1
|
Coste M, Diouf A, Ndong C, Diouf A, Périères L, Nishimwe ML, Bureau M, Ndiaye A, Maradan G, Diallo A, Boyer S. Investigating linkage to care following community-based screening for hepatitis B virus in rural Senegal: A mixed methods study. J Viral Hepat 2024. [PMID: 38837819 DOI: 10.1111/jvh.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
This paper investigates linkage to care following community-based screening for hepatitis B virus (HBV) in rural Senegal. HBV-positive participants who completed a biological and clinical examination to assess liver disease and treatment eligibility were referred to a regional hospital (if eligible for treatment), invited to join the Sen-B research cohort study (adults with detectable viral load) or referred to their local health centre (all others). Logistic regressions were conducted to investigate factors associated with (i) uptake of the scheduled post-screening examination, and (ii) HBV management initiation. Obstacles to HBV management were identified using thematic analysis of in-depth patient interviews. Of the 206 HBV-positive participants, 163 (79.1%) underwent the examination; 47 of the 163 (28.8%) initiated HBV management. Women, people not migrating for >6 months/year, individuals living in households with more agricultural and monetary resources, with other HBV-positive participants, and beneficiaries of the national cash transfer program, were all more likely to undergo the examination. The likelihood of joining the Sen-B cohort increased with household monetary resources, but decreased with agricultural resources. Initiation of HBV management in local health centre was higher among participants with a non-agricultural economic activity. Individuals reported wariness and confusion about HBV management content and rationale at various stages of the care continuum, in particular with respect to venous blood sampling and management without treatment. In conclusion, HBV community-based test-and-treat strategies are feasible, but early loss to follow-up must be addressed through simplified, affordable management and community support and sensitization.
Collapse
Affiliation(s)
- Marion Coste
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Assane Diouf
- Campus International IRD-UCAD de l'IRD, UMR VITROME, IRD-Univ., AP-HM, SSA, IHU-Méditerranée Infection, Dakar, Senegal
| | - Cilor Ndong
- Department of Anthropology, Université Cheikh Anta Diop, Dakar, Senegal
| | - Aissatou Diouf
- Centre Régional de Recherche et de Formation à la Prise en Charge Clinique de Fann, Dakar, Senegal
| | - Lauren Périères
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Marie Libérée Nishimwe
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Morgane Bureau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Assane Ndiaye
- Campus International IRD-UCAD de l'IRD, UMR VITROME, IRD-Univ., AP-HM, SSA, IHU-Méditerranée Infection, Dakar, Senegal
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Aldiouma Diallo
- Centre Régional de Recherche et de Formation à la Prise en Charge Clinique de Fann, Dakar, Senegal
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| |
Collapse
|
2
|
Brahmania M, Rogal S, Serper M, Patel A, Goldberg D, Mathur A, Wilder J, Vittorio J, Yeoman A, Rich NE, Lazo M, Kardashian A, Asrani S, Spann A, Ufere N, Verma M, Verna E, Simpson D, Schold JD, Rosenblatt R, McElroy L, Wadwhani SI, Lee TH, Strauss AT, Chung RT, Aiza I, Carr R, Yang JM, Brady C, Fortune BE. Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease. Hepatol Commun 2024; 8:e0413. [PMID: 38696374 PMCID: PMC11068141 DOI: 10.1097/hc9.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/05/2024] [Indexed: 05/04/2024] Open
Abstract
Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.
Collapse
Affiliation(s)
- Mayur Brahmania
- Department of Medicine, Division of Gastroenterology and Transplant Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shari Rogal
- Department of Medicine, Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arpan Patel
- Department of Medicine, Division of Gastroenterology, University of California Los Angeles, Los Angeles, California, USA
| | - David Goldberg
- Department of Medicine, Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Amit Mathur
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Julius Wilder
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Vittorio
- Department of Pediatrics, Division of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA
| | - Andrew Yeoman
- Department of Medicine, Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - Nicole E. Rich
- Department of Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mariana Lazo
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ani Kardashian
- Department of Medicine, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Sumeet Asrani
- Department of Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA
| | - Ashley Spann
- Department of Medicine, Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nneka Ufere
- Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manisha Verma
- Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Elizabeth Verna
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Dinee Simpson
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Jesse D. Schold
- Department of Surgery and Epidemiology, University of Colorado, Aurora, Colorado, USA
| | - Russell Rosenblatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Lisa McElroy
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharad I. Wadwhani
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Tzu-Hao Lee
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Alexandra T. Strauss
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Raymond T. Chung
- Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ignacio Aiza
- Department of Medicine, Liver Unit, Hospital Ángeles Lomas, Mexico City, Mexico
| | - Rotonya Carr
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Jin Mo Yang
- Department of Medicine, Division of Gastroenterology, Catholic University of Korea, Seoul, Korea
| | - Carla Brady
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brett E. Fortune
- Department of Medicine, Division of Hepatology, Montefiore Einstein Medical Center, Bronx, New York, USA
| |
Collapse
|
3
|
Mohareb AM, Kouamé MG, Nouaman M, Kim AY, Larmarange J, Neilan AM, Lacombe K, Freedberg KA, Boyd A, Coffie P, Hyle EP. What does the scale-up of long-acting HIV pre-exposure prophylaxis mean for the global hepatitis B epidemic? J Int AIDS Soc 2024; 27:e26218. [PMID: 38444112 PMCID: PMC10935702 DOI: 10.1002/jia2.26218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION The HIV and hepatitis B virus (HBV) epidemics are interconnected with shared routes of transmission and specific antiviral drugs that are effective against both viruses. Nearly, 300 million people around the world live with chronic HBV, many of whom are from priority populations who could benefit from HIV prevention services. Oral pre-exposure prophylaxis (PrEP) for HIV has implications in the prevention and treatment of HBV infection, but many people at increased risk of HIV acquisition may instead prefer long-acting formulations of PrEP, which are currently not active against HBV. DISCUSSION People at increased risk for HIV acquisition may also be at risk for or already be living with HBV infection. Oral PrEP with tenofovir is effective in preventing both HIV and HBV, and tenofovir is also the recommended treatment for chronic HBV infection. Although implementation of oral PrEP has been challenging in sub-Saharan Africa, investments in its scale-up could secondarily reduce the clinical impact of HBV. Long-acting PrEP, including injectable medicines and implantable rings, may overcome some of the implementation challenges associated with oral PrEP, such as daily pill burden, adherence challenges and stigma; however, current formulations of long-acting PrEP do not have activity against HBV replication. Ideally, PrEP programmes would offer both oral and long-acting formulations with HBV screening to optimize HIV prevention services and HBV prevention and care, when appropriate. People who are not immune to HBV would benefit from being vaccinated against HBV before initiating long-acting PrEP. People who remain non-immune to HBV despite vaccination may benefit from being offered oral, tenofovir-based PrEP given its potential for HBV PrEP. People using PrEP and living with HBV who are not linked to dedicated HBV care would also benefit from laboratory monitoring at PrEP sites to ensure safety when using and after stopping tenofovir. PrEP programmes are ideal venues to offer HBV screening, HBV vaccination for people who are non-immune and treatment with tenofovir-based PrEP for people with indications for HBV therapy. CONCLUSIONS Long-acting PrEP holds promise for reducing HIV incidence, but its implications for the HBV epidemic, particularly in sub-Saharan Africa, should not be overlooked.
