Review and Meta-analysis. J Clin Exp Hepatol . 2014;4(3):226-240. doi:10.1016/j.jceh.2014.07.008 Xiao Y, Thompson AJ, Howell J. Point-of-Care Tests for Hepatitis B: An Overview. Cells . 2020;9(10):2233. doi:10.3390/cells9102233 Martyn E, O'Regan S, Harris P, et al. Hepatitis B virus (HBV) screening, linkage and retention-in-care in inclusion health populations: Evaluation of an outreach screening programme in London. 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Hong Kong SAR: Government of the Hong Kong Special Administrative Region. Published 2023. Accessed May 25, 2025. https://www.hepatitis.gov.hk/english/mtct/maternal_transmission_of_hepatitis_b.html. Viral Hepatitis Control Office, Department of Health. Hong Kong Viral Hepatitis Action Plan 2020–2024 . Hong Kong SAR: Government of the Hong Kong Special Administrative Region. Accessed May 25, 2025. https://www.hepatitis.gov.hk/doc/action_plan/Action%20Plan_Full%20Version_PDF_en.pdf The Government of the Hong Kong Special Administrative Region. The Chief Executive's 2024 Policy Address . October 2024. Accessed June 3, 2025. Lu X, Juon HS, Lee S. Do Recommendations by Healthcare Providers, Family-members, Friends, and Individual Self-Efficacy Increase Uptake of Hepatitis B Screening? Results of a Population-Based Study of Asian Americans. Int J MCH AIDS . 2017;6(1):9-18. doi:10.21106/ijma.176 Brener L, Horwitz R, Cama E, et al. Understanding stigma and attitudes towards hepatitis B among university students in Australia of Chinese and Vietnamese background. BMC Public Health . 2024;24(1):2801. doi:10.1186/s12889-024-20226-0 Huang J, Guan ML, Balch J, et al. Survey of hepatitis B knowledge and stigma among chronically infected patients and uninfected persons in Beijing, China. Liver Int . 2016;36(11):1595-1603. doi:10.1111/liv.13168 Census and Statistics Department. Thematic Household Survey Report No. 78: Provision of Medical Benefits by Employers/Companies and Coverage of Individually Purchased Medical Insurance . Hong Kong SAR: Government of the Hong Kong Special Administrative Region; 2024. Additional Declarations Competing interest reported. M.T.L. is a member of the Task Group on Guideline Formulation for Community Pharmacy under the Primary Healthcare Commission, Health Bureau, Hong Kong SAR Government, representing The University of Hong Kong. The Task Group contributes to setting guidelines and standards for community pharmacy services, including hepatitis B management in primary care. This role is unpaid and does not pose any financial conflict. All other authors declare that they have no competing interests. Supplementary Files SupplementaryMaterialsPOCBMCPCV2.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers invited by journal 25 Sep, 2025 Editor invited by journal 04 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Submission checks completed at journal 03 Sep, 2025 First submitted to journal 03 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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09:40:55","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136214,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7442621/v1/897eccebe75c9e4f80c156f5.html"},{"id":93027634,"identity":"e895ef81-8bae-465a-877a-58af23e6d7af","added_by":"auto","created_at":"2025-10-08 09:40:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":542444,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy Flow Diagram for HBsAg POC Screening, Questionnaire Administration, and Linkage-to-care pathway.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1Studyflowdiagram600dpi.png","url":"https://assets-eu.researchsquare.com/files/rs-7442621/v1/3d5ee138d26e2b54815e219b.png"},{"id":93026592,"identity":"fddfbda9-42ea-486f-8f2d-f39a79e9eb3c","added_by":"auto","created_at":"2025-10-08 09:32:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1868245,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrect Response Rates to CHB-Related Knowledge Questions by Thematic Domain.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBar charts showing the percentage of participants who correctly answered each knowledge question related to hepatitis B, grouped by thematic domain: disease transmission (9 items), disease management (4 items), and disease progression (3 items). Data reflect variable accuracy across domains, with the highest correct rates observed in progression-related items.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure2CorrectResponseRatesdpi600.png","url":"https://assets-eu.researchsquare.com/files/rs-7442621/v1/376b3806d79771faf517033f.png"},{"id":93026589,"identity":"2d055d43-9a1a-4d58-bc18-8d39dfbabf0e","added_by":"auto","created_at":"2025-10-08 09:32:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1667721,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant Responses to Five CHB-Related Stigma Statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEach pie chart illustrates the proportion of participants who agreed or disagreed with individual statements reflecting perceived stigma associated with chronic hepatitis B infection (n = 109).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure3ParticipantResponsestoStigmaStatementsdpi600.png","url":"https://assets-eu.researchsquare.com/files/rs-7442621/v1/dc5cdce8f661950790c22ce6.png"},{"id":93029481,"identity":"598cf287-f6a0-45d0-8624-83dc4359a1ac","added_by":"auto","created_at":"2025-10-08 09:56:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5733550,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7442621/v1/c8cbd6db-c579-48f3-9dd1-a1d4b0e86181.pdf"},{"id":93026593,"identity":"4209a0ce-4257-413d-8fac-89df8c7578e4","added_by":"auto","created_at":"2025-10-08 09:32:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":381860,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsPOCBMCPCV2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7442621/v1/ff8a2280d26797db5ab299e2.pdf"}],"financialInterests":"Competing interest reported. M.T.L. is a member of the Task Group on Guideline Formulation for Community Pharmacy under the Primary Healthcare Commission, Health Bureau, Hong Kong SAR Government, representing The University of Hong Kong. The Task Group contributes to setting guidelines and standards for community pharmacy services, including hepatitis B management in primary care. This role is unpaid and does not pose any financial conflict. All other authors declare that they have no competing interests.","formattedTitle":"Feasibility on Point-of-Care Testing and Knowledge, Attitudes, and Satisfaction of Patients on Chronic Hepatitis B in Primary Healthcare: A Pilot Study in Hong Kong","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic hepatitis B (CHB) caused by hepatitis B virus (HBV) is a leading cause of liver disease worldwide, contributing to significant morbidity and mortality due to complications such as liver cirrhosis and hepatocellular carcinoma.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Despite the availability of effective vaccination and antiviral therapy, CHB remains a major public health concern. Globally, only 14% of the 254\u0026nbsp;million individuals living with CHB have been diagnosed, and only 8% of those eligible for treatment are receiving it, highlighting a substantial gap in the care cascade.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Early detection is crucial, yet many individuals with CHB remain undiagnosed until advanced stages.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHong Kong has a CHB prevalence of approximately 5.6%, translating to an estimated 410,000 affected individuals.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e According to the Centers for Disease Control and Prevention (CDC), this places Hong Kong within the intermediate prevalence category (2\u0026ndash;7%),, for which universal or population-level screening is recommended to enable timely diagnosis and management.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e While targeted screening is recommended for at-risk populations, universal screening programs remain unavailable and primary healthcare screening is often underutilized. World Health Organization (WHO) recommends that all adults have routine access to hepatitis B surface antigen (HBsAg) serological testing, with appropriate linkage to prevention, care, and treatment services.