Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia

Abstract

IntroductionWe evaluated antiviral therapy (AVT) eligibility in a population-based sample of adults with chronic hepatitis B virus (HBV) infection in Zambia. Materials and methodsUsing a household survey, adults (18+ years) were tested for hepatitis B surface antigen (HBsAg). Sociodemographic correlates of HBsAg-positivity were identified with multivariable regression. HBsAg-positive individuals were referred to a central hospital for physical examination, elastography, and phlebotomy for HBV DNA, hepatitis B e antigen, serum transaminases, platelet count, and HIV-1/2 antibody. We determined the proportion of HBV monoinfected adults eligible for antiviral therapy (AVT) based on European Association for the Study of the Liver (EASL) 2017 guidelines. We also evaluated the performance of two alternative criteria developed for use in sub-Saharan Africa, the World Health Organization (WHO) and Treat-B guidelines. ResultsAcross 12 urban and 4 rural communities, 4,961 adults (62.9% female) were tested and 182 (3.7%) were HBsAg-positive, 80% of whom attended hospital follow-up. HBsAg-positivity was higher among men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 0.99-1.87) and with decreasing income (AOR, 0.89 per household asset; 95% CI, 0.81-0.98). Trends toward higher HBsAg-positivity were also seen at ages 30-39 years (AOR, 2.11; 95% CI, 0.96-4.63) and among pregnant women (AOR, 1.74; 95% CI, 0.93-3.25). Among HBV monoinfected individuals (i.e., HIV-negative) evaluated for AVT, median age PLOS ONE | https://doi.

Point-of-Care Tests for Hepatitis B: An Overview

“…A common application of these HBsAg POCs is to measure seroprevalence in general or specific subpopulations in low-resource settings [ 52 , 53 , 54 , 55 , 56 ]. They have also been used in mass screening programs for hepatitis B in both community outreach [ 24 , 57 ] and health-facility-based screening [ 52 , 53 , 58 , 59 , 60 , 61 , 62 ] in low-resource settings and shown great public health benefits. For example, in a community-based outreach screening program conducted in 75 camps in Southern India [ 63 ], the “screen and vaccinate/linkage to care” strategy led to over 7700 vaccinations in the camps and 162 people with high viral load getting treatment.…”

Diagnostic performance of non-invasive fibrosis markers for chronic hepatitis B in sub-Saharan Africa: a Bayesian individual patient data meta-analysis

“…Cohorts represented by HEPSANET group members were described in 21 articles. 11,13,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] We contacted corresponding authors from the remaining 3 articles, [43][44][45] and all authors agreed to contribute individual patient data. We additionally included unpublished data from three sites (Cape Town, South Africa; Thiès, Senegal; and Dakar, Senegal) and data from one additional study published since the search was conducted from Malawi.…”

“…45 Two studies had significant loss to follow up between community diagnosis and evaluation. 38,46 Among 3,549 included participants, median age was 33 years (inter-quartile range (IQR) 28-41) and 60% were male (Table 1 APRI and GPR had the best discriminant performance, with AUROC of 0.81 and 0.82 for cirrhosis and 0.75 and 0.76 for significant fibrosis, respectively. FIB-4 had relatively lower AUROC of 0.77 for cirrhosis and 0.68 for significant fibrosis.…”

Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi

“…[33] In Zambia 10% were treatment eligible by WHO criteria and 17% by EASL 2017 criteria. [34] In a hospital-based sample in Ethiopia, 20% had cirrhosis and 25.2% required treatment by EASL 2012 criteria. [35] These compare to estimates from a recent systematic review where globally, 12% of participants in community studies required treatment.…”