Collapse
Affiliation(s)
- Amir M. Mohareb
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard University Center for AIDS ResearchBostonMassachusettsUSA
| | - Menan Gérard Kouamé
- Département de Santé PubliqueUFR d'Odonto‐stomatologieUniversité Félix Houphouët BoignyAbidjanCôte d'Ivoire
| | - Marcellin Nouaman
- Département de Santé PubliqueUFR d'Odonto‐stomatologieUniversité Félix Houphouët BoignyAbidjanCôte d'Ivoire
| | - Arthur Y. Kim
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard University Center for AIDS ResearchBostonMassachusettsUSA
| | - Joseph Larmarange
- Centre Population et DéveloppementUniversité Paris Cité, IRD, InsermParisFrance
| | - Anne M. Neilan
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard University Center for AIDS ResearchBostonMassachusettsUSA
- Division of General Academic PediatricsDepartment of PediatricsMassachusetts General HospitalBostonMassachusettsUSA
| | - Karine Lacombe
- Sorbonne Université, IPLESPParisFrance
- Department of Infectious DiseasesSt. Antoine Hospital, AP‐HPParisFrance
| | - Kenneth A. Freedberg
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard University Center for AIDS ResearchBostonMassachusettsUSA
- Department of General Internal MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Anders Boyd
- Stichting HIV MonitoringAmsterdamthe Netherlands
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
- Amsterdam UMC, Infectious DiseasesAmsterdamthe Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious DiseasesAmsterdamthe Netherlands
| | - Patrick Coffie
- Département de Santé PubliqueUFR d'Odonto‐stomatologieUniversité Félix Houphouët BoignyAbidjanCôte d'Ivoire
- Département de Dermatologie et InfectiologieUniversité Félix Houphouët‐BoignyAbidjanCôte d'Ivoire
| | - Emily P. Hyle
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard University Center for AIDS ResearchBostonMassachusettsUSA
| |
Collapse
|
4
|
Hayes MJ, Beavon E, Traeger MW, Dillon JF, Radley A, Nielsen S, Byrne CJ, Richmond J, Higgs P, Hellard ME, Doyle JS. Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102489. [PMID: 38440399 PMCID: PMC10909633 DOI: 10.1016/j.eclinm.2024.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Background The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding None.
Collapse
Affiliation(s)
| | | | - Michael W. Traeger
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
| | - John F. Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | - Suzanne Nielsen
- Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher J. Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| |
Collapse
|
5
|
Friebel-Klingner TM, Alvarez GG, Lappen H, Pace LE, Huang KY, Fernández ME, Shelley D, Rositch AF. State of the Science of Scale-Up of Cancer Prevention and Early Detection Interventions in Low- and Middle-Income Countries: A Scoping Review. JCO Glob Oncol 2024; 10:e2300238. [PMID: 38237096 PMCID: PMC10805431 DOI: 10.1200/go.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 10/18/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE Cancer deaths in low- and middle-income countries (LMICs) will nearly double by 2040. Available evidence-based interventions (EBIs) for cancer prevention and early detection can reduce cancer-related mortality, yet there is a lack of evidence on effectively scaling these EBIs in LMIC settings. METHODS We conducted a scoping review to identify published literature from six databases between 2012 and 2022 that described efforts for scaling cancer prevention and early detection EBIs in LMICs. Included studies met one of two definitions of scale-up: (1) deliberate efforts to increase the impact of effective intervention to benefit more people or (2) an intervention shown to be efficacious on a small scale expanded under real-world conditions to reach a greater proportion of eligible population. Study characteristics, including EBIs, implementation strategies, and outcomes used, were summarized using frameworks from the field of implementation science. RESULTS This search yielded 3,076 abstracts, with 24 studies eligible for inclusion. Included studies focused on a number of cancer sites including cervical (67%), breast (13%), breast and cervical (13%), liver (4%), and colon (4%). Commonly reported scale-up strategies included developing stakeholder inter-relationships, training and education, and changing infrastructure. Barriers to scale-up were reported at individual, health facility, and community levels. Few studies reported applying conceptual frameworks to guide strategy selection and evaluation. CONCLUSION Although there were relatively few published reports, this scoping review offers insight into the approaches used by LMICs to scale up cancer EBIs, including common strategies and barriers. More importantly, it illustrates the urgent need to fill gaps in research to guide best practices for bringing the implementation of cancer EBIs to scale in LMICs.
