Seroprevalence of Hepatitis B and C and HIV Infections and Associated Risk Factors Among Pregnant Women Attending Antenatal Care Unit at Simada Hospital, South Gondar Zone, Northwest Ethiopia

Hepatitis and human immunodeficiency virus (HIV) are major public health issues in developing countries, including Ethiopia. These viruses can be transmitted from mother to child during birth or through contact with contaminated blood. In many areas of Ethiopia, viral hepatitis and HIV infections are significant health concerns for pregnant women. However, there is limited information about these issues in various parts of the country, particularly in the Amhara Region. Therefore, this study was aimed at determining the prevalence of Hepatitis B virus (HBV), Hepatitis C virus (HCV), and HIV infections and identifies the associated risk factors among pregnant women attending an antenatal care (ANC) unit at Simada Hospital, Amhara Region, Northwest Ethiopia. A hospital-based cross-sectional study was conducted on 248 pregnant women from January 2021 to March 2021. Five milliliters of venous blood was collected from each study participant, and serum was tested for Hepatitis B surface antigen (HBsAg), anti-HCV, and anti-HIV antibodies using commercially available rapid test kits. A logistic regression analysis was used to identify possible risk factors for the occurrence of hepatitis and HIV infections. The overall seroprevalence of HBV, HCV, and HIV infections was 10 (4%), 5 (2%), and 5 (2%), respectively. Prevalence of coinfection was 1.2% (3/248), 0.4% (1/248), and 0.4% (1/248) for HBV/HCV, HBV/HIV, and HCV/HIV, respectively. History of abortion (adjusted odds ratio (AOR) = 11.028, 95% confidence interval (CI) = 1.671-72.776, p value = 0.013) and a history of blood transfusions (AOR = 11.298, 95%CI = 1.066-119.777, p value = 0.044) were observed to be significantly associated with an increased risk of HBV infections. However, having multiple sexual partners (AOR = 18.819, 95%CI = 1.074-329.680, p value = 0.045) and history of abortion (AOR = 12.550, 95%CI = 1.174-134.202, p value = 0.036) were the only significant predictors of HCV and HIV infection, respectively. In the current study, we found an intermediate prevalence of HBV and HCV in pregnant women. Therefore, continuous screening of pregnant women for the stated viral infections should be performed to minimize the transmission of the viruses to their children.

Viral Hepatitis B and Its Implications for Public Health in DR Congo: A Systematic Review

Background: The prevalence of hepatitis B virus infection remains high in the Democratic Republic of Congo (DRC), constituting a public health problem in view of the fatal complications it causes, notably cirrhosis and hepatocellular carcinoma. The aim of this study was to provide an overview of the situation of viral hepatitis B in the DRC and in particular its implications for public health. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group guidelines. Google Scholar, PubMed, and ResearchGate were used as databases. The review essentially analyzed the viral hepatitis B (HBV) vaccination status of study subjects, diagnostic means, HBV genotypes in DR Congo, seroprevalence of HBV infection, subjects' level of knowledge and perceptions of HBV, co-infection/comorbidity with HBV infection, factors associated with HBV infection and public health issues raised by HBV infection. Results: The vast majority of studies (69%) were carried out to determine the seroprevalence of HBV infection. The Determine rapid test was the most widely used test (10 studies), sometimes combined with ELISA (3 studies) and polymerase chain reaction (PCR) (1 study, for genotyping). Some of the public health issues raised by hepatitis B virus infection were identified in the course of the included studies, in relation to co-infection, comorbidity, associated factors, and individuals' level of knowledge and perceptions of HBV. Certain factors were identified as being closely associated with HBV, notably healthcare professions (e.g., doctor, laboratory technician) and having several sexual partners. In terms of perception of HBV, the hepatitis B virus is recognized as dangerous, and the majority of people questioned in the various studies were aware that vaccination remains the most effective means of prevention. Conclusions: Hepatitis B is a highly contagious infectious disease present in the DRC, with a higher prevalence among healthcare professionals, sex workers, patients with certain diseases including HIV, and people with a history of blood transfusion. The surveillance system within the national blood transfusion program needs to be strengthened. Raising public awareness of the seriousness of viral hepatitis B, offering vaccination to at-risk populations, and systematically screening pregnant women and blood donors for HBV infection could help reduce the prevalence of viral hepatitis B.