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The WHO further encourages integration of HBV testing into existing community- and facility-based programmes, including antenatal care, human immunodeficiency virus (HIV), or tuberculosis (TB) clinics, to maximize coverage and efficiency.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Traditional screening methods require venipuncture, laboratory-based testing, and follow-up visits, which can be barriers to access, particularly for individuals with limited healthcare engagement.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Given these challenges, innovative, cost-effective, and convenient screening approaches are needed to improve CHB detection rates in primary healthcare settings.\u003c/p\u003e\u003cp\u003ePoint-of-care (POC) testing presents a potential solution by enabling rapid and convenient screening in primary healthcare or community settings. HBsAg POC testing has been developed and validated in various international settings, demonstrating high sensitivity and specificity compared to conventional laboratory-based assays.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Studies conducted in resource-limited settings and primary healthcare environments have shown that POC testing can facilitate timely diagnosis and improve linkage-to-care.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The availability of rapid, finger-prick blood tests offers an alternative to traditional screening methods, potentially increasing patient uptake and reducing delays in diagnosis. Patient satisfaction is a critical factor in the adoption of new healthcare technologies, including POC testing.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Despite the potential of HBsAg POC testing, local data on barriers, facilitators and patient satisfaction toward HBsAg POC testing in Hong Kong are limited.\u003c/p\u003e\u003cp\u003eThis study aims to evaluable the feasibility and acceptability of HBsAg POC testing in primary healthcare settings in Hong Kong. Specifically, we assessed participants\u0026rsquo; knowledge of CHB, attitudes toward HBV testing, factors influencing perceived stigma, and satisfaction with the POC process. The findings provide insight into barriers and facilitators to screening, informing future community-based strategies to enhance awareness on HBV testing and uptake of testing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eA cross-sectional feasibility study was conducted from 16 Sep 2024 to 31 May 2025 at the Central and Western District Health Centre Express (C\u0026amp;W DHCE), a community-based primary healthcare provider in Hong Kong. Eligible participants underwent POC testing and completed a structured questionnaire in Traditional Chinese. Participants who screened positive for HBsAg were referred to the Linkage-to-care Clinic (LTCC) at Queen Mary Hospital (QMH) in Hong Kong for further clinical assessment and specialist care by a hepatologist (L.L.Y.M.). Outcomes were tracked via the electronic health record (eHR) system with informed consent. A summary of the study flow is presented in Figure 1.\u003c/p\u003e\n\u003cp\u003eStudy Population\u003c/p\u003e\n\u003cp\u003eAdults aged 18 years or above attending C\u0026amp;W DHCE were eligible. Inclusion criteria included the ability to read Chinese and communicate in Cantonese or Mandarin. Exclusion criteria were known CHB infection, current pregnancy, or serious comorbidities.\u0026nbsp;This feasibility study employed a convenience sampling approach, with the sample size determined based on pragmatic considerations including available resources, time frame, and expected daily patient volume at the screening site.\u003c/p\u003e\n\u003cp\u003eStudy Procedures\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent. Participants underwent HBsAg POC testing using the Abbott Diagnostics Determine\u0026trade; HBsAg 2 rapid test kit, which has a detection limit of 0.1 IU/mL. This assay was prequalified by the WHO in 2019 as one of the most sensitive rapid tests for HBsAg detection.\u003csup\u003e11\u003c/sup\u003e Capillary blood was collected via fingerstick, with results available in 15 minutes. During this time, participants completed the questionnaire.\u003c/p\u003e\n\u003cp\u003eQuestionnaire Design\u003c/p\u003e\n\u003cp\u003eThe questionnaire comprised five main sections: (1) demographics, (2) HBV-related history, (3) CHB-related knowledge, (4) stigma and attitudes toward CHB and testing, and (5) satisfaction with POC testing.\u0026nbsp;The questionnaire was developed in Chinese and administered in this language, as approved by the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB).\u0026nbsp;Selected items were adapted from previously published instruments, translated into Traditional Chinese and modified for cultural and healthcare context appropriateness in Hong Kong by a bilingual expert panel (M.T.L., L.L.Y.M. and J.V.H.T.).\u003csup\u003e10,12\u003c/sup\u003e An English translation is provided as Supplementary File 1 for transparency and for the benefit of reviewers and readers.\u003c/p\u003e\n\u003cp\u003eThe demographics section collected clinical characteristics such as age, sex, education level, employment status, district of residence, birthplace, household composition, and presence of chronic illnesses. The HBV\u0026ndash;related history session assessed self-reported vaccination status, health insurance coverage, family doctor access, prior doctor-initiated discussions about HBV testing, whether participants were willing to undergo HBV testing if offered free of charge, and whether participants personally knew someone with CHB. CHB-related knowledge using 16 true/false questions divided into three thematic domains: transmission, management, and progression. Each correct response was awarded one point, while incorrect or unanswered responses were scored as 0. Total scores ranged from 0 to 16, with higher scores indicating greater knowledge. Stigma was assessed using five binary yes/no statements reflecting anticipated emotional or social responses to hypothetical CHB diagnosis, such as anticipated shame, embarrassment, social withdrawal, or perceived burden on family and employment. Attitude to CHB included willingness to test under various scenarios (e.g., if recommended by a physician, or if treatment/vaccination were free). One item assessed willingness to seek treatment if tested positive, which was used as a proxy for linkage-to-care intention. Satisfaction with POC testing was measured using a 0 to 10 visual analogue scale across seven items. These assessed participants\u0026rsquo; experience with six domains of the testing process, including the sample collection method, confidence in the procedure, confidence in the test results, perceived convenience, cost-related considerations, and the extent to which the testing facilitated engagement with healthcare providers and disease management.\u003c/p\u003e\n\u003cp\u003eData Analysis\u003c/p\u003e\n\u003cp\u003eDescriptive statistics summarized participant characteristics and outcome variables. Continuous variables were presented as means \u0026plusmn; standard deviations (SD), and categorical variables as frequencies and percentages. CHB Knowledge scores were analyzed as continuous variables (total and domain-specific). Multiple linear regression assessed associations between knowledge and demographic or psychosocial factors. Binary logistic regression identified predictors of stigma. All models included the same independent variables. POC satisfaction was not included in regression, as they were assessed after the intervention and could not influence baseline knowledge. All collected data were complete, with no missing values for the variables analyzed. Statistical analyses were performed using R software (version 3.6.1) and a two-sided p-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eEthical consideration and approval\u003c/p\u003e\n\u003cp\u003eThis study was approved by the HKU/HA HKW IRB under approval number UW 24-542. The study adheres to the principles outlined in the Declaration of Helsinki, ensuring the ethical conduct of research involving human subjects. Written informed consent was obtained from all participants prior to their enrolment. Confidentiality and data privacy were strictly maintained, with all identifiable information anonymized in compliance with data protection regulations.