Collapse
Affiliation(s)
| | - Gloria Guevara Alvarez
- Department Public Health Policy and Management, School of Global Public Health, New York University, New York, NY
| | - Hope Lappen
- Division of Libraries, New York University, New York, NY
| | - Lydia E. Pace
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Keng-Yen Huang
- Department of Population Health, Center for Early Childhood Health & Development (CEHD), New York, NY
| | - Maria E. Fernández
- Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, School of Public Health Houston, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Donna Shelley
- Department Public Health Policy and Management, School of Global Public Health, New York University, New York, NY
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
6
|
Lebbie W, Allan-Blitz LT, Nyama ET, Swaray M, Lavalie D, Mhango M, Patiño Rodriguez M, Gupta N, Bitwayiki R. Barriers to longitudinal follow-up for hepatitis B treatment in rural Sierra Leone: A mixed methods study of retention in care. Clin Liver Dis (Hoboken) 2024; 23:e0225. [PMID: 38831767 PMCID: PMC11146505 DOI: 10.1097/cld.0000000000000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 06/05/2024] Open
Abstract
HBV disproportionately affects resource-limited settings, and retaining patients in longitudinal care remains challenging. We conducted a mixed methods investigation to understand the causes of losses to follow-up within an HBV clinic in rural Sierra Leone. We developed a multivariable logistic regression model of baseline clinical and sociodemographic factors predicting losses to follow-up, defined as failing to present for a follow-up visit within 14 months of enrollment. We included patients enrolled between April 30, 2019 and March 1, 2020, permitting 14 months of follow-up by April 30, 2021. We then developed a survey to solicit patient perspectives on the challenges surrounding retention. We interviewed randomly selected patients absent from HBV care for at least 6 months. Among 271 patients enrolled in the Kono HBV clinic, 176 (64.9%) did not have a follow-up visit within 14 months of the study end point. Incomplete baseline workup (aOR 2.9; 95% CI: 1.6-4.8), lack of treatment at baseline (aOR 5.0; 95% CI: 1.7-14.4), and having cirrhosis at baseline (aOR 3.3; 95% CI: 0.99-10.8) were independently associated with being lost to follow-up. For the patient survey, 21 patients completed the interview (median age 34 years [IQR: 25-38]). Travel-related factors were the most frequently reported barrier to retention (57%). Almost 30% suggested improved customer care might support retention in care; 24% requested to be given medication. In our setting, factors that might reduce losses to follow-up included expanded criteria for treatment initiation, overcoming transportation barriers, reducing wait times, ensuring against stockouts, and scaling up point-of-care testing services.
Collapse
Affiliation(s)
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Mohamed Swaray
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| | - Daniel Lavalie
- Ministry of Health and Sanitation, Freetown, Sierra Leone, Britannica, WA
| | - Michael Mhango
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| | | | - Neil Gupta
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Remy Bitwayiki
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| |
Collapse
|
7
|
Nguyen LBL, Lemoine M, Ndow G, Ward ZJ, Hallet TB, D'Alessandro U, Thursz M, Nayagam S, Shimakawa Y. Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis. Lancet Glob Health 2024; 12:e66-e78. [PMID: 38097300 DOI: 10.1016/s2214-109x(23)00467-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Global elimination of hepatitis B virus (HBV) requires expanded uptake of antiviral therapy, potentially by simplifying testing algorithms, especially in resource-limited countries. We evaluated the effectiveness, cost-effectiveness, and budget impact of three strategies that determine eligibility for anti-HBV treatment, as compared with the WHO 2015 treatment eligibility criteria, in The Gambia. METHODS We developed a microsimulation model of natural history using data from the Prevention of Liver Fibrosis and Cancer in Africa programme (known as PROLIFICA) in The Gambia, for an HBV-infected cohort of individuals aged 20 years. The algorithms included in the model were a conventional strategy using the European Association for the Study of the Liver (EASL) 2017 criteria, a simplified algorithm using hepatitis B e antigen and alanine aminotransferase (the Treatment Eligibility in Africa for the Hepatitis B Virus [TREAT-B] score), a Treat All approach for all HBV-infected individuals, and the WHO 2015 criteria. Outcomes to measure effectiveness were disability-adjusted life years (DALYs) and years of life saved (YLS), which were used to calculate incremental cost-effectiveness ratios (ICERs) with the WHO 2015 criteria as the base-case scenario. Costs were assessed from a modified social perspective. A budget impact analysis was also done. We tested the robustness of results with a range of sensitiviy analyses including probabilistic sensitivity analysis. FINDINGS Compared with the WHO criteria, TREAT-B resulted in 4877 DALYs averted and Treat All resulted in 9352 DALYs averted, whereas the EASL criteria led to an excess of 795 DALYs. TREAT-B was cost-saving, whereas the ICER for Treat All (US$2149 per DALY averted) was higher than the cost-effectiveness threshold for The Gambia (0·5 times the country's gross domestic product per capita: $352). These patterns did not change when YLS was the outcome. In a modelled cohort of 5000 adults (aged 20 years) with chronic HBV infection from The Gambia, the 5-year budget impact was $1·14 million for Treat All, $0·66 million for TREAT-B, $1·03 million for the WHO criteria, and $1·16 million for the EASL criteria. Probabilistic sensitivity analysis indicated that among the Treat All, EASL, and TREAT-B algorithms, Treat All would become the most preferred strategy only with a willingness-to-pay threshold exceeding approximately $72 000 per DALY averted or $110 000 per YLS. INTERPRETATION Although the Treat All strategy might be the most effective, it is unlikely to be cost-effective in The Gambia. A simplified strategy such as TREAT-B might be a cost-saving alternative. FUNDING UK Research and Innovation (Medical Research Council). TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Liem B Luong Nguyen
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France; CIC Cochin Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK; Medical Research Council Unit, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Gibril Ndow
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK; Medical Research Council Unit, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Timothy B Hallet
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK
| | - Shevanthi Nayagam
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK; Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France.
