Cross-sectional study of chronic hepatitis B virus infection in Rwandan high-risk groups: unexpected findings on prevalence and its determinants

Abstract

ObjectivesUsing secondary data from 208 079 Rwandans, we determined the prevalence of chronic hepatitis B virus (HBV) infection among high-risk groups and its demographic, geographical and health-related determinants.DesignIn this cross-sectional study, we obtained and analysed data from a national hepatitis B vaccination and screening campaign conducted in Rwanda in 2017. We performed logistic regression to examine associations between chronic HBV infection and related factors such as risk status and geographical characteristics.SettingIndividuals were sampled nationally in all 30 districts across 4 provinces and the city of Kigali and all prisons in Rwanda.ParticipantsThe study involves 208 079 individuals at high risk including prisoners and other high-risk groups (oHRG).Main outcomeThe primary outcome for our study was hepatitis B surface antigens (HBsAg) prevalence.FindingsFrom 208 079 adults participants, 206 517 (99.2%) had valid HBsAg results, 4.3% of 64 944 prisoners and 4.0% of 140 985 oHRG were HBV positive. The prevalence was higher in Northern Province 5.1%, (95% CI 4.8 to 5.4). In multivariate analysis, the odds of infection decreased with increasing age, and hepatitis C antibody positivity reduced the odds for chronic HBV (OR 0.58, 95% CI 0.52 to 0.66 and OR 0.74, 95% CI 0.62 to 0.89 among oHRG and prisoners, respectively). In addition, being female was associated with lower odds of HBV (OR 0.70, 95% CI 0.66 to 0.74 and OR 0.80, 95% CI 0.65 to 0.98 among oHRG and prisoners, respectively).ConclusionWe found that individuals below 55 years of age and individuals who belong to high-risk groups (ie, sex workers, injection drug users, men who have sex with men, etc) have a higher probability of chronic HBV infection. Infection with chronic hepatitis C virus was not correlated with chronic HBV infection in our study population. Potential explanations include differential routes of transmission, specific immunological and pathophysiological factors or different effects of health prevention and control programmes.

Prevalence of Hepatitis B Virus Infection among Inmates at the Monrovia Central Prison, Liberia

“…It is noteworthy that the sample size of this study was smaller as compared to those of the Ghana and Nigeria studies cited [ 19 , 20 , 21 ]. In general, however, the HBV prevalence in Liberia may be truly lower, but it was higher when compared with the prevalence from similar studies conducted in Rwanda or India, which reported a prevalence of 4.3% [ 23 ] and 8% [ 24 ], respectively. Furthermore, an extremely low prevalence of 0.9% has been reported among jail inmates in the USA [ 15 ], which could be attributed to the institutionalized measures of infection prevention and control programs besides the other interventions in place in American correctional facilities [ 25 ].…”

Prevalence and risk factors associated with hepatitis B and C infection among patients with Non- Communicable Diseases in three rural Rwandan districts: A retrospective cross-sectional study

“…Furthermore, because NCD patients are already in regular contact with the healthcare system, they may be more easily mobilized for screening and linkage to treatment compared to other high-risk populations. Although Rwanda has conducted limited targeted screening among people living with human immunode ciency virus(HIV), pregnant women(8, 19),prisoners, sex workers, injection drug users, and men who have sex with men(MSM) (20), NCD patients are not currently targeted for hepatitis screening by the national Rwandan hepatitis program. In this context, our team implemented a targeted HBV and HCV screening among patients with NCDs in rural setting.…”