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipant Characteristics, Healthcare Access, and HBV-Related History\u003c/h2\u003e\n \u003cp\u003eA total of 109 participants were enrolled (response rate: 78.9%). The mean age was 60.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6 years, with 63.3% female and 73.4% married. 83.5% were reported to live with family members. Regarding educational attainment, over half (56.6%) had completed secondary education, while 32.3% had attained tertiary education or above. Most participants were either retired (43.7%) or in full-time employment (33.0%). The majority (75.0%) were born in Hong Kong. Most participants (80.7%) reported no chronic diseases, and 46.8% reported having health insurance.\u003c/p\u003e\n \u003cp\u003eRegarding healthcare access, 57.8% of participants reported having a regular family doctor, yet only 7.3% recalled that HBV screening had ever been discussed. Willingness to undergo HBsAg POC testing was high as 99.1% would accept testing if offered free of charge, and 100% expressed willingness if recommended by a physician.\u003c/p\u003e\n \u003cp\u003eIn terms of HBV\u0026ndash;related history, 30.3% reported a history of HBV vaccination, primarily due to childhood or school-based programs (64.0%). 24.8% of participants reported that they personally knew someone diagnosed with CHB. Among those unvaccinated, barriers included unclear accessibility of vaccination (36.4%), low perceived need (25.0%), and limited understanding of vaccine benefits (22.7%). These results were presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, Supplementary Table \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e, S2 and S3.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of Participant Characteristics, Healthcare Access, and Hepatitis B\u0026ndash;Related History (n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValue (n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAges (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives with others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (83.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (73.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelow primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (56.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-time Employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (33.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePart-time Employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to Work due to Illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife/Househusband\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrently Job Searching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDistrict of Residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHong Kong Island\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (91.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKowloon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNew Territories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirthplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHong Kong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutside Hong Kong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrent Chronic Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (80.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 types or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance Coverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsured (Personal or Group Insurance)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot insured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHave a family doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63 (57.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration since last visit to any doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (84.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor ever mentioned HBsAg POC testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (89.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWillingness to receive HBsAg POC testing if it is free\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108 (99.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnow someone (family members or friends) with CHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (50.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHBV vaccination history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo or not sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eCHB-related Knowledge\u003c/h2\u003e\n \u003cp\u003eThe overall average knowledge score was 11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 out of 16. Domain analysis showed that participants scored highest in the disease progression domain (mean 88.7%). Most of the participant correctly identified that CHB can lead to liver cancer (91.7%), recognized its association with cirrhosis (98.2%), and aware that the disease can be asymptomatic (76.2%). This demonstrated that most participants demonstrated strong understanding of CHB complications and prevention. The disease management domain also showed relatively strong performance (mean 75.5%). Most participants were aware that CHB is preventable (91.7%) and that HBV vaccine is available (94.5%). However, only 41.3% correctly understood that CHB is not curable, revealing a notable gap in understanding of disease treatment and chronicity. Knowledge in the transmission domain was comparatively limited, with an average score of 67.4%, indicating greater variability and misconceptions. While most participants correctly identified blood-borne and mother-to-child transmission routes, only 55.0% recognized sexual contact as a mode of transmission. Encouragingly, 97.2% correctly identified that HBV cannot be transmitted through handshakes. However, fewer than half understood that HBV is not genetically inherited (46.8%) or transmissible via shared food or utensils (55.0%). The lowest correct response (27.5%) was recorded for the misconception that HBV can be transmitted by consuming raw shellfish, likely reflecting disease confusion with hepatitis A or E. While participants had good understanding of CHB complications and some aspects of disease management, knowledge gaps remain, particularly regarding transmission routes and treatment misconceptions. Figure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the correct response rates across all CHB-related knowledge questions answered by participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eLow Stigma Score\u003c/h2\u003e\n \u003cp\u003eParticipants reported low stigma levels towards CHB (mean score: 0.58 out of 5). Very few participants felt CHB would be associated with shame (0.9%), embarrassment (2.8%), or job loss (5.5%). Figure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e displays participants\u0026rsquo; responses to five CHB-related stigma statements.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eHBV Screening Facilitators and Linkage-to-Care Intention\u003c/h2\u003e\n \u003cp\u003eParticipants demonstrated high willingness to undergo HBV screening when certain facilitators were present. 99.1% would receive HBV screening if it were provided for free and all participants reported that they would accept screening if recommended by doctors. All participants indicated willingness to receive treatment if diagnosed or if the treatment is free. This strong intent highlights the feasibility of implementing screening programs with direct linkage to care, especially when combined with point-of-care testing and integrated clinical support.