| |
Collapse
|
8
|
Camara M, Tantuoyir MM, SeyedAlinaghi S, Ghiasvand F, Ahmadinejad Z. Prevalence of hepatitis B infection in the Gambian population: A narrative review of recent developments. Prev Med Rep 2023; 36:102401. [PMID: 37719791 PMCID: PMC10500481 DOI: 10.1016/j.pmedr.2023.102401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Hepatitis B is a "silent epidemic", fifty to a hundred (50-100) times more infectious than HIV, a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). HBV can cause acute and chronic infection and subsequently results in a high risk of death from cirrhosis and liver cancer. Despite the availability of a safe and effective vaccine, HBV continues to be a global burden including in The Gambia. This study reviewed the recent trends in the epidemiological characteristics of HBV in the Gambia. The researchers conducted an online literature search for primary studies on HBV prevalence published in the past two decades from Jan 1992 to Feb 2022 inclusive on Google Scholar, PubMed, and Scopus. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness, and methodological coherence. We found that HBV infection prevalence is above 8% in The Gambia. Moreover, HBV is the most common cause of hepatocellular carcinoma (HCC) in Gambia. Liver cirrhosis and HCC have the highest mortality contribution among hepatitis patients, with occult HBV carriers as major culprits. Also, vaccination coverage has declined from 91% to 88% according to reports from current literature. To achieve the WHO goal of eliminating HBV by 2030, policies targeting infection transmission control among risk groups, community awareness programs, research, price reduction of drugs, mass vaccinations, and diagnostics should be urgently instituted.
Collapse
Affiliation(s)
- Muhammed Camara
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Edward Francis Small Teaching Hospital, Banjul, the Gambia
| | - Marcarious M. Tantuoyir
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghiasvand
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Spearman CW, Andersson MI, Bright B, Davwar PM, Desalegn H, Guingane AN, Johannessen A, Kabagambe K, Lemoine M, Matthews PC, Ndow G, Riches N, Shimakawa Y, Sombié R, Stockdale AJ, Taljaard JJ, Vinikoor MJ, Wandeler G, Okeke E, Sonderup M. A new approach to prevent, diagnose, and treat hepatitis B in Africa. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:24. [PMID: 38798823 PMCID: PMC11116268 DOI: 10.1186/s44263-023-00026-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/02/2023] [Indexed: 05/29/2024]
Abstract
There are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB.
Collapse
Affiliation(s)
- C. Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monique I. Andersson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
| | - Bisi Bright
- LiveWell Initiative, Yesuf Abiodun Street, Victoria Island, Lagos, Nigeria
- Women in Hepatitis Africa, Womens Wellness Center for Hepatitis, Isale Ajoke, Iwaya-Makoko, Lagos State, Nigeria
| | - Pantong M. Davwar
- Department of Internal Medicine, Jos Univeristy Teaching Hospital, Jos, Nigeria
| | - Hailemichael Desalegn
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alice Nanelin Guingane
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso
| | - Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kenneth Kabagambe
- The National Organisation for People Living With Hepatitis B, Kampala, Uganda
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Philippa C. Matthews
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK
- Division of Infection and Immunity, University College London, Gower Street, London, WC1E 6BT UK
- Department of Infectious Diseases, University College London Hospital, Euston Road, London, NW1 2BU UK
| | - Gibril Ndow
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Nicholas Riches
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d’Épidémiologie Des Maladies Émergentes, Paris, France
| | - Roger Sombié
- Service d’hépato-Gastroentérologie, CHU Yalgado OUÉDRAOGO, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Alexander J. Stockdale
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunity, University of Liverpool, Liverpool, UK
| | - Jantjie J. Taljaard
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Michael J. Vinikoor
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Edith Okeke
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - on behalf of the Hepatitis B in Africa Collaborative Network (HEPSANET)
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
- LiveWell Initiative, Yesuf Abiodun Street, Victoria Island, Lagos, Nigeria
- Women in Hepatitis Africa, Womens Wellness Center for Hepatitis, Isale Ajoke, Iwaya-Makoko, Lagos State, Nigeria
- Department of Internal Medicine, Jos Univeristy Teaching Hospital, Jos, Nigeria
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The National Organisation for People Living With Hepatitis B, Kampala, Uganda
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK
- Division of Infection and Immunity, University College London, Gower Street, London, WC1E 6BT UK
- Department of Infectious Diseases, University College London Hospital, Euston Road, London, NW1 2BU UK
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Institut Pasteur, Université Paris Cité, Unité d’Épidémiologie Des Maladies Émergentes, Paris, France
- Service d’hépato-Gastroentérologie, CHU Yalgado OUÉDRAOGO, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunity, University of Liverpool, Liverpool, UK
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| |
Collapse
|
10
|
Bittaye SO, Kambi A, Tekanyi MAI, Tamba S, Sanneh L, Sisawo MM, Jatta A, Fatty G, Jeng A, Jallow MS, Leigh O, Njie R. Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients. BMC Gastroenterol 2023; 23:321. [PMID: 37730538 PMCID: PMC10510158 DOI: 10.1186/s12876-023-02952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND As a result of the lack of screening programs and the difficulty in making a proper diagnosis, the majority of hepatocellular carcinoma (HHC) patients present late in low-resource countries. The study therefore assesses the clinical features, stage and prognostic variables of patients with HCC in The Gambia. METHODS From December 2015 to January 2019, patients with a confirmed diagnosis of HCC were enrolled. All patients' medical history, ultrasound scan, FibroScan and laboratory details were collected. RESULTS Two hundred and sixty (260) patients were enrolled. The mean age of HCC patients was 40 years, and 210 (80.7%) of them were male. The most common gastrointestinal symptoms were early satiety 229 (88.1%) and abdominal pain 288 (87.7%), while the most common constitutional symptoms were weight loss 237 (91.2%) and easy fatiguability 237 (91.2%). Hepatomegaly 205 (78.8%) was the most common sign. On ultrasound scan, lesions were mostly multifocal 175 (67.3%), and the median FibroScan score was 75 kPa. The median fibrosis 4 and aspartate transferase platelet ratio index were 4.6 and 2.2, respectively. Hepatitis B surface antigen (HBsAg) was positive in 170 (65.4%) patients, and the median AFP level was 3263 ng/ml. HCC patients with positive HBsAg were more likely to be male 145 (85.3%) vs 62 (72.1%) (p = 0.011), much younger 39.9 vs 51.4 yrs (p = < 0.0001), more likely to have abdominal pain 156 (91.8%) vs 68 (79.1%) (p = 0.002), jaundice 78 (45.9%) vs 29 (33.7%) (p = 0.042), dark urine 117 (68.8%) vs 46 (53.5%) (p = 0.018), raised transaminases (Aspartate transaminases 224.5 (32-7886) vs 153 (18-610), p = < 0.01, Alanine transferases 71 (5-937) vs 47 (8-271), p = < 0.001) and decreased platelet count 207 (33-941) vs 252 (52- 641) (p = 0.021) compared to patients with HCC who were HBsAg-negative. CONCLUSIONS The prognosis of patients with HCC is poor in developing countries such as The Gambia, where screening programs and treatment modalities are scarce. Young males are disproportionately affected, and HBV is a major cause of HCC in The Gambia.
