Hepatitis B infection status among South Africans attending public health facilities over a five-year period: 2015 to 2019

Hepatitis B infection (HBsAg and HBeAg) status among women attending antenatal care at public healthcare facilities of South Africa, 2017

Eight years after WHO adopted a resolution to eliminate hepatitis B by the year 2030, the disease remains a global public health concern, with vertical transmission of HBV being a major obstacle to this goal. Our study aimed to determine the HBV infection status of pregnant women in South Africa at a national level to evaluate the risk of vertical transmission and provide evidence for public health decision-making. We conducted HBsAg testing on 1,942 HIV-uninfected and 2,312 HIV-infected pregnant women from South Africa's public health sector in 2017, followed by HBeAg testing on HBsAg-positive samples. Our data were stratified by five-year age groups and province. The overall HBV prevalence was 11.24% (478/4,254), significantly higher among HIV-infected women (15.83%) compared to HIV-uninfected women (5.77%, p = 0.007). HBV prevalence was highest among women 40-44 years (14.00%) and in Limpopo Province (19.35%). Coinfection rates of HIV-HBV ranged from 14.00% to 17.00% among women 15-44 years, and provincially, rates were highest in Limpopo, North West, and Western Cape Provinces (>20%). HBeAg prevalence among HBsAg positive women was 9.48%, with higher rates among HIV infected women (11.29%) compared to HIV-uninfected women (7.34%, p = 0.7931). HBeAg prevalence was highest among women 15-19 (10.81%), 20-24 (11.88%) and 40-44 years (25.00%), and provincially, highest in North West (26.67%). Our findings highlight the significant prevalence of HBV infection among pregnant women in 2017, emphasising concerns about vertical transmission, particularly given the high prevalence of HBeAg among HBsAg-positive women. We advocate for the prompt implementation of a universal birth dose of the HBV vaccine in South Africa to augment existing vaccination schedules and mitigate the risk of vertical transmission, thereby advancing progress towards WHO elimination targets.

Knowledge, attitudes and practices to hepatitis B among South African primary healthcare staff

BACKGROUND

 Hepatitis B virus (HBV), a significant cause of liver disease globally, is recognised as a 2030 elimination target by the World Health Organization (WHO). Healthcare workers (HCWs) require appropriate HBV knowledge to identify, manage and prevent HBV.

AIM

 We investigated the knowledge, attitude and practices (KAP) pertaining to HBV among HCWs to establish insights into awareness and inform the delivery of training.

SETTING

 The study was conducted among HCWs of 18 primary healthcare facilities in Bloemfontein, Free State province, South Africa.

METHODS

 Data were collected via anonymous, self-applied, 28-question-questionnaires in English. Data were captured on a Microsoft Excel spreadsheet and analysed by a biostatistician, using Statistical Analyses Software (SAS 9.4).

RESULTS

 The response rate was 88% (88/100), and median participant age was 44 years. Participants were mostly female (83%), professional nurses (65%) with more than 8 years of experience (60%). Median scores were 83% for epidemiology and transmission, 50% for clinical picture, 44% for laboratory diagnosis, 40% for management and 40% for prevention. No difference was noted based on number of years of experience.

CONCLUSION

 Considerable gaps in KAP to HBV were noted among primary HCWs in Bloemfontein. Larger studies are needed to ascertain the KAP towards HBV among South African HCWs, to identify areas for enhanced training.Contribution: Hepatitis B virus, an important cause of liver disease in Africa, is poorly identified and managed. Our study highlights the need to strengthen HCW education to ensure individuals are appropriately diagnosed, managed and educated on preventative measures, to reduce the burden of disease.

A case-control study of risk factors for incident hepatitis B virus infection in South African blood donors

OBJECTIVES

Hepatitis B virus (HBV) infection remains a global health problem. Risk factors for HBV infection are usually assessed in prevalent rather than incident infections. To identify demographic and behavioral risks associated with incident HBV among South African blood donors.

METHODS

A case-control study was performed between November 2014 and January 2018. Cases were blood donors testing positive for HBV DNA with or without hepatitis B surface antigen but negative for antibody to hepatitis B core antigen. Participants completed an audio computer-assisted structured interview on exposures during the previous 6 months. Sex-specific multivariable logistic regression yielded independent associations between risks and HBV infection.

RESULTS

56 females and 37 males with incident HBV were compared to 438 female and 439 male controls, respectively. For females, risk factors were accepting money or goods for sex, using agents to prepare one's anus prior to anal sex, penetrating injury, non-Black race, and lower educational status. Men reporting homosexual or bisexual orientation or sex with other men, previous injury, referral for HBV testing, or lack of medical insurance were at increased risk. For both sexes, having more than two male sexual partners increased risk.

CONCLUSIONS

Sexual behaviors predominated over parenteral exposures as risks for incident HBV in both female and male blood donors.