\u003c/p\u003e\n \u003cp\u003eSocial context appeared to influence participants\u0026rsquo; willingness to undergo HBV screening. When asked whether they would be more likely to be tested if they knew a family member or friend with CHB, 95.4% responded affirmatively. Among the 27 participants who reported knowing someone with CHB, 96.3% indicated increased likelihood of testing, compared to 95.1% among those who did not or were unsure. Participants who knew someone with CHB had higher odds of expressing willingness to undergo screening than those who did not or were unsure, corresponding to an odds ratio of 1.33. While this finding suggests a modest influence of social familiarity with HBV on screening intention, overall willingness remained high across all groups. The details were summarized in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eWillingness to Test if Family or Friend Has CHB\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKnows Someone with CHB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMore Likely to Test\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNot More Likely to Test\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo/Not Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e104\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e109\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eFactors Associated with CHB Knowledge\u003c/h2\u003e\n \u003cp\u003eMultiple linear regression analysis showed that participants who were born in Hong Kong demonstrated significantly higher knowledge scores compared to those born elsewhere (\u0026beta;\u0026thinsp;=\u0026thinsp;0.95, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029). Similarly, knowing a family member or friend with CHB was positively associated with knowledge (\u0026beta;\u0026thinsp;=\u0026thinsp;0.74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049). Positive trends were also observed among participants who had received the HBV vaccine, those whose doctor had previously discussed HBV screening, and those living alone. No significant associations were observed for age, sex, education level, employment status, marital status, chronic disease status, insurance coverage, family doctor access, recent doctor visits, or stigma score. Details were summarized in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple Linear Regression Predicting CHB Knowledge Score\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(5.57, 13.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.046, 0.048)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.97, 0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.15, 2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.089 \u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.50, 1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.13, 0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.40, 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBorn in Hong Kong\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.95\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.10, 1.81)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.58, 1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnows someone with CHB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.01, 1.48)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;1.25, 0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHas family doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;1.15, 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecent doctor visit (\u0026lt;\u0026thinsp;1 year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;1.17, 0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor discussed HBV test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.02, 2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.053 \u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.01, 1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052 \u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStigma present (\u0026ge;\u0026thinsp;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;0.93, 0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eModel summary\u003c/strong\u003e: R\u0026sup2; = 0.3088, Adjusted R\u0026sup2; = 0.1974, F(15, 93)\u0026thinsp;=\u0026thinsp;2.77, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e. \u0026beta; represents the unstandardized regression coefficient. CI\u0026thinsp;=\u0026thinsp;confidence interval. A positive \u0026beta; indicates higher knowledge score relative to the reference category. Reference categories: female (sex), not married (marital status), not employed (employment), not born in Hong Kong (birthplace), no chronic disease, not insured, no family doctor, no recent doctor visit (\u0026gt;\u0026thinsp;1 year), did not discuss HBV testing with doctor, not vaccinated, does not live alone, does not know someone with CHB, and no stigma (score\u0026thinsp;=\u0026thinsp;0). \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (*) was considered statistically significant. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.10 (\u0026dagger;) was considered borderline significance and interpreted as a trend.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eSeparate multiple linear regression models were conducted to examine predictors of domain-specific CHB knowledge, including transmission, management, and progression, in which the results were summarized in Supplementary Table S5, Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and Supplementary Table S6 respectively. Male sex was significantly associated with lower knowledge scores in disease management domain (\u0026beta; = \u0026minus;\u0026thinsp;0.36, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). No other variables showed significant associations in this model.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple Linear Regression Predicting CHB Disease Management Knowledge Score\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(0.21, 3.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.030 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.02, 0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ndash;0.36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026ndash;0.68, \u0026minus;\u0026thinsp;0.04)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.030 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.28, 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.15, 0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.07, 0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.09, 0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBorn in Hong Kong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.14, 0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.21, 0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows someone with CHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.24, 0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.54, 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHas family doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.20, 0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecent doctor visit (\u0026lt;\u0026thinsp;1 year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.78, 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor discussed HBV test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.31, 0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.14, 0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStigma present (\u0026ge;\u0026thinsp;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(\u0026ndash;0.60, 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eModel summary\u003c/strong\u003e: R\u0026sup2; = 0.225, Adjusted R\u0026sup2; = 0.100, F(15, 93)\u0026thinsp;=\u0026thinsp;1.80, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e. \u0026beta; represents the unstandardized regression coefficient. CI\u0026thinsp;=\u0026thinsp;confidence interval. A positive \u0026beta; indicates a higher CHB disease management knowledge score relative to the reference category. Reference categories: female (sex), not married (marital status), not employed (employment), not born in Hong Kong (birthplace), no chronic disease, not insured, no family doctor, no recent doctor visit (\u0026gt;\u0026thinsp;1 year), did not discuss HBV testing with doctor, not vaccinated, does not live alone, does not know someone with CHB, and no stigma (score\u0026thinsp;=\u0026thinsp;0). \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (*) was considered statistically significant. