Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets

Abstract

The WHO global health sector strategy on viral hepatitis, created in May, 2016, aims to achieve a 90% reduction in new cases of chronic hepatitis B and C and a 65% reduction in mortality due to hepatitis B and C by 2030. Hepatitis B virus (HBV) is endemic in sub-Saharan Africa, and despite the introduction of universal hepatitis B vaccination and effective antiviral therapy, the estimated overall seroprevalence of hepatitis B surface antigen remains high at 6·1% (95% uncertainty interval 4·6-8·5). In this Series paper, we have reviewed the literature to examine the epidemiology, burden of liver disease, and elimination strategies of hepatitis B in sub-Saharan Africa. This paper reflects a supranational perspective of sub-Saharan Africa, and recommends several priority elimination strategies that address the need both to prevent new infections and to diagnose and treat chronic infections. The key to achieving these elimination goals in sub-Saharan Africa is the effective prevention of new infections via universal implementation of the HBV birth-dose vaccine, full vaccine coverage, access to affordable diagnostics to identify HBV-infected individuals, and to enable linkage to care and antiviral therapy.

The potential impact of the demographic transition in the Senegal-Gambia region of sub-Saharan Africa on the burden of infectious disease and its potential synergies with control programmes: the case of hepatitis B

“…HBV is one such infection and one which gives rise to a substantial burden of disease. Global mortality associated with viral hepatitis ranks equally with that from HIV/AIDS and tuberculosis, and in 2016 the World Health Assembly adopted a strategy for its global elimination [21], with HBV being responsible for the majority of deaths associated with viral hepatitis [22]. Nonetheless, the great heterogeneity in the global distribution of the burden of disease arising from HBV [27, 28] might hinder steps towards its elimination.…”

“…HBV infection is a major example of an infection causing a substantial continuing burden of disease worldwide [21–23], including cirrhosis and liver cancer; thus, it calls for a redoubling of efforts and prioritisation of actions aimed at elimination [22]. HBV has a complex epidemiology in which such key processes as transmission, infection, and disease development are strongly age-related [24–26].…”

Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

“…In highly endemic areas, HBV infection during infancy and early childhood via MTCT is a prominent risk factor for developing chronic infection (more than 50%) as well as cirrhosis or primary liver cancer (approximately 25%) . The World Health Organization (WHO) plans to achieve a 90% reduction in new cases of chronic HBV and hepatitis C virus (HCV) infection and a 65% reduction in mortality by 2030 . To achieve this goal, blocking HBV MTCT is essential to reduce the number of new HBV carriers and HBV‐related deaths.…”

Mother‐to‐child transmission of hepatitis B: What more needs to be done to eliminate it around the world?

“…This inexpensive serological test (<15 USD) deserves to be validated in pregnant women, to select women for peripartum antiviral treatment. However, in some resource‐limited settings, if none of these simplified diagnostic tests can be assessed and implemented, treating all the HBsAg‐positive pregnant women regardless of their HBV DNA levels, as it is done in HIV‐infected women to prevent HIV MTCT, should be considered although this remains highly debated . A recent economic modelling suggested the cost‐effectivness of such strategy but this needs to be rigourously evaluated before guidelines can be issued.…”