Epidemiology of hepatitis B virus infection among pregnant women in Africa: a systematic review and meta-analysis

BACKGROUND

Although hepatitis B infection is highly endemic in Africa, information on its epidemiology among pregnant women in the region is limited. Therefore, this systematic review provided up-to-date information on the epidemiology of hepatitis B virus (HBsAg) infection among pregnant women in Africa.

METHODS

A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews. The Web of Science, Scopus, PubMed, Google Scholar, and African journals online were searched to identify relevant studies published between January 1, 2015, and May 21, 2024, on hepatitis B virus infection in pregnant women living in Africa. The Joanna Briggs Institute tool was used to assess the methodological qualities of the included studies. The random effects model was used to estimate the pooled prevalence of HBV infection. I2 assessed the amount of heterogeneity. Publication bias was assessed using Egger's test and a funnel plot.

RESULTS

We included 91 studies from 28 African countries. The pooled prevalence of hepatitis B infection among pregnant women in Africa was 5.89% (95% CI: 5.26-6.51%), with significant heterogeneity between studies (I2 = 97.71%, p < 0.001). Family history of hepatitis B virus infection (AOR = 2.72, 95%CI: 1.53-3.9), multiple sexual partners (AOR = 2.17, 95%CI: 1.3-3.04), and sharing sharp materials were risk factors for hepatitis B infection.

CONCLUSION

An intermediate endemic level of hepatitis B virus infection (2-7%) was observed among pregnant women in Africa. To prevent disease transmission, interventions should focus on pregnant women with a family history of hepatitis B infection, multiple sexual partners, and sharing sharp materials.

High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo

INTRODUCTION

Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population.

METHODS

A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status.

RESULTS

For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL).

CONCLUSION

This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.

Characterizing hepatitis B virus infection in children in the Democratic Republic of Congo to inform elimination efforts

Objective

Despite global reductions in hepatitis B virus (HBV) prevalence, an estimated 6.2 million children are infected, two-thirds of whom live in the WHO Africa region. We sought to characterize childhood HBV to inform elimination efforts in the Democratic Republic of Congo (DRC), one of the largest and most populous African countries.

Methods

Using the most recent (2013-14) nationally representative Demographic and Health Survey in the DRC, we analyzed HBV surface antigen (HBsAg) on dried blood spots and associated survey data from children aged 6-59 months. We estimated HBsAg-positivity prevalence nationally, regionally, and by potential correlates of infection. We evaluated spatial variation in HBsAg-positivity prevalence, overall and by age, sex, and vaccination status.

Findings

Using data from 5,679 children, we found national HBsAg-positivity prevalence was 1.3% (95% CI: 0.9%-1.7%), but ranged from 0.0% in DRC's capital city province, Kinshasa, to 5.6% in northwestern Sud-Ubangi Province. Prevalence among boys (1.8%, 95% CI: 1.2%-2.7%) was double that among girls (0.7%, 95%CI: 0.4%-1.3%). Tetanus antibody-negativity, rurality, and lower household wealth were also significantly associated with higher HBsAg-positivity prevalence. We observed no difference in prevalence by age. Children had higher HBsAg-positivity odds if living with ≥1 HBsAg-positive adult household member (OR: 2.3, 95%CI: 0.7-7.8), particularly an HBsAg-positive mother (OR: 7.2, 95%CI:1.6-32.2).

Conclusion

In the largest national survey of HBV among children and household contacts in the DRC, we found that childhood HBV prevalence was 10-60 times the global target of 0.1%. We highlight specific regions and populations for further investigation and focused prevention efforts.

Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo

Background

The World Health Organization Africa region has high regional hepatitis B virus (HBV) prevalence, and evidence suggests more frequent horizontal HBV transmission than other regions. Context-specific epidemiological studies are needed to inform additional HBV prevention measures.

Methods

In the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care in high-volume maternity clinics in Kinshasa, Democratic Republic of Congo. We recruited households of pregnant women ("index mothers") who were HBsAg-positive and HBsAg-negative, defining households as index-positive and index-negative, respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates.