Collapse
Affiliation(s)
- Sheikh Omar Bittaye
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.
| | - Abubacarr Kambi
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Momodou A I Tekanyi
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Saydiba Tamba
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Lamin Sanneh
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Momodou Musa Sisawo
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Abdoulie Jatta
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Gibril Fatty
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Adam Jeng
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Momodou Salieu Jallow
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
- Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ousman Leigh
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
- Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- American International University, Serekunda, Gambia
| | - Ramou Njie
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| |
Collapse
|
11
|
Ndow G, Vo-Quang E, Shimakawa Y, Ceesay A, Tamba S, Njai HF, Bojang L, Hateley C, Takao Y, Opoku E, Warsop Z, Ingiliz P, D'Alessandro U, Chemin I, Mendy M, Thursz M, Njie R, Lemoine M. Clinical characteristics and outcomes of patients with cirrhosis and hepatocellular carcinoma in The Gambia, west Africa: a prospective cohort study. Lancet Glob Health 2023; 11:e1383-e1392. [PMID: 37517420 DOI: 10.1016/s2214-109x(23)00263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/06/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Chronic liver disease is a major cause of premature death in sub-Saharan Africa. Efficacy of antiviral therapy among patients with hepatitis B virus (HBV)-related cirrhosis is not well established in Africa. We described the clinical characteristics and outcomes of patients with cirrhosis and hepatocellular carcinoma in The Gambia and assessed the impact of tenofovir disoproxil fumarate (TDF) on survival of HBV-infected patients with cirrhosis. METHODS In this prospective cohort study, we followed up adults who were consecutively diagnosed with cirrhosis or hepatocellular carcinoma between 2012 and 2015 in The Gambia, west Africa. Patients with chronic HBV infection and cirrhosis, without hepatocellular carcinoma, were offered TDF. Primary outcome was overall survival. To determine the effect of TDF on survival, we performed a Cox proportional hazard regression model with inverse probability of treatment weighting (IPTW) based on propensity score. FINDINGS Of 529 patients enrolled in this study, 336 patients (252 with hepatocellular carcinoma and 84 with cirrhosis) were analysed. Patients were predominantly male (253 [75%] men and 83 [25%] women), with a median age of 42 years (IQR 33-55). 276 (84%) of 327 of patients with data were positive for HBV biomarkers, 31 (10%) of 311 were positive for hepatitis C virus antibodies, and 22 (10%) of 223 were positive for hepatitis D virus antibodies. 64% of patients with hepatocellular carcinoma had multifocal tumour, with a median size of 7·5 cm (IQR 5·4-10·8). 173 patients with hepatocellular carcinoma and 70 patients with cirrhosis were included in the survival analysis. Median survival was 1·5 months (95% CI 1·1-2·0) in patients with hepatocellular carcinoma and 17·1 months (11·2-24·0) in patients with cirrhosis (log-rank p<0·0001). In patients with hepatocellular carcinoma, ascites (hazard ratio [HR] 1·78, 95% CI 1·21-2·60), partial or complete portal thrombosis (HR 2·61, 1·58-4·30), and platelet count (HR 1·80, 1·19-2·70) were independent predictive factors of mortality at baseline. In HBV-infected patients with cirrhosis, median turnaround time between cirrhosis diagnosis and TDF initiation was 4·9 months (IQR 3·2-7·3). In IPTW analysis, TDF treatment was associated with improved survival in patients with HBV-related cirrhosis (adjusted HR 0·14, 0·06-0·34; p<0·0001). INTERPRETATION These results highlight poor survival of patients with cirrhosis or hepatocellular carcinoma as well as the effectiveness of TDF in reducing the premature mortality of patients with cirrhosis and HBV infection. Interventions for early diagnosis and treatment of cirrhosis as well as screening programmes for hepatocellular carcinoma are urgently required in Africa. FUNDING European Commission and Medical Research Council UK. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Gibril Ndow
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
| | - Erwan Vo-Quang
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Hepatology Department, Henri-Mondor University Hospital, INSERM U955, Créteil, France
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Amie Ceesay
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Saydiba Tamba
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Harr F Njai
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Lamin Bojang
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Charlotte Hateley
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
| | - Yuki Takao
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
| | - Emmanuel Opoku
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
| | - Zakary Warsop
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
| | - Patrick Ingiliz
- Hepatology Department, Henri-Mondor University Hospital, INSERM U955, Créteil, France
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | | | - Maimuna Mendy
- International Agency for Research on Cancer, Lyon, France
| | - Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
| | - Ramou Njie
- Edward Francis Small Teaching Hospital, Banjul, The Gambia; School of Medicine & Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Maud Lemoine
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK; Department of Surgery and Cancer, Liver Unit, St Mary's Hospital, Imperial College London, London, UK.
