Clinical Profile and Limitations in the Management of HBV Patients Attending Clinic at a District Hospital in Ghana

Abstract

Background. Chronic hepatitis B (CHB) is estimated to cause between 500,000 and 1.2 million deaths worldwide every year through cirrhosis and hepatocellular carcinoma (HCC). Liver cirrhosis and HCC are the commonest liver diseases causing death in Ghana. The most critical problem in the management of CHB in sub-Saharan Africa is the high cost of investigations and antiviral drugs. There is scanty information concerning newly diagnosed CHB patients and their management challenges in Ghana. This study sought to determine the clinical characteristics and management challenges of CHB patients in Ghana. Methodology. A prospective cohort study was conducted involving newly diagnosed CHB patients being managed at St. Dominic Hospital. Patient demographic and clinical features were abstracted using a standardized questionnaire. The proportion of patients able to undertake investigations and treatment were determined, and the limitations to standard management were recorded. The performance of APRI score in the diagnosis of cirrhosis was also investigated. Results. Of the 334 patients with newly diagnosed CHB, the median age at diagnosis was 35 (IQR 28–44) years. Less than a quarter (22.2%) were able to undertake viral load testing and 23.4% were eligible for treatment. Of those who were eligible for treatment, only 42.3% were able to initiate treatment. Almost a third of cases (32.1%) reported late with liver-related complications. The sensitivity of APRI score with cut-off value of 2 in the diagnosis of liver cirrhosis was 70.2% and specificity was 97.9%. Conclusion. A high proportion of newly diagnosed CHB patients presented late and with liver-related complications. Majority were not able to afford viral load testing and antiviral medication. Screening of hepatitis B among the general population and inclusion of CHB management in the National Health Insurance Scheme should be encouraged.

HBV and HCV prevalence and treatment eligibility assessment at a primary health facility in Ghana

“…The situation in Ghana is similar, according to the Polaris Observatory Network, as at 2022 Ghana had a CHB population of 2,769,000, of which only 0.7% had been diagnosed (Polaris Observatory Collaborators et al, 2023). Most HBV patients in Ghana and most African countries would remain undiagnosed because CHB is mostly asymptomatic and patients would usually present late to the hospital CHB complications arise (Duah & Nartey, 2023; Spearman et al, 2023). In Ghana, HBV screening is usually undertaken at health facilities, mostly based on risk assessment and supplemented by community-based testing undertaken by non-governmental organisations (Nartey et al, 2022).…”

“…The Ghanaian treatment guideline developed in 2014 stipulates treatment for all patients with HBV-related cirrhosis and fibrosis (APRI > 2) with detectable viraemia and chronic active hepatitis, that is persistently elevated ALT (> 2x ULN) (ULN not defined) and viraemia of ≥ 20,000 IU/ irrespective of HBeAg status. However, A recent study at a primary health centre in the Eastern Ghana reported a significant number of patients were unable perform viral load, an essential component in the Ghanaian guideline (Duah & Nartey, 2023). Would the adoption of a simple, yet sensitive guideline like TREAT-B in Ghana, especially at the primary health care level result in reducing the burden of CHB complications?…”