Hepatitis B Virus Prevalence and Vaccination in Men Who Have Sex With Men in West Africa (CohMSM ANRS 12324—Expertise France)

Abstract

Background Although men who have sex with men (MSM) are at high risk of hepatitis B virus (HBV) infection, they do not have access to vaccination in West Africa, which is a highly endemic region. We investigated HBV prevalence and associated factors, as well as acceptability and difficulties of vaccination in MSM enrolled in an operational research program in Burkina Faso, Côte d’Ivoire, Mali, and Togo. Methods We followed up 779 MSM in 2015–2018. Participants who were negative for both hepatitis B surface antigen (HBsAg) and antibodies (anti-HBs) at enrollment were offered HBV vaccination. Factors associated with HBV infection were identified using logistic regression models. Results Overall, HBV prevalence was 11.2% (95% confidence interval [CI], 9.0%–13.6%). It was lower in Togo than in Côte d’Ivoire (2.7% vs 17.3%; adjusted odds ratio [aOR], 0.12; 95% CI, 0.02–0.28) and higher in participants with 6+ recent male sexual partners (21.0% vs 9.3%; aOR, 1.48; 95% CI, 1.12–1.97). Of 528 participants eligible for vaccination, 484 (91.7%) were willing to be vaccinated and received at least 1 dose (ranging from 68.2% in Abidjan to 96.4% in Bamako; P < .001). Of the latter, 390 (80.6%) received 3 or 4 doses. The proportion of participants for whom the minimum required time between each dose was respected ranged from 10.9% in Bamako to 88.6% in Lomé (P < .001). Conclusions MSM in West Africa should be targeted more for HBV screening and vaccination. Although vaccination is well accepted by MSM, greater training of health care workers and education of MSM are required.

Hepatitis B virus infection (HBV) and HIV-HBV coinfection among men who have sex with men, transgender women, and genderqueer individuals in Harare and Bulawayo Zimbabwe, 2019

“…The association between age and HBV infection among MSM and TGW/GQ individuals in Africa is less evident in the literature. Our results show that age is associated with HBV infection, in line with a study among MSM in Thailand [ 30 ], but other studies from Kenya and West Africa did not find age to be significantly associated with HBV infection [ 8 , 23 ]. Notably, none of our survey participants aged 18–19 tested positive for HBV.…”

“…Our survey found that the prevalence of HBV was more than four times higher among PLHIV compared to HIV-negative participants. These results are in line with other studies among MSM in Kenya [ 23 ], United States [ 24 ], and Peru [ 25 ] which showed higher incident rates or prevalence of HBV among PLHIV, but differs from studies in Nigeria and West Africa which showed that among MSM HBV prevalence was not significantly different between those with and without HIV [ 6 , 8 ]. Identifying HIV-HBV coinfection is critically important as viral hepatitis progresses faster and causes more liver-related health problems among PLHIV than people who do not have HIV [ 26 ].…”

“…However, HBV data for these groups is sparse, particularly in Africa. Of the more than 50 African countries only a small number have reported HBV prevalence estimates among MSM and the estimates have varied widely – 4 % in South Africa [ 3 ], 5.4 % in Tanzania [ 4 ], 7.1 % in Togo [ 5 ], 10 % in Nigeria [ 6 ], 14–23 % in the Central African Republic [ 7 ], and 11.2 % in Burkina Faso, Côte d’Ivoire, Mali, and Togo combined [ 8 ]. Furthermore, data on HBV infection prevalence among TGW in Africa is minimal and is often not disaggregated from MSM data, making it challenging to identify any unique vulnerabilities [ 6 ].…”

“…Even though MSM are at a higher risk for both HBV and HIV infection compared to other adults [ 2 , 13 ], there is little data on HIV-HBV coinfection among MSM in Africa and almost no data on HIV-HBV coinfection among TGW worldwide. Prior research conducted in South Africa, Nigeria, and West Africa found the prevalence of HIV-HBV coinfection among MSM to be 2 %, 6 %, and 14 %, respectively, but limited information exists in other settings [ 3 , 6 , 8 ].…”

Contribution of HIV/AIDS-Related Human and Social Sciences Research to a Better Understanding of the Challenges of Hepatitis B Prevention, Diagnosis and Care

“…It is in this context that the importance of the need to implement combination HIV prevention [23] takes on its full meaning, through a wide arsenal of prevention and harmreduction tools, including making self-tests available, and offering screening in associationbased and community spaces [24][25][26]. The logic of implementing combination prevention for HIV is absolutely valid for the field of hepatitis B prevention, where many inequalities in access to care-especially for vaccination-persist [27]. Combination prevention is essential to adapt screening systems (e.g., outreach screening) to the specific experiences of populations affected by HBV infection.…”