| |
Collapse
|
12
|
Howell J, Seaman C, Wallace J, Xiao Y, Scott N, Davies J, de Santis T, Adda D, El-Sayed M, Feld JJ, Gane E, Lacombe K, Lesi O, Mohamed R, Silva M, Tu T, Revill P, Hellard ME. Pathway to global elimination of hepatitis B: HBV cure is just the first step. Hepatology 2023; 78:976-990. [PMID: 37125643 PMCID: PMC10442143 DOI: 10.1097/hep.0000000000000430] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 05/02/2023]
Abstract
Hepatitis B (HBV) is a major cause of global morbidity and mortality, and the leading cause of liver cancer worldwide. Significant advances have recently been made toward the development of a finite HBV treatment that achieves permanent loss of HBsAg and HBV DNA (so-called "HBV cure"), which could provide the means to eliminate HBV as a public health threat. However, the HBV cure is just one step toward achieving WHO HBV elimination targets by 2030, and much work must be done now to prepare for the successful implementation of the HBV cure. In this review, we describe the required steps to rapidly scale-up future HBV cure equitably. We present key actions required for successful HBV cure implementation, integrated within the World Health Organization (WHO) Global Health Sector Strategy (GHSS) 2022-2030 framework. Finally, we highlight what can be done now to progress toward the 2030 HBV elimination targets using available tools to ensure that we are preparing, but not waiting, for the cure.
Collapse
Affiliation(s)
- Jessica Howell
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
- Department Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
- Department Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Seaman
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
- Department Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jack Wallace
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
| | - Yinzong Xiao
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
| | - Nick Scott
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
| | - Jane Davies
- Department Global Health and Infectious diseases, Menzies School of Public Health, Darwin, Northern Territory, Australia
| | - Teresa de Santis
- Department Global Health and Infectious diseases, Menzies School of Public Health, Darwin, Northern Territory, Australia
| | | | - Manal El-Sayed
- Department Paediatrics, Ain Shams University, Cairo, Egypt
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Edward Gane
- Department Medicine, University of Auckland, Auckland, New Zealand
| | - Karine Lacombe
- Sorbonne Université, IPLESP, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Olufunmilayo Lesi
- Global HIV, Hepatitis, and STI Programme, World Health Organisation, Geneva, Switzerland
| | - Rosmawati Mohamed
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Marcelo Silva
- Department Hepatology and Liver Transplantation, Austral University Hospital, Buenos Aires, Argentina
| | - Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, New South Wales, Australia
- University of Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory (VIDRL), Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Margaret E. Hellard
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
- Department Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
- Department Infectious Diseases, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Djaogol T, Périères L, Marcellin F, Diouf A, Carrieri MP, Diallo A, Boyer S. Hepatitis B prevention and treatment needs in women in Senegal (ANRS 12356 AmBASS survey). BMC Public Health 2023; 23:825. [PMID: 37143029 PMCID: PMC10161542 DOI: 10.1186/s12889-023-15710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Although mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is prevalent in West Africa, epidemiological data on HBV infection in women remain scarce. We studied i) hepatitis B surface antigen (HBsAg) prevalence and its correlates, ii) HBV screening history and serological status awareness, iii) MTCT risk and treatment needs in Senegalese women. METHODS A cross-sectional population-based serosurvey for HBsAg positivity was conducted in 2018-2019 in the rural area of Niakhar (Fatick region, Senegal). Participants were offered home-based HBV screening and answered face-to-face questionnaires. HBsAg-positive participants underwent clinical and biological assessments. Data were weighted and calibrated to be representative of the area's population. Logistic regression models helped identify factors associated with HBsAg-positivity in adult women (> 15 years old). RESULTS HBsAg prevalence in adult women was 9.2% [95% confidence interval: 7.0-11.4]. Factors associated with HBsAg-positivity were being 15-49 years old (ref: ≥ 50), living in a household with > 2 other HBsAg-positive members, and knowing someone with liver disease. Only 1.6% of women had already been tested for HBV; no one who tested HBsAg positive was already aware of their serological status. In women 15-49 years old, 5% risked MTCT and none were eligible for long-term antiviral treatment. CONCLUSIONS Adult women have a high HBsAg prevalence but a low MTCT risk. Low rates of HBV screening and serological status awareness argue for the adoption of systematic screening during pregnancy using free and rapid diagnostic tests. Additionally, screening household members of HBsAg-positive women may greatly improve the cascade of care in rural Senegal. TRIAL REGISTRATION ClinicalTrials.gov identifier (NCT number): NCT03215732.
