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

Abstract

Introduction: Rwanda’s Hepatitis C elimination campaign has relied on mass screening campaigns. An alternative “micro-elimination” strategy, which focuses on specific segments of the population such as non-communicable disease (NCD) patients, could be a more efficient approach to identifying patients and linking them to care. Methods: This retrospective cross-sectional study used routine data collected during a targeted screening campaign among NCD patients in Kirehe, Kayonza, and Burera districts of Rwanda and patients receiving oncology services from the Butaro District Hospital. The campaign used rapid diagnostic tests to screen for Hepatitis B surface antigen (HBsAg) and Hepatitis C antibody (anti-HCV). We reported prevalence and 95% confidence intervals for HBsAg and anti-HCV, assessed for associations between patients’ clinical programs and hepatitis B and C, and reported outcomes along the cascade of care for the two diseases. Results: out of 7,622 were NCD patients, 3398 (45.9%) of whom self-reported a prior hepatitis screening. Prevalence of HBsAg was 2.0% (95% CI: 1.7%-2.3%) and anti-HCV was 6.7% (95% CI: 6.2%-7.3%). The prevalence of HBsAg was significantly higher among patients younger than 40 years (2.4%). Increased age was significantly associated with anti-HCV (12.0% among patients ≥70 years). Of the 148 individuals who screened positive for HbsAg, 124 had viral load results returned, 102 had detectable viral loads (median viral load: 451 UI/mL), 9 were eligible for treatment, and three were linked to care of the 507 individuals who screened positive for anti-HCV, 468 had their viral load results returned (median viral load: 1,130,000 UI/mL), 304 had detectable viral loads, and 230 were linked to care. Conclusion: Anti-HCV prevalence among Rwandan patients with NCD was high, likely due to their older age. Findings of this study indicated that HBsAg was high concentrated among NCD patients below 40 years maybe as consequence of their sexual behavior at late adolescent age. Repeated screening and elevated hepatitis risk among repeat screeners suggests suboptimal linkage to hepatitis treatment. NCD-HCV co-infected patients had high HCV viral loads and may be at risk of poor outcomes from hepatitis C. Hepatitis C micro-elimination campaigns among NCD patients are a feasible and acceptable strategy to enhance case detection in this high-prevalence population with elevated viral loads and may support linkage to care for hepatitis C among elderly populations.