Results

We enrolled 1006 participants from 200 households (100 index-positive, 100 index-negative) across Kinshasa. HBsAg-positivity prevalence was more than twice as high in index-positive households (5.0% [95% confidence interval {CI}, 2.8%-7.1%]) as in index-negative households (1.9% [95% CI, .6%-3.2%]). HBsAg-positivity prevalence was 3.3 (95% CI, .9-11.8) times as high among direct offspring in index-positive versus index-negative households. Factors associated with HBsAg positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among offspring in index-positive households.

Conclusions

Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.

Hepatitis B virus prevalence and transmission in the households of pregnant women in Kinshasa, Democratic Republic of Congo

Background

Despite routine infant vaccination and blood donor screening, the Democratic Republic of Congo (DRC) has high hepatitis B virus (HBV) prevalence compared to the United States and Europe. Through the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we characterized household prevalence in DRC's capital, Kinshasa, to inform additional prevention efforts.

Methods

We introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care (ANC) in high-volume maternity clinics in Kinshasa. We recruited households of pregnant women who were HBsAg-positive and HBsAg-negative, defining households as "exposed" and "unexposed," respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates.

Results

We enrolled 1,006 participants from 200 households (100 exposed, 100 unexposed) across Kinshasa. HBsAg prevalence was more than twice as high in exposed households (5.0%; 95% CI: 2.8%-7.1%) as in unexposed households (1.9%; 0.6%-3.2%). Exposed direct offspring had 3.3 (0.9, 11.8) times the prevalence of unexposed direct offspring. Factors associated with HBsAg-positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among exposed offspring.

Conclusions

Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.

Prevalence of hepatitis B and C viral co-infection and associated factors with HIV infection in children in South Kivu, Democratic Republic of the Congo

BACKGROUND

The World Health Organization's (WHO) 2030 goal of eradicating Hepatitis B and C viruses must also include HIV co-infected children. However, data on the prevalence of this condition are lacking in the Democratic Republic of Congo (DRC), which is considered as one of the countries with high-prevalence of these viruses. The need to assess the extent of this co-infection in the children of this country is therefore important in order to capitalize on efforts to improve prevention and management of both infections.

METHODOLOGY

This is a comparative cross-sectional study conducted from February 04, 2015 to September 03, 2019 at 14 General Reference Hospitals with a pediatric HIV management programme in South Kivu province. The study compared the frequency of hepatitis B (HBV) and C (HCV) markers and factors associated with these two viruses in two equal groups: HIV-positive and HIV-negative children. The data were analyzed using the SPSS version 20.0 software and the significance level was set at p-value less than 0.05.

RESULTS

The study involved a total of 594 children, 297 of whom were HIV-positive and 297 negative. HBsAg was found in 8.7% of HIV-positive patients and 0.7% for HCV antibodies. On the other hand, among the HIV-negative patients, the proportion of HBsAg was 0.7% but no cases with anti-HCV antibodies were detected. HIV status increases by 14 times the risk of co-occurring with HBV [OR 14.1 (95% CI: 3.33-60.2); p < 0.001] and this risk is not apparent for HCV (p = 0.297). Multivariate logistic regression showed that history of jaundice in the family (aOR:4.19;95% CI: 2.12-11.59), recent hospitalization (aOR:10.7;95% CI: 6.69-17.2), surgery (aOR: 3.24;95% CI: 1.18-8.92), piercing (aOR: 4.26;95% CI: 1.70-10.7) and transfusion in the last 6 months (aOR: 2.69;95% CI: 1.55-4.67) were significantly associated with higher risk of being HBV- HIV co-infected.

CONCLUSION

This study investigated the importance of hepatitis viral co-infections in HIV-positive children in South Kivu. Particular attention should be paid to prevention and early detection of these co-infections in this population.

Seroprevalence and associated risk factors of hepatitis C infection among diabetic patients in South-Kivu, Eastern Democratic Republic of the Congo: A cross-sectional study

Background and Aims

Hepatitis C virus (HCV) infection and diabetes mellitus (DM) are two frequent diseases in the Democratic Republic of the Congo (DRC) and several studies seem to show a link between the two diseases worldwide. However, no study has evaluated this link in our country. The present study aimed at determining the seroprevalence of HCV in diabetic patients as well as associated risk factors.

