Ultrasound-Guided Antiviral Therapy for Chronic Hepatitis B in Low-Resource Settings – The PUSH Protocol

Discover the innovative PUSH protocol using point-of-care ultrasound (POCUS) to optimize antiviral therapy initiation for chronic hepatitis B (CHB) in low-resource settings. This streamlined, cost-effective approach addresses barriers like limited access to elastography and viral load testing by utilizing B-mode ultrasound to detect liver complications, including cirrhosis and hepatocellular carcinoma (HCC). Designed for implementation by frontline clinicians, the PUSH protocol employs three sonographic windows to identify key markers such as surface nodularity, coarse echotexture, altered vascularity, and caudate lobe enlargement. It enables accurate, same-day treatment decisions, significantly enhancing CHB management in resource-limited environments. This prospective observational study highlights the feasibility and effectiveness of training clinicians to use this protocol with high concordance rates compared to experienced sonographers. The study’s findings show that patients with ultrasound-detected liver complications often exhibit more severe clinical symptoms and elevated liver function tests, underscoring the protocol’s value in guiding therapy. With the potential to improve access to CHB care, reduce HBV-related deaths, and integrate ultrasound into hepatitis programs, the PUSH protocol is a pivotal step forward in global health.