Collapse
Affiliation(s)
- Tchadine Djaogol
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-P 1401, F-33000, Bordeaux, France
| | - Lauren Périères
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- VITROME, Campus IRD-UCAD, Dakar, Senegal
| | - Fabienne Marcellin
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Maria Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Sylvie Boyer
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| |
Collapse
|
14
|
Howell J, Van H, Pham MD, Sawhney R, Li F, Bhat P, Lubel J, Kemp W, Bloom S, Majumdar A, McCaughan GW, Hall S, Spelman T, Doyle JS, Hellard M, Visvanathan K, Thompson A, Drummer HE, Anderson D. Validation of a novel point-of-care test for alanine aminotransferase measurement: A pilot cohort study. Liver Int 2023; 43:989-999. [PMID: 36719055 DOI: 10.1111/liv.15531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alanine aminotransferase (ALT) measurement is essential for evaluation of liver disease. We validated a novel rapid point-of-care (POC) test for ALT1 against laboratory ALT. METHODS Stored plasma samples from adults with chronic liver disease (Test cohort n = 240; Validation cohort n = 491) were analysed using the BioPoint® antigen immunoassay POC ALT1 lateral flow test, which provides quantitative ALT results (Axxin handheld reader) or semi-quantitative results (visual read, cut off 40 IU/ml). The accuracy of POC ALT1 to detect ALT > 40 IU/L was determined by ROC analysis. In patients with chronic hepatitis B, treatment eligibility (EASL criteria) was determined using POC ALT1 and compared to laboratory ALT. RESULTS POC ALT1 test had good accuracy for laboratory ALT > 40 IU/L: AUROC 0.93 (95% CI: 0.89-0.96) in the Test cohort and AUROC 0.92 (95% CI: 0.88-0.95) in the Validation cohort. POC ALT1 cut off of 0.8 for ALT > 40 IU/L maximised sensitivity (97%) and specificity (71%) in the Test cohort (42% laboratory ALT > 40 IU/L) and yielded PPV 84% and NPV 91% in the Validation cohort (19% laboratory ALT > 40 IU/L). Semi-quantitative POC ALT1 had good accuracy for laboratory ALT in the Validation cohort (AUROC 0.85, 95% CI: 0.81-0.99; sensitivity 77% and specificity 93%). Combined with HBV DNA and transient elastography, both quantitative and semi-quantitative POC ALT1 tests had good accuracy for excluding hepatitis B treatment needs (sensitivity 96%, specificity 78% and NPV 99%). CONCLUSION The POC ALT1 test had good accuracy for elevated ALT levels and for determining treatment eligibility among people with chronic hepatitis B.
Collapse
Affiliation(s)
- Jessica Howell
- Burnet Institute, Melbourne, Australia
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Huy Van
- Burnet Institute, Melbourne, Australia
| | - Minh D Pham
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rohit Sawhney
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Fan Li
- Burnet Institute, Melbourne, Australia
| | | | - John Lubel
- Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Central Clinical School, Monash University, Melbourne, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Avik Majumdar
- A.W.Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Geoffrey W McCaughan
- A.W.Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
- Centenary Institute, Sydney, Australia
| | - Samuel Hall
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Kumar Visvanathan
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | - Heidi E Drummer
- Burnet Institute, Melbourne, Australia
- Department of Microbiology, Monash University, Clayton, Victoria, Australia
- Department of Microbiology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia
| | | |
Collapse
|
15
|
Howell J, Van H, Pham MD, Sawhney R, Li F, Bhat P, Lubel J, Kemp W, Bloom S, Majumdar A, McCaughan G, Spelman T, Doyle JS, Hellard M, Visvanathan K, Thompson A, Anderson D. A novel point-of-care test for cirrhosis based on dimeric to monomeric IgA ratio in blood: a pilot cohort study. Hepatol Commun 2023; 7:e0106. [PMID: 36995999 PMCID: PMC10069834 DOI: 10.1097/hc9.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND AND AIMS Dimeric IgA to monomeric IgA ratio (dIgA ratio) is a biomarker of gut mucosal leakage in liver cirrhosis. We evaluated the diagnostic performance of a novel point-of-care (POC) dIgA ratio test for cirrhosis. METHODS Plasma samples from people with chronic liver disease were analyzed using the BioPoint POC dIgA ratio antigen immunoassay lateral flow test. Cirrhosis was defined by Fibroscan>12.5 kPa, clinical evidence of cirrhosis or liver histopathology. POC dIgA test diagnostic accuracy was determined in a test cohort using receiver operating characteristic curve analysis; optimal cutoffs for sensitivity and specificity were then applied to a validation cohort. RESULTS A total of 1478 plasma samples from 866 patients with chronic liver disease were included (test cohort n = 260, validation cohort n = 606). In all, 32% had cirrhosis; 44% Child-Pugh A, 26% Child-Pugh B, and 29% Child-Pugh C. Median POC dIgA ratio was higher in cirrhosis (0.9) compared with no cirrhosis (0.4, p < 0.001), and in Child-Pugh class B/C compared with A cirrhosis (1.4 Child-Pugh B/C vs. 0.6 Child-Pugh A, p < 0.001). POC dIgA ratio test had good diagnostic accuracy for liver cirrhosis in the test cohort (area under the receiver operating characteristic curve=0.80); a dIgA ratio cutoff of 0.6 had a sensitivity of 74% and specificity of 86%. POC dIgA test accuracy was moderate in the validation cohort (area under the receiver operating characteristic curve=0.75; positive predictive value 64%, negative predictive value 83%). Using a dual cutoff approach, 79% of cirrhosis cases were correctly diagnosed and further testing was avoided in 57%. CONCLUSIONS POC dIgA ratio test had moderate accuracy for cirrhosis. Further studies evaluating the accuracy of POC dIgA ratio testing for cirrhosis screening are warranted.