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.10 (\u0026dagger;) was considered borderline significance and interpreted as a trend.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eFactors Associated with Stigma towards CHB\u003c/h2\u003e\n \u003cp\u003eBinary logistic regression was conducted to identify predictors of perceived CHB\u0026ndash;related stigma (defined as a score\u0026thinsp;\u0026ge;\u0026thinsp;1). Stigma was negatively associated with being married, employed, or living with others, and positively associated with insurance status. Significant predictors included living alone (OR\u0026thinsp;=\u0026thinsp;0.08, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), being married (OR\u0026thinsp;=\u0026thinsp;0.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037), being employed (OR\u0026thinsp;=\u0026thinsp;0.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041), being born in Hong Kong (OR\u0026thinsp;=\u0026thinsp;0.14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), and having health insurance (OR\u0026thinsp;=\u0026thinsp;3.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018). The results were summarized in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLogistic Regression Predicting Presence of CHB\u0026ndash;Related Stigma\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.99, 1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.34, 2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLives alone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ndash;2.57\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.01, 0.53)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.08\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ndash;1.64\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.04, 0.87)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.44, 1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ndash;1.27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.08, 0.91)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBorn in Hong Kong\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ndash;2.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.03, 0.49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004 **\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.44, 4.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows someone with CHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.52, 4.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsured\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u0026thinsp;1.25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e(1.28, 10.38)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018 *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHas family doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.84, 6.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecent doctor visit (\u0026lt;\u0026thinsp;1 year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.49, 9.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor discussed HBV testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.03, 1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.41, 4.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge score (0 to 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.66, 1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eModel summary\u003c/strong\u003e: Residual deviance\u0026thinsp;=\u0026thinsp;116.78 on 93 degrees of freedom, AIC\u0026thinsp;=\u0026thinsp;148.78\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e. \u0026beta; represents the log odds coefficient from logistic regression. OR\u0026thinsp;=\u0026thinsp;odds ratio, calculated as exp(\u0026beta;). A positive \u0026beta; indicates higher odds of reporting stigma (score\u0026thinsp;\u0026ge;\u0026thinsp;1) relative to the reference category. Reference categories: female (sex), not married (marital status), not employed (employment), not born in Hong Kong (birthplace), no chronic disease, not insured, no family doctor, no recent doctor visit (\u0026gt;\u0026thinsp;1 year), doctor has not discussed HBV testing, not vaccinated, does not live alone, does not know someone with CHB. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (*) was considered statistically significant. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (**) was considered highly significant.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eSatisfaction Toward HBsAg POC Testing\u003c/h2\u003e\n \u003cp\u003eParticipant satisfaction with the HBsAg POC testing process was high across multiple domains, as summarized in Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e. Participants reported particularly strong agreement regarding the convenience of testing (9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 out of 10), and the immediacy of test results (9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 out of 10). Confidence in the test results was similarly strong (9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 out of 10). Participants also agreed that on-site POC testing contributed positively to their relationship with healthcare professionals (8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 out of 10). Notably, agreement with the statement that \u0026ldquo;laboratories have better hygiene standards than point-of-care testing\u0026rdquo; was relatively low (4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 out of 10). This indicates that participants did not perceive a significant difference in hygiene standards between the two settings.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab6\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of HBsAg POC testing satisfaction questionnaire (n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAreas\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatements\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean score (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian score (range)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollection\u003c/p\u003e\n \u003cp\u003eprocess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI would rather have blood taken by finger rick than by needle in my arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.6 (\u0026plusmn;\u0026thinsp;2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConfidence in\u003c/p\u003e\n \u003cp\u003ethe process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaboratories have better hygiene processes than point-of-care testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.4 (\u0026plusmn;\u0026thinsp;3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConfidence in\u003c/p\u003e\n \u003cp\u003ethe results\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI have confidence in the information given the results by my physician or\u003c/p\u003e\n \u003cp\u003epractice regarding my on-site point-of-care HBsAg test result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.1 (\u0026plusmn;\u0026thinsp;1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (5\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConvenience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot having to travel to an outside laboratory would be convenient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.4 (\u0026plusmn;\u0026thinsp;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (5\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutside pathology laboratories involve extra time and transport costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.7 (\u0026plusmn;\u0026thinsp;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDisease\u003c/p\u003e\n \u003cp\u003emanagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaving immediate feedback on the test result for my condition was\u003c/p\u003e\n \u003cp\u003eimportant as it allowed/would allow me to discuss the management of\u003c/p\u003e\n \u003cp\u003emy condition with healthcare professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.5 (\u0026plusmn;\u0026thinsp;0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (6\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn-site HBsAg point-of care-testing strengthened/would strengthen my\u003c/p\u003e\n \u003cp\u003erelationship with healthcare professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.8 (\u0026plusmn;\u0026thinsp;1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (4\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eThe score ranges from 0 (completely disagree) to 10 (completely agree) for all statements. The higher the score the higher.