Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study

Lemoine, Maud; Shimakawa, Yusuke; Njie, Ramou; Taal, Makie; Ndow, Gibril; Chemin, Isabelle; Ghosh, Sumantra; Njai, Harr Freeya; Jeng, Adam; Sow, A.I.; Touré-Kâne, Coumba; Mboup, Souleymane; Suso, Penda; Tamba, Saydiba; Jatta, Abdullah; Sarr, Louise; Kambi, Aboubacar; Stanger, William; Nayagam, Shevanthi; Howell, Jessica; Mpabanzi, Liliane; Nyan, Ousman; Corrah, Tumani; Whittle, Hilton; Taylor-Robinson, Simon D; D’Alessandro, Umberto; Mendy, Maimuna; Thursz, Mark

doi:10.1016/s2214-109x(16)30130-9

Cited by 150 publications

(227 citation statements)

References 29 publications

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“…A recent review article reported HIV/HBV co-infection in the range 5.0–8.3% in East Africa and 2.7–35.7% in West Africa [29]. However, the only previous study to report HIV/HBV co-infection in an African HBV cohort found a relatively low prevalence of HIV (3.3%) among HBsAg positive individuals in The Gambia [30], in keeping with our findings. Although HIV and HBV share the same transmission routes, most adults with CHB have been infected in early childhood and would not have any increased risk of acquiring HIV later in life [31].…”

Section: Discussionsupporting

confidence: 90%

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

et al. 2017

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BackgroundTreatment for chronic hepatitis B (CHB) is virtually absent in sub-Saharan Africa. Here we present early experiences from a pilot program for treatment of CHB in Ethiopia.MethodsAdults (≥18 years) with CHB were included in a cohort study at St. Paul’s Hospital Millennium Medical College, Addis Ababa, from February 2015. The baseline assessment included liver function tests, viral markers and transient elastography (Fibroscan 402, Echosense, France). Logistic regression models were used to identify predictors of fibrosis. Tenofovir disoproxil fumarate (TDF) was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. The initial 300 patients underwent a more comprehensive evaluation and are presented here.ResultsOne-hundred-and-thirty-eight patients (46.0%) were women and median age was 30 years (interquartile range 26–40). Co-infections were rare: four patients (1.3%) were anti-HCV positive, 11 (3.7%) were anti-HDV positive, whereas 5 (1.7%) had HIV-infection. The majority were hepatitis B e-antigen (HBeAg) negative (n = 262; 90.7%) and had a normal (≤40 U/L) alanine aminotransferase (ALT) (n = 245; 83.1%). Of 268 patients with a valid Fibroscan result, 79 (29.5%) had significant fibrosis (>7.9 kPa). Independent predictors of fibrosis were male sex, age > 35 years and viral load >20,000 IU/ml. In total, 74 patients (24.7%) started TDF therapy, of whom 46 (62.2%) had cirrhosis.ConclusionsThe majority were HBeAg negative and had normal ALT. However, one quarter of the patients were in need of antiviral treatment, underscoring the need to scale up CHB treatment on the African continent.Trial registration NCT02344498 (ClinicalTrials.gov identifier). Registered 16 January 2015.

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Section: Discussionsupporting

confidence: 90%

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

et al. 2017

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“…The [29]. However, the only previous study to report HIV/HBV co-infection in an African HBV cohort found a relatively low prevalence of HIV (3.3%) among HBsAg positive individuals in The Gambia [30], in keeping with our findings. Although HIV and HBV share the same transmission routes, most adults with CHB have been infected in early childhood and would not have any increased risk of acquiring HIV later in life [31].…”

Section: Discussionsupporting

confidence: 91%

Early Experiences from One of the First Treatment Programs for Chronic Hepatitis B in Sub-Saharan Africa