Methodology

A multicenter cross-sectional study allowed us to sample diabetic patients in two diabetic healthcare centers of Bukavu city in the eastern part of the DRC, from December 2020 to December 2022. A questionnaire was submitted to the diabetic patients to collect sociodemographic data, anamnestic data on risk factors for HCV infection, and clinical data on DM. These factors were analyzed based on anti-HCV serological results.

Results

Among the 180 selected patients, 19 (10.6%) were tested positive for anti-HCV antibodies. After multivariate analysis, the identified factors influencing these outcomes were male sex (adjusted odds ratio [aOR]: 3.5, p = 0.027), dental extraction (aOR: 7.6, p = 0.001), and living in a privileged environment (aOR: 0.29, p = 0.03). The factors related to DM such as the type, the disease duration, or the usual type of treatment did not influence the serological results.

Conclusion

This study shows that HCV seroprevalence in diabetic patients is very high compared with the general population. This suggests combined screening and management policies in this population.

Awareness and prevalence of hepatitis C virus infection among pregnant women in Nigeria: A national pilot cross-sectional study

BACKGROUND

There are no national data on hepatitis C virus awareness and burden among pregnant women to justify its routine screening.

OBJECTIVES

To investigate awareness, seroprevalence and risk factors for hepatitis C virus infection among pregnant women in Nigeria.

METHODS

A total of 159 pregnant women from antenatal clinics across six geopolitical zones in Nigeria consented to anti-hepatitis C virus testing which was confirmed using polymerase chain reaction technique. Confirmed hepatitis C virus positive women were further tested for hepatitis B and HIV. Participants were evaluated for risk factors for hepatitis C virus. Odds ratios, adjusted odds ratios, and their 95% confidence intervals (CIs) were determined, and p-values of <0.05 were considered significant.

RESULTS

Of 159 participants, 77 (48.4%; 95% confidence interval = 38.2%-60.5%) were aware of hepatitis C virus infection and awareness of hepatitis C virus was associated with young age (odds ratio = 2.21; 95% confidence interval = 1.16-4.21), high educational level (odds ratio = 3.29; 95% confidence interval = 1.63-6.64), and participants' occupation (odds ratio = 0.51; 95% confidence interval = 0.26-0.99). In multivariable logistic regression, adjusted for confounders, the association between awareness of hepatitis C virus and participants' young age (adjusted odds ratio = 1.60; 95% confidence interval = 1.09-2.35; p = 0.018) and high educational level (adjusted odds ratio = 1.48; 95% confidence interval = 1.17-1.86; p = 0.001) remained significant. Hepatitis C virus seroprevalence was found to be 1.3% (95% confidence interval = 0.2%-4.5%). All (100.0%, 95% confidence interval = 12.1%-100.0%) the hepatitis C virus-positive participants and 99 (63.1%, 95% confidence interval = 51.3%-76.8%) hepatitis C virus-negative participants had identifiable hepatitis C virus risk factors. Dual seropositivity of anti-hepatitis C virus/anti-HIV and anti-hepatitis C virus/hepatitis B surface antigen each accounted for 0.6%. The most identified risk factors were multiple sexual partners (15.7%), shared needles (13.8%), and blood transfusion (11.3%). There was no significant association between the risk factors and hepatitis C virus positive status.

CONCLUSION

Awareness of hepatitis C virus infection among pregnant women in Nigeria is low and those aware are positively influenced by young age and high educational level. The prevalence of hepatitis C virus infection is high and provides preliminary evidence to justify antenatal routine screening.

Prevalence of sexually transmitted infections among cervical cancer suspected women at University of Gondar Comprehensive Specialized Hospital, North-west Ethiopia

Background

Sexually transmitted infections (STIs) such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Syphilis have continued a significant public health problem, especially in areas with substandard infection prevention and control programs. It is known that STIs are largely associated with the increased occurrence of cervical cancer. To date, little is known about the burden of STIs among cervical cancer suspected women in Ethiopia.

Objectives

To assess the seroprevalence of STIs and associated risk factors among cervical cancer suspected women with special emphasis on HIV, HBV, HCV, and Syphilis.

