Role of unsafe medical practices and sexual behaviours in the hepatitis B and C syndemic and HIV co-infection in Rwanda: a cross-sectional study

Abstract

ObjectivesThis study describes the burden of the hepatitis B, C and HIV co-infections and assesses associated risk factors.SettingThis analysis used data from a viral hepatitis screening campaign conducted in six districts in Rwanda from April to May 2019. Ten health centres per district were selected according to population size and distance.ParticipantsThe campaign collected information from 156 499 participants (51 496 males and 104 953 females) on sociodemographic, clinical and behavioural characteristics. People who were not Rwandan by nationality or under 15 years old were excluded.Primary and secondary outcomesThe outcomes of interest included chronic hepatitis C virus (HCV) infection, chronic hepatitis B virus (HBV) infection, HIV infection, co-infection HIV/HBV, co-infection HIV/HCV, co-infection HBV/HCV and co-infection HCV/HBV/HIV. Multivariable logistic regressions were used to assess factors associated with HBV, HCV and HIV, mono and co-infections.ResultsOf 156 499 individuals screened, 3465 (2.2%) were hepatitis B surface antigen positive and 83% (2872/3465) of them had detectable HBV desoxy-nucleic acid (HBV DNA). A total of 4382 (2.8%) individuals were positive for antibody-HCV (anti-HCV) and 3163 (72.2%) had detectable HCV ribo-nucleic acid (RNA). Overall, 36 (0.02%) had HBV/HCV co-infection, 153 (0.1%) HBV/HIV co-infection, 238 (0.15%) HCV/HIV co-infection and 3 (0.002%) had triple infection. Scarification or receiving an operation from traditional healer was associated with all infections. Healthcare risk factors—history of surgery or transfusion—were associated with higher likelihood of HIV infection with OR 1.42 (95% CI 1.21 to 1.66) and OR 1.48 (1.29 to 1.70), respectively, while history of physical traumatic assault was associated with a higher likelihood of HIV and HBV/HIV co-infections with OR 1.69 (95% CI 1.51 to 1.88) and OR 1.82 (1.08 to 3.05), respectively.ConclusionsOverall, mono-infections were common and there were differences in significant risk factors associated with various infections. These findings highlight the magnitude of co-infections and differences in underlying risk factors that are important for designing prevention and care programmes.

Prevalence and associated risk factors for hepatitis B and C viruses among refugee populations living in Mahama, Rwanda: A cross-sectional study

“…Our findings on viral load positivity reflect a similarity with previous study conducted in Rwanda where 83% of the HBsAg positive had detectable HBV DNA while 72.2% of anti-HCV positive were confirmed with HCV RNA [ 27 ]. Younger men were not only more likely to be HBsAg positive, they were also more likely to have detectable viral load.…”

“…As it has been previously reported in Rwanda and Egypt, we also found possible evidence of household transmission of both HBV and HCV [ 27 , 28 ]. Within-household transmission could reflect a combination of sexual transmission between partners and vertical transmission during pregnancy, as has been documented for both HBV and HCV [ 29 ].…”

Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020

“…frequency of unprotected sex [11,12]. Several studies have shown that low adherence to condom use, multiple sexual partners, unsafe sexual practices, illicit drug use, and co-infection with other STI increase the risk of HBV and HCV transmission [13,14]. FSW also have a higher risk of contracting STI from their non-paying partners than from their paying clients [13,14].…”

Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

“…addition to scarification or traditional healer operations, healthcare interventions were associated with an increased likelihood of HIV or HCV infection. [10] Healthcare-acquired HCV infection accounts for a significant portion of the infections in highly HCV-prevalent countries such as Egypt and Pakistan. [11] However, data to suggest this as a mode of HCV transmission in SA are lacking.…”