Aberra¹,

Desalegn²,

Berhe³

et al. 2016

Journal of Hepatology

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Background: Treatment for chronic hepatitis B (CHB) is virtually absent in sub-Saharan Africa. Here we present early experiences from a pilot program for treatment of CHB in Ethiopia. Methods: Adults (≥18 years) with CHB were included in a cohort study at St. Paul's Hospital Millennium Medical College, Addis Ababa, from February 2015. The baseline assessment included liver function tests, viral markers and transient elastography (Fibroscan 402, Echosense, France). Logistic regression models were used to identify predictors of fibrosis. Tenofovir disoproxil fumarate (TDF) was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. The initial 300 patients underwent a more comprehensive evaluation and are presented here. Results: One-hundred-and-thirty-eight patients (46.0%) were women and median age was 30 years (interquartile range 26-40). Co-infections were rare: four patients (1.3%) were anti-HCV positive, 11 (3.7%) were anti-HDV positive, whereas 5 (1.7%) had HIV-infection. The majority were hepatitis B e-antigen (HBeAg) negative (n = 262; 90.7%) and had a normal (≤40 U/L) alanine aminotransferase (ALT) (n = 245; 83.1%). Of 268 patients with a valid Fibroscan result, 79 (29.5%) had significant fibrosis (>7.9 kPa). Independent predictors of fibrosis were male sex, age > 35 years and viral load >20,000 IU/ml. In total, 74 patients (24.7%) started TDF therapy, of whom 46 (62.2%) had cirrhosis. Conclusions: The majority were HBeAg negative and had normal ALT. However, one quarter of the patients were in need of antiviral treatment, underscoring the need to scale up CHB treatment on the African continent. Trial registration: NCT02344498 (ClinicalTrials.gov identifier). Registered 16 January 2015.

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“…Two factors were significantly associated with HbsAg: gender and ever having sexual intercourse. The Gambia, a prevalence of 3.1% was found among male blood donors between the ages of 16 and 19 [19]. In addition, the data from the PROLIFICA study indicates that the prevalence of HBsAg positivity increased with age among men from the blood bank and men from the community to reach a peak between 30…”

Section: Discussionmentioning

confidence: 97%

Prevalence of Hepatitis B among Students from the University of Lomé, Togo in 2015

Ekouévi¹,

Thomas²,

Dieudonné³

et al. 2017

OJEpi

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Objective: Hepatitis B virus (HBV) is endemic in sub-Saharan Africa where more than 80 million subjects are chronic carriers. However, screening is not systematic in the population and prevalence data are scarce, especially among the youth population. The objective of this study was to estimate the prevalence of HBV and its correlates among first-year University students at the University of Lomé. Study design: A cross-sectional survey was conducted between November 2015 and January 2016 at the University of Lomé during the annual checkup offered to newly enrolled students. Method: A self-administered questionnaire was used to collect data on demographics and sexual behaviors, and rapid tests were used for the detection of Antigen HB S (HBsAg) and HIV in each participant. A logistic regression model was performed to identify factors associated with HBsAg positivity. Results: A total of 800 students (56.2% were men) were screened among 1505 students who participated in the study. The median age was 20 years (IQR: [18 -21]). The overall prevalence of HBsAg was 4.6% (95% CI: [3.2 -6.3]): 5.8% among men and 3.1% among women (p = 0.04). The prevalence of HIV was 0.8; 95%CI [0.3% -1.6%] and one case (0.1%) of coinfection HIV and HBV was identified. Factors associated with HBsAg positivity were male gender [adjusted Odds Ratio (aOR) = 2.08, 95% CI: 1.02 -5.00, p = 0.0447] and ever having a sexual relationship [aOR = 2.44; 95% CI = 1.11 -5.78, p= 0.0264]. Conclusion: This study among university students demonstrates that the prevalence of HBV is high among this population and that there is a need for prevention programs to target this vulnerable population. This is an additional argument How to cite this paper:

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Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study

Abstract: European Commission (FP7).

Cited by 150 publications

References 29 publications

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

Early Experiences from One of the First Treatment Programs for Chronic Hepatitis B in Sub-Saharan Africa

Prevalence of Hepatitis B among Students from the University of Lomé, Togo in 2015

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Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study

Abstract: European Commission (FP7).

Cited by 150 publications

References 29 publications

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

Early Experiences from One of the First Treatment Programs for Chronic Hepatitis B in Sub-Saharan Africa

Prevalence of Hepatitis B among Students from the University of Lom&#233;, Togo in 2015

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Prevalence of Hepatitis B among Students from the University of Lomé, Togo in 2015