Methods

A hospital-based cross-sectional study was conducted among cervical cancer suspected women at the University of Gondar Comprehensive Specialized Hospital from February to April 2017. A pre-tested and structured questionnaire was used to collect data on patients’ characteristics. The patient’s serum or plasma samples were tested for HIV, HBV, HCV, and syphilis using enzyme-linked immunosorbent assay. In all aspects, the standard operational procedure was strictly followed. Data were analyzed using SPSS version 20 software and presented using tables. Statistical associations were measured using bivariate and multivariable logistic regression. A p-value of below 0.05 was considered statistically significant.

Result

A total of 403 cervical cancer suspected women with the mean age of 42.54 (SD + 11. 24) years were enrolled in the study. The overall prevalence of STIs was 16.6% (67/403) and the prevalence of HIV, HBV, HCV, and syphilis was 36/403 (8.9%), 10/403 (2.5%), 4/403 (1%), and 29/403 (7.2%) respectively. History of multiple sexual partners (Adjusted OR = 3.02, 95%CI 1.57–5.79, P = 0.001), alcohol addiction (Adjusted OR = 2.2, 95%CI 1.07–4.5, P = 0.031), history of STI (Adjusted OR = 3.38; 95% CI: 1.76–6.47, P = 0.00) and not use of condom (Adjusted OR = 4.99; 95% CI: 1.5–16.16, P = 0.007) were significantly associated with STIs.

Conclusion

The prevalence of STIs was generally higher among cervical cancer suspected patients. Health education is encouraged to promote awareness about the prevention of STIs.

Seroprevalence of HBV, HCV, and HIV and Associated Risk Factors Among Apparently Healthy Pregnant Women in Anyigba, Nigeria

Globally, infection of pregnant women by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) pose a significant health challenge for not just the mothers but also the newborn infant. This study was undertaken to assess the prevalence of HIV, HCV, and HBV among pregnant women attending antenatal clinic in Kogi State University Teaching Hospital (KSUTH), Anyigba, Nigeria. Sera samples obtained from 200 consented pregnant women were screened for hepatitis B surface antigen (HBsAg), anti-HCV, and anti-HIV antibodies using commercially available immunoassay test kit. Demographic variables and obstetric characteristic were obtained using structured questionnaire. Of the 200 sera tested, the seroprevalence rates were 1.0%, 0.5%, and 8.5% for HBsAg, anti-HCV, and anti-HIV antibodies, respectively. Although 0.5% were coinfected with HIV/HCV, none was simultaneously infected by the three viruses. Age, marital status, trimester, and educational and occupational status did not significantly affect the prevalence of HIV, HCV, and HBV infections. However, factors such as history of abortion/miscarriage (p = 0.04), intravenous drug use (p = 0.001), and history of other sexually transmitted infection (p = 0.01) were significantly higher in relation to HIV seropositivity. In conclusion, findings from this study revealed high HIV seroprevalence and a clear decline of hepatitis C and B infection prevalence compared with previous epidemiological data. Reason for the latter could be attributed to the current efforts to reduce mother-to-child transmission and possible HBV vaccination programs. High burden of HIV infection in our study suggests the needs to strengthen the national prevention programs including education of the people on the risk factors of HIV transmission.

Seroprevalences and Correlates of Hepatitis B and C Among Cameroonian Pregnant Women

Background and rationale:

Viral hepatitis B (VHB) and viral hepatitis C (VHC) are major public health issues in resource-poor countries where vertical transmission remains high.

Aim:

To assess prevalences and correlates of VHB and VHC among women attending antenatal clinic.

Methods:

A cross-sectional study at the Yaounde Central Hospital from January 1 to June 30, 2016. We included 360 pregnant women who were screened for hepatitis B virus surface antigen (HbsAg) and VHCAb by rapid diagnostic test (DiaSpot Diagnostics, USA) followed by confirmation of positive results by a reference laboratory. Odds ratios (95% confidence interval [CI]) were used to measure associations between variables. Statistical significance was set for P-value <.05.

Results:

Mean age was 27.9 ± 5.6 years. The prevalences of HbsAg and VHCAb were 9.4% (n = 34) and 1.7% (n = 6), respectively. Multiplicity of sex partners was significantly associated with HbsAg positivity (adjusted odds ratio [aOR]: 11.6; 95% CI: 5.1-26.7; P < .001) while none of the studied factors was associated with VHCAb.