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides important insights in terms of public knowledge, attitudes, stigma, and satisfaction with HBsAg POC testing in a primary healthcare setting in Hong Kong.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eCHB-Related Knowledge and Associated Factors\u003c/h2\u003e\u003cp\u003eParticipants demonstrated fair overall knowledge of CHB, with better understanding of complications and prevention but notable misconceptions in disease transmission. Many misunderstood sexual transmissions or believed in non-transmissible routes such as food sharing or genetic inheritance, suggesting disease knowledge confusion with hepatitis A or E. Awareness of CHB\u0026rsquo;s incurability was also limited. Prior studies echo similar knowledge deficits. For example, a United States study among Asians found many believed HBV could be inherited or spread through food, while fewer recognized links to liver cancer or treatability.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Multivariable analysis found that being born in Hong Kong and knowing someone with CHB were significant predictors of higher knowledge. Positive trends were also observed among those vaccinated, who had discussed HBV testing with doctors, or lived alone. Interestingly, education and insurance status were not significantly associated with knowledge of CHB. This suggests other contextual or system-level influences may play a greater role in CHB knowledge acquisition in Hong Kong.\u003c/p\u003e\u003cp\u003eMales scored lower in disease management, which may reflect fewer encounters with HBV-related care. A 2022 study in Australia also reported high HBV knowledge among recently pregnant women.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e In Hong Kong, antenatal HBV screening is a standard practice, and new mothers are often required to bring their infants to clinics for the second and third doses of the HBV vaccine.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e These repeated interactions with the healthcare system may reinforce HBV-related knowledge among women. Leveraging maternal care and reproductive health services to strengthen CHB literacy presents a valuable opportunity. Meanwhile, male-targeted education strategies should be developed to address potential knowledge gaps and ensure more equitable health literacy across genders.\u003c/p\u003e\u003cp\u003eThese results have clear implications for public health policy. In Hong Kong, as an intermediate endemicity region with a well-developed primary healthcare system, enhancing public knowledge through evidence-based education campaigns is crucial to improving screening uptake and early detection. Multi-channel education efforts including primary healthcare should correct misconceptions and normalize HBV discussions. Frontline providers should be equipped with materials to reinforce awareness, aligning with the \u003cem\u003eHong Kong Viral Hepatitis Action Plan 2020\u0026ndash;2024\u003c/em\u003e.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eFacilitators of Screening and Linkage to Care\u003c/h2\u003e\u003cp\u003eParticipants demonstrated a strong willingness to undergo screening when tests were free and recommended by doctors. Personal connection with someone with CHB modestly increased screening intention. These findings support embedding free HBV testing in primary healthcare settings to lower structural barriers and enhance screening uptake. Encouragingly, all participants expressed willingness to engage in follow-up care if diagnosed, highlighting the importance of integrating testing with clear referral mechanisms, public subsidy schemes, and patient education to support successful linkage-to-care. The combination of high screening interest and strong intent to seek care reinforces the feasibility of POC-based HBV screening in Hong Kong. These findings support the feasibility of embedding free HBV testing services within primary healthcare settings to lower structural barriers and enhance screening uptake. Notably, the Hong Kong government has announced plans to implement hepatitis B screening in primary healthcare through DHCs, as stated in the 2024 Policy Address.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Our data provides timely evidence supporting this policy direction, demonstrating strong public receptivity to testing and identifying key facilitators of successful screening and linkage to care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eInfluence of Family Doctors\u003c/h2\u003e\u003cp\u003eAlthough participants indicated they would follow a doctor\u0026rsquo;s advice to test, only 7.3% reported previous discussions on HBV testing with their physicians. This reflects a missed opportunity for early case identification and linkage to care in Hong Kong\u0026rsquo;s primary healthcare system, where 64.9% reported having a regular family doctor. Evidence from international studies reinforces the critical role of primary healthcare providers in driving HBV screening uptake. Studies found doctors were the most common reason for testing among screened individuals, but provider engagement remains suboptimal even in high-risk populations.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These findings mirror local observations and suggest a passive HBV screening approach limits the reach and effectiveness of existing control strategies. Integrating HBV screening in primary healthcare settings could greatly expand its reach. Family doctors should be supported to proactively identify high-risk individuals, while community pharmacists and nurses can help raise awareness and improve access. Leveraging these trusted providers through a multidisciplinary approach will be key to enhancing screening uptake, ensuring linkage to care, and advancing HBV elimination goals under \u003cem\u003ethe Hong Kong Viral Hepatitis Action Plan 2020\u0026ndash;2024\u003c/em\u003e.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eLow Stigma and Its Role in Facilitating Screening\u003c/h2\u003e\u003cp\u003eOur cohort reported notably low levels of CHB-related stigma in Hong Kong. This contrasts with findings from the United States and mainland China, where stigma included fears of shame, job loss, and relationship concerns.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In Hong Kong, the more accepting social context may promote greater willingness to screen and disclose infection status. Logistic regression showed that being married, employed, or living with others was associated with lower stigma, while having insurance was linked to higher stigma, possibly due to disclosure concerns. Unlike in some countries such as the United States, where insurance coverage is more widely available or employer-based schemes are common, Hong Kong does not offer universal health insurance. Only 49.7% have employer or self-paid medical insurance.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e This unique context may influence how individuals perceive stigma and privacy concerns in accessing care. Cultural and social context, rather than education or healthcare access, appeared more predictive of stigma in Hong Kong. These findings support continued stigma reduction efforts through primary healthcare engagement and public education.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eHigh Satisfaction with HBsAg POC Testing in Primary Healthcare Setting\u003c/h2\u003e\u003cp\u003eTo our knowledge, this is the first study to evaluate the satisfaction of HBsAg POC testing in HBV screening. Participants reported high levels of satisfaction with HBsAg POC testing, particularly regarding convenience, immediacy, and facilitation of dialogue with providers. This mirrors findings from POC use in chronic disease management, where patients valued speed, confidence, and enhanced provider communication.