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Alex Stockdale

@alexstockdale.bsky.social

490 followers 500 following 43 posts

Senior Clinical Lecturer in Infectious Diseases at the University of Liverpool and Malawi Liverpool Wellcome Research Programme. Epidemiology, virology and implementation science. Interested in eliminating hepatitis B as a public health threat in Africa.

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Alex Stockdale @alexstockdale.bsky.social · Aug 19

Hepatitis B care must be overhauled to meet WHO 2030 elimination targets

news.liverpool.ac.uk/2025/08/19/g...

Global study warns hepatitis B care must be overhauled to meet WHO 2030 elimination targets - University of Liverpool News

Global study warns hepatitis B care must be overhauled to meet WHO 2030 elimination targets

news.liverpool.ac.uk

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Alex Stockdale @alexstockdale.bsky.social · Aug 18

Denial, anger, bargaining, depression and acceptance?

Alex Stockdale @alexstockdale.bsky.social · Aug 17

@worldhepalliance.bsky.social

Alex Stockdale @alexstockdale.bsky.social · Aug 17

8/ HBV antiviral treatment prevents HCC and improves survival- and is cheap and effective. We need urgent improvements to our service delivery to address a leading cause of liver related death globally.

Alex Stockdale @alexstockdale.bsky.social · Aug 17

7/ our care cascade shows huge losses at every step of patient care and we need to learn how to do it better- learning from HIV care. Implementation research, better training and equipping of primary or decentralised care is needed to promote access to care

Alex Stockdale @alexstockdale.bsky.social · Aug 17

6/ some innovative community models linked to dedicated research clinics had very good rates of assessment and treatment initiation but the long term outcomes are lacking.

Alex Stockdale @alexstockdale.bsky.social · Aug 17

5/ really serious losses observed in linking pregnant women to HBV care after delivery- 56·9% (40·2–72·1; I2=98·8%) linked to care (five cohorts) and when community screening led to self-directed care (without follow up arrangements) 33·2% (23·1–45·1; I2=98·6%)

Alex Stockdale @alexstockdale.bsky.social · Aug 17

4/ retention in care is a real problem and especially among patients not started on antiviral treatment - RR 1·72 [95% CI 1·16–2·54]; p=0·019 for retention in care for those on AVT vs not

Alex Stockdale @alexstockdale.bsky.social · Aug 17

3/ 12% don’t commence antiviral therapy when eligible, again it is worse in primary or co-managed care

Alex Stockdale @alexstockdale.bsky.social · Aug 17

2/ over 15% don’t complete an assessment of their treatment eligibility in specialist care and it is worse in co-managed and primary care.

Alex Stockdale @alexstockdale.bsky.social · Aug 17

Our review just published in Lancet Gastro Hepatology. We looked at outcomes across the care cascade for people living with hepatitis B and found some serious gaps in care provision. We need to do better #hepsky #idsky #liversky. www.thelancet.com/journals/lan...

Service delivery models and care cascade outcomes for people living with chronic hepatitis B: a global systematic review and meta-analysis

Considerable attrition was seen across the chronic hepatitis B care cascade, with low rates of retention especially in patients not on antiviral therapy. Assessment for treatment eligibility and initi...

www.thelancet.com

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Alex Stockdale @alexstockdale.bsky.social · Jul 2

Never let excel get anywhere near dates! It’s a menace

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Alex Stockdale @alexstockdale.bsky.social · Jun 14

Introducing sumvar for R. A package to rapidly summarise and visualise variables with one-line commands, bringing the brilliant tab and sum functions from stata, to R. Install it from cran using install.packages(“sumvar”). #rstats

alstockdale.github.io/sumvar/

Summarise Continuous and Categorical Variables, Check for Duplicates and Missing Data

The sumvar package quickly explores continuous and categorical variables. sumvar aims to bring the ease and simplicity of the "sum" and "tab" functions from stata, to R.

alstockdale.github.io

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Alex Stockdale @alexstockdale.bsky.social · May 10

They did emphasise shared decision making which is a great idea

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Alex Stockdale @alexstockdale.bsky.social · May 10

Much clearer, simpler and easier to implement in practice. A job well done

Alex Stockdale @alexstockdale.bsky.social · May 10

But for HBeAg positive young people, no recommendation for treatment, given a lack of strong evidence of benefit

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Alex Stockdale @alexstockdale.bsky.social · May 10

Elevated ALT and HBV DNA >2000, or LSM>8kPa and detectable HBV DNA are the main criteria, liberalising treatment thresholds.

Alex Stockdale @alexstockdale.bsky.social · May 10

A packed conference room to hear about the new HBV treatment guidelines from #EASL2025

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Alex Stockdale @alexstockdale.bsky.social · May 6

What are the three platforms?

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Alex Stockdale @alexstockdale.bsky.social · Feb 28

Demonise and Oppress Government Employees

Alex Stockdale @alexstockdale.bsky.social · Feb 27

7. Presently the birth dose vaccination coverage in the WHO African region is just 18%. We aim to assess in The Gambia and Malawi the effectiveness, cost-effectiveness, feasibility and safety if tenofovir alone is enough, in settings with low birth dose coverage, in our study starting this year.

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Alex Stockdale @alexstockdale.bsky.social · Feb 27

6. With enough coverage of birth dose vaccination and maternal antiviral prophylaxis we estimate the we could reduce vertical transmission to <0.1%, achieving the WHO elimination targets. The question is- is tenofovir alone effective when birth dose vaccination coverage is low?

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Alex Stockdale @alexstockdale.bsky.social · Feb 27

5. We’ll also need antiviral prophylaxis with tenofovir- cheap, effective and safe in pregnancy- for women with high viral loads (>200,000 IU/ml). The challenge is access to viral load testing. New WHO guidelines recommend a treat-all policy in pregnancy when viral load testing is unavailable.

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Alex Stockdale @alexstockdale.bsky.social · Feb 27

4. Vaccine coverage is an important part of the solution but it’s not enough- data from Cameroon show that even with timely birth dose, over 30% women with high viral loads continue to experience vertical transmission.

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Alex Stockdale @alexstockdale.bsky.social · Feb 27

3. We found a depressingly slow reduction in vertical transmission events, from a peak of 339,000 (149,000- 634,000) in 2001 to 172,000 (82,000-383,000) in 2022. That’s still 0.4% of live births having hep B vertical transmission almost 40 years after development of an effective vaccine.

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