Conclusion:

The high prevalence of hepatitis B among pregnant women supports systematic screening and free vaccination of pregnant women and women of childbearing age.

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

Background

There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up.

Methods

Hepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these.

Results

We interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers.

Conclusions

At this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing.

Electronic supplementary material

The online version of this article (10.1186/s12879-017-2767-0) contains supplementary material, which is available to authorized users.

Prevalence of human immunodeficiency virus and hepatitis B virus infections in young women seeking abortion care in Ethiopia: a cross - sectional study

BACKGROUND

Young women aged 15-24 years are members of key populations at higher risk for Human Immunodeficiency Virus (HIV) acquisition through sexual intercourse. In areas where unprotected sex is a common practice, Hepatitis B virus (HBV) commonly transmitted via sexual and parenteral routes. The study aimed at determining HIV and HBV infections prevalence in young women attending health institutions for abortion care in Bahir Dar city, Ethiopia.

METHODS

A cross - sectional study was conducted from January 2015 to June 2015. Convenient sampling technique was used. Demographic and explanatory variables were collected using a structured questionnaire via face to face interview. The presence of antibody to HIV infection was detected using national HIV diagnostic test algorithm. Hepatitis B surface antigen (HBsAg) was detected using ELISA. Data were analyzed using descriptive, fisher's exact and independent sample T test as appropriate.

RESULTS

A total of 360 young women aged 15-24 years participated in the study. The median age of the women was 22 years. Overall, 16 (4.4 %) (95 % CI: 2.7-7.1 %) women were positive for either HBV or HIV infections. The prevalence of HIV and HBV infections were 9 (2.5 %) (95 % CI: 1.3-4.7 %) and 7 (1.94 %) (95 % CI: 0.95-4.0 %), respectively. The mean age of first sexual intercourse was 17.6 and 19.3 in HIV and HBV infected women, respectively. The prevalence of HIV infection was significantly associated with lower educational status (P < 0.001), divorced marital status (P = 0.009) and ever had symptom of other sexually transmitted infections (P = 0.001). The proportion of HBV was higher in women aged 15-17 years (P = 0.02).

CONCLUSION

Though there were no co-infections, HIV and HBV infections are major health problems in young women seeking abortion care. Therefore, appropriate prevention, treatment and care services must be reached to these higher risk populations.

Systematic review and meta-analysis of hepatitis C virus infection in the Democratic Republic of Congo

OBJECTIVES

Hepatitis C virus (HCV) infection is endemic in the Democratic Republic of the Congo (DRC), where the prevalence of HCV antibodies (anti-HCV) is reported to range from 0.2% to 13.7%. However, the reported prevalence rates have been inconsistent. Therefore, a meta-analysis of observational studies was conducted to provide updates on the prevalence of HCV infection in the DRC.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Medline, EMBASE and Google Scholar were searched for publications reporting on HCV infection in the DRC up to autumn 2015. In addition, a manual search was undertaken to detect relevant papers. Studies performed in groups at low risk of HCV (blood donors and pregnant women) were used for the meta-analysis. The random effects model was used to estimate the pooled prevalence of anti-HCV.

RESULTS

Sixteen studies with 13,799 participants (aged 6 months-71 years) met the inclusion criteria. The studies were performed in blood donors, pregnant women, military personnel, individuals with human immunodeficiency virus, children, commercial sex workers, Congolese patients living in Canada, patients with sickle cell disease and hospitalized patients. The reviewed studies revealed the presence of anti-HCV in almost all studied age groups and did not differ between sexes. The pooled prevalence of anti-HCV was 2.9% [95% confidence interval 1.5-4.3%]. Subgroup analyses revealed that the prevalence rates of anti-HCV in blood donors and pregnant women were 2.7% (95% confidence interval: 1.1-4.4%) and 3.3% (1.4-5.1%), respectively.

CONCLUSIONS

HCV infection remains an issue of public concern in the DRC, demonstrating a need for adequate hepatitis control programmes. Efforts must be made to virtually eliminate transfusion-transmitted HCV throughout the country.