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e These results justify broader implementation of HBsAg POC testing in primary healthcare, especially in DHCs and community-based settings such as community pharmacies. By streamlining access and reducing barriers, POC testing could improve early detection and linkage-to-care, supporting HBV elimination targets.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eLimitations of the study\u003c/h2\u003e\u003cp\u003eThis study was limited by sampling from one district and an older, health-conscious participant pool, limiting generalizability. The absence of a control group precluded direct comparisons with standard care. Additionally, the questionnaire did not explicitly state that CHB treatment is typically long-term or lifelong. As a result, participants\u0026rsquo; reported willingness to initiate treatment may not reflect real-world adherence if the chronic nature of therapy were fully understood. Broader sampling across districts and comparative studies are recommended.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eFuture Research Direction\u003c/h2\u003e\u003cp\u003eFuture studies should evaluate long-term clinical outcomes of early detection and linkage-to-care by HBsAg POC testing, its cost-effectiveness, and how best to integrate it into broader screening initiatives. Further investigation into the role of family doctors is crucial. Understanding barriers to discussing HBV screening in routine consultations and developing strategies to enhance their involvement in preventive care could increase screening uptake.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides valuable insights into the knowledge, attitudes, and satisfaction regarding HBV screening in Hong Kong. While participants demonstrated fair overall knowledge, significant gaps remain, particularly in understanding transmission modes and the incurability of CHB. The study also highlights the positive impact of low stigma in encouraging screening uptake and the crucial role family doctors can play in promoting screening. High satisfaction with HBsAg POC testing, particularly regarding its convenience and rapid results, underscores the potential for integrating POC testing into routine screening programs. In conclusion, addressing knowledge gaps, encouraging family doctor involvement, and expanding access to HBsAg POC testing are essential steps in improving HBV screening and prevention efforts in Hong Kong. These findings provide early real-world evidence supporting the Hong Kong SAR government\u0026rsquo;s plan to implement HBV screening in primary healthcare and offer insight into how future programs can be optimized for success.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Term\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAkaike Information Criterion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eC\u0026amp;W DHCE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCentral and Western District Health Centre Express\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChronic Hepatitis B\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConfidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eeHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eElectronic Health Record\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHBV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHepatitis B Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHBsAg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHepatitis B Surface Antigen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHepatocellular Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHKU/HA HKW IRB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInstitutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIRB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInstitutional Review Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIU/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInternational Units per Millilitre\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLTCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLinkage-to-care Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOdds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoint-of-Care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQMH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQueen Mary Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) under approval number UW 24-542. The study adheres to the principles outlined in the Declaration of Helsinki, ensuring the ethical conduct of research involving human subjects. Written informed consent was obtained from all participants prior to their enrolment. Confidentiality and data privacy were strictly maintained, with all identifiable information anonymized in compliance with data protection regulations.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person\u0026rsquo;s data in any form.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eDe-identified individual participant data that underlie the findings of this study (including text, tables, and figures), along with the data dictionary and study protocol, will be made available from the corresponding author upon reasonable request. Data will be available beginning at the time of publication with no set end date. Access will be granted to researchers with a methodologically sound proposal, subject to approval and a signed data access agreement.\u003c/p\u003e\n\u003cp\u003eCompeting Interest declaration\u003c/p\u003e\n\u003cp\u003eM.T.L. is a member of the Task Group on Guideline Formulation for Community Pharmacy under the Primary Healthcare Commission, Health Bureau, Hong Kong SAR Government, representing The University of Hong Kong. The Task Group contributes to setting guidelines and standards for community pharmacy services, including hepatitis B management in primary care. This role is unpaid and does not pose any financial conflict. All other authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eM.T.L. conceptualized the study, designed the methodology, coordinated the project, and led the investigation. M.F.Y., C.L.C. and L.L.Y.M. provided academic supervision and oversight throughout the project. J.S.H.L. and S.S.Y.Y. coordinated and supervised the implementation of point-of-care HBsAg testing at the Central and Western District Health Centre Express. \u0026nbsp;M.T.L. and J.V.H.T. conducted the literature search and contributed to questionnaire development and manuscript drafting. M.T.L. and V.K.C.C. were responsible for data curation and acquisition. M.T.L. and L.L.Y.M. wrote the original draft. All authors contributed to writing by review and editing. M.T.L. and S.S.Y.Y. had full access to and verified the underlying data reported in the manuscript. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the C\u0026amp;W DHCE for their support in patient recruitment and provision of HBsAg POC testing kits. Special thanks to Professor Anna S.F. Lok and her team for sharing the validated Chinese-language questionnaire used in previous studies. Written consent has been obtained from them to be acknowledged. The author used ChatGPT (GPT-4, OpenAI, accessed via ChatGPT Plus on web) to assist with improving readability and language clarity in the manuscript. All AI-generated content was reviewed and edited by the authors to ensure accuracy and appropriateness.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information\u003c/p\u003e\n\u003cp\u003eM.T.L.: Senior Pharmacist, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eJ.S.H.L.: Project Coordinator, Central and Western District Health Centre Express, operated by The Hong Kong Society for Rehabilitation, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eJ.V.H.T.: Senior Research Assistant, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eS.S.Y.Y.: Care Coordinator, Central and Western District Health Centre Express, operated by The Hong Kong Society for Rehabilitation, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eV.K.C.C.: Research Assistant, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eM.F.Y.:\u0026nbsp;Chair Professor and Chief of Division of Gastroenterology and Hepatology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eC.L.C.: Associate Professor, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China\u003c/p\u003e\n\u003cp\u003eL.L.Y.M.: Clinical Assistant Professor, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. L.L.Y.M. is the corresponding author and her email is [email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e \u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. \u003cem\u003eGlobal Hepatitis Report 2024\u003c/em\u003e. Geneva, Switzerland: World Health Organization; 2024. Accessed April 19, 2025. https://www.who.int/publications/i/item/9789240085886.\u003c/li\u003e\n \u003cli\u003eCornberg M, Sandmann L, Jaroszewicz J, et al. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. \u003cem\u003eJ Hepatol\u003c/em\u003e. 2025. doi:10.1016/j.jhep.2025.03.018.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. \u003cem\u003eGuidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection\u003c/em\u003e. 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Published 2024 Dec 29. doi:10.3390/v17010034\u003c/li\u003e\n \u003cli\u003eKhuroo MS, Khuroo NS, Khuroo MS. Accuracy of Rapid Point-of-Care Diagnostic Tests for Hepatitis B Surface Antigen-A Systematic Review and Meta-analysis. \u003cem\u003eJ Clin Exp Hepatol\u003c/em\u003e. 2014;4(3):226-240. doi:10.1016/j.jceh.2014.07.008\u003c/li\u003e\n \u003cli\u003eXiao Y, Thompson AJ, Howell J. Point-of-Care Tests for Hepatitis B: An Overview. \u003cem\u003eCells\u003c/em\u003e. 2020;9(10):2233. doi:10.3390/cells9102233\u003c/li\u003e\n \u003cli\u003eMartyn E, O\u0026apos;Regan S, Harris P, et al. Hepatitis B virus (HBV) screening, linkage and retention-in-care in inclusion health populations: Evaluation of an outreach screening programme in London. \u003cem\u003eJ Infect\u003c/em\u003e. 2024;88(2):167-172. doi:10.1016/j.jinf.2023.12.012\u003c/li\u003e\n \u003cli\u003eLaurence CO, Gialamas A, Bubner T, et al. Patient satisfaction with point-of-care testing in general practice. \u003cem\u003eBr J Gen Pract\u003c/em\u003e. 2010;60(572):e98-e104. doi:10.3399/bjgp10X483508\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Determine\u0026trade; HBsAg 2 \u0026ndash; Product Detail. WHO Prequalification of In Vitro Diagnostics Programme. Published 2019. Accessed May 25, 2025. https://extranet.who.int/prequal/vitro-diagnostics/0451-013-00\u003c/li\u003e\n \u003cli\u003eCheng S, Li E, Lok AS. Predictors and Barriers to Hepatitis B Screening in a Midwest Suburban Asian Population. \u003cem\u003eJ Community Health\u003c/em\u003e. 2017;42(3):533-543. doi:10.1007/s10900-016-0285-4\u003c/li\u003e\n \u003cli\u003eAhad M, Wallace J, Xiao Y, et al. Hepatitis B and pregnancy: understanding the experiences of care among pregnant women and recent mothers in metropolitan Melbourne. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2022;22(1):817. doi:10.1186/s12889-022-13112-0\u003c/li\u003e\n \u003cli\u003eViral Hepatitis Control Office, Department of Health. \u003cem\u003eMother-to-child Transmission of Hepatitis B\u003c/em\u003e. Hong Kong SAR: Government of the Hong Kong Special Administrative Region. Published 2023. Accessed May 25, 2025. https://www.hepatitis.gov.hk/english/mtct/maternal_transmission_of_hepatitis_b.html.\u003c/li\u003e\n \u003cli\u003eViral Hepatitis Control Office, Department of Health. \u003cem\u003eHong Kong Viral Hepatitis Action Plan 2020\u0026ndash;2024\u003c/em\u003e. Hong Kong SAR: Government of the Hong Kong Special Administrative Region. 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Understanding stigma and attitudes towards hepatitis B among university students in Australia of Chinese and Vietnamese background. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2024;24(1):2801. doi:10.1186/s12889-024-20226-0\u003c/li\u003e\n \u003cli\u003eHuang J, Guan ML, Balch J, et al. Survey of hepatitis B knowledge and stigma among chronically infected patients and uninfected persons in Beijing, China. \u003cem\u003eLiver Int\u003c/em\u003e. 2016;36(11):1595-1603. doi:10.1111/liv.13168\u003c/li\u003e\n \u003cli\u003eCensus and Statistics Department. \u003cem\u003eThematic Household Survey Report No. 78: Provision of Medical Benefits by Employers/Companies and Coverage of Individually Purchased Medical Insurance\u003c/em\u003e. Hong Kong SAR: Government of the Hong Kong Special Administrative Region; 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic Hepatitis B, Hepatitis B Virus, Point-of-Care Testing, HBsAg Screening, Primary Healthcare, Knowledge, Attitude, Stigma, Satisfaction, Hong Kong","lastPublishedDoi":"10.21203/rs.3.rs-7442621/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7442621/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eChronic hepatitis B (CHB) remains a significant public health challenge in Hong Kong, with an estimated prevalence of 5.6%. Despite effective antiviral therapy, screening uptake remains suboptimal. This study evaluated the feasibility of hepatitis B surface antigen (HBsAg) point-of-care (POC) testing in primary healthcare setting and assessed participants\u0026rsquo; knowledge, attitudes, stigma and satisfaction.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted between September 2024 and May 2025 at the Central and Western District Health Centre Express, a government-initiated primary healthcare facility in Hong Kong. A total of 109 adults received HBsAg POC testing using the Abbott Determine\u0026trade; HBsAg 2 rapid test kit and completed a structured questionnaire assessing demographics, CHB knowledge, perceived stigma, screening facilitators and barriers, and satisfaction. Regression analyses were performed to identify predictors of knowledge and stigma.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eParticipants demonstrated generally good CHB knowledge about CHB (mean score\u0026thinsp;=\u0026thinsp;11.7 / 16), yet gaps remained in understanding transmission and incurability. Higher knowledge was associated with being born in Hong Kong and knowing someone with CHB. Males had lower knowledge in disease management. Perceived stigma was low overall (mean score\u0026thinsp;=\u0026thinsp;0.57 / 5). Being married, employed, or living with others were protective factors, whereas having health insurance was linked to higher stigma. Participants expressed high satisfaction with the POC testing process, particularly its convenience and immediacy of results. All participatns were willing to be tested if recommended by doctors, yet only 7.3% reported prior discussion about HBV testing with their physicians.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eOverall knowledge on chronic hepatitis B is satisfactory with some groups having a higher disease knowledge. Misconceptions about transmission and curability remain. HBsAg POC testing was feasible and highly acceptable in primary healthcare setting in Hong Kong. Findings highlight the importance of empowering family doctors to initiate screening discussions and addressing specific knowledge gaps through targeted education. These strategies could improve screening uptake and support Hong Kong\u0026rsquo;s progress toward CHB elimination goals.\u003c/p\u003e","manuscriptTitle":"Feasibility on Point-of-Care Testing and Knowledge, Attitudes, and Satisfaction of Patients on Chronic Hepatitis B in Primary Healthcare: A Pilot Study in Hong Kong","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 09:32:50","doi":"10.21203/rs.3.rs-7442621/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-09T10:27:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7784112807922190254039941601835677343","date":"2025-10-06T01:48:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T09:16:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-04T16:55:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-04T03:06:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T02:45:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-09-04T02:41:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d956036-38e6-41fe-86ae-91605843ad43","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T09:32:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 09:32:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7442621","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7442621","identity":"rs-7442621","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}