Collapse
Affiliation(s)
- Jessica Howell
- Burnet Institute, Melbourne, Victoria, Australia
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Huy Van
- Burnet Institute, Melbourne, Victoria, Australia
| | - Minh D. Pham
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rohit Sawhney
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | - Fan Li
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - John Lubel
- Department of Gastroenterology, The Alfred Hospital and Monash Central Clinical School, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital and Monash Central Clinical School, Melbourne, Victoria, Australia
| | | | - Avik Majumdar
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Geoff McCaughan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Centenary Institute, Sydney, New South Wales, Australia
| | | | - Joseph S. Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Kumar Visvanathan
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Thompson
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
16
|
Schmit N, Nayagam S, Lemoine M, Ndow G, Shimakawa Y, Thursz MR, Hallett TB. Cost-effectiveness of different monitoring strategies in a screening and treatment programme for hepatitis B in The Gambia. J Glob Health 2023; 13:04004. [PMID: 36655869 PMCID: PMC9853089 DOI: 10.7189/jogh.13.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Clinical management of chronic hepatitis B virus (HBV) infection is complex and access to antiviral treatment remains limited in sub-Saharan Africa. International guidelines recommend monitoring at least annually for disease progression among HBV-infected people not meeting treatment criteria at initial diagnosis. This study aimed to assess the impact and cost-effectiveness of alternative strategies for monitoring. Methods We used a mathematical model of HBV transmission and natural history, calibrated to all available West African data, to project the population-level health impact, costs and cost-effectiveness of different monitoring strategies for HBV-infected individuals not initially eligible for antiviral treatment. We assumed that these patients were found in the year 2020 in a hypothetical community-based screening programme in The Gambia. Monitoring frequencies were varied between every 5 and every 1 year and targeted different age groups. Results The currently recommended annual monitoring frequency was likely to be not cost-effective in comparison with other strategies in this setting. 5-yearly monitoring in 15-45-year olds, at US$338 per disability-adjusted life year averted, had the highest probability of being the most effective cost-effective monitoring strategy. Conclusions Monitoring less frequently than once a year is a cost-effective strategy in a community-based HBV screening and treatment programme in The Gambia, with the optimal strategy depending on the cost-effectiveness threshold. Efficiencies may be gained by prioritising the 15-45-year age group for more intensive monitoring.
Collapse
Affiliation(s)
- Nora Schmit
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Shevanthi Nayagam
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Maud Lemoine
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gibril Ndow
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yusuke Shimakawa
- Unité d’Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Mark R Thursz
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
17
|
Li X, Wang J, Ding X, Xu Y, Yu M, Wu H, Deng N, Li W, Chen J. Clinical study of lenvatinib in the treatment of hepatitis virus-related hepatocellular carcinoma and antiviral therapy. Front Pharmacol 2023; 13:1032881. [PMID: 36703739 PMCID: PMC9871375 DOI: 10.3389/fphar.2022.1032881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Lenvatinib is recommended as a first-line tyrosine kinase inhibitor for advanced hepatocellular carcinoma (HCC) since 2017. The aim of this study was to compare the clinical action of lenvatinib in hepatitis B virus (HBV)-related HCC and hepatitis C virus (HCV)-related HCC. Methods: A continuous cohort of advanced HCC was retrospectively enrolled. And the patients were divided into HBV-related HCC and HCV-related HCC based on previous history of hepatitis virus infection. Then propensity score matching (PSM) was conducted to compare objective response rate (ORR),disease control rate (DCR),progression-free survival (PFS),overall survival (OS) and safety between the two groups. Results: A total of 203 eligible patients were included, with 72 HBV-related HCC and 36 HCV-related HCC after PSM. Both ORR (20.8% vs. 5.6%, P = .0759) and DCR (76.4% vs. 52.8%, P = .0232) were significantly higher in the HBV-related HCC than in the HCV-related HCC. Although no statistical differences in PFS (6.1 months vs. 3.3 months, P = .17) and OS (14.9 months vs. 17.7 months, P = .96) were observed between the two groups, there was a trend of difference in the PFS survival curve. On multivariate regression analysis of PFS, both HBV infection (HR, .54; 95% CI, .31-.95; P = .0332) and antiviral time >5 years (HR, .49; 95% CI, .26-.9; P = .0219) were identified as independent favorable factors, and AFP >200 ng/mL (HR, 1.88; 95% CI, 1.1-3.22; P = .0216) were found to be an independent adverse factor. In addition, compared with HCC who received the first dose of antiviral drugs less than 5 years, the patients who were administered those drugs over 5 years had a significantly favorable PFS (11.27 months vs. 3.87 months, P = .0011). Lenvatinib was well tolerated in all patients and the adverse events (AEs) were similar between the two groups. Conclusion: It seemed that lenvatinib benefited more in HBV-related advanced HCC in delaying disease progression, compared to those with HCV-related advanced HCC.
Collapse
Affiliation(s)
- Xiaomi Li
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jingyan Wang
- Department of Interventional Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Ding
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yawen Xu
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghua Yu
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Wu
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Na Deng
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China,*Correspondence: Wei Li, ; Jinglong Chen,
| | - Jinglong Chen
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China,*Correspondence: Wei Li, ; Jinglong Chen,
| |
Collapse
|
18
|
Johannessen A, Stockdale AJ, Henrion MYR, Okeke E, Seydi M, Wandeler G, Sonderup M, Spearman CW, Vinikoor M, Sinkala E, Desalegn H, Fall F, Riches N, Davwar P, Duguru M, Maponga T, Taljaard J, Matthews PC, Andersson M, Mboup S, Sombie R, Shimakawa Y, Lemoine M. Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa. Nat Commun 2023; 14:45. [PMID: 36596805 PMCID: PMC9810658 DOI: 10.1038/s41467-022-35729-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
In sub-Saharan Africa, simple biomarkers of liver fibrosis are needed to scale-up hepatitis B treatment. We conducted an individual participant data meta-analysis of 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries to assess the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index and two other fibrosis biomarkers using a Bayesian bivariate model. Transient elastography was used as a reference test with liver stiffness measurement thresholds at 7.9 and 12.2kPa indicating significant fibrosis and cirrhosis, respectively. At the World Health Organization-recommended cirrhosis threshold (>2.0), aspartate aminotransferase-to-platelet ratio index had sensitivity (95% credible interval) of only 16.5% (12.5-20.5). We identified an optimised aspartate aminotransferase-to-platelet ratio index rule-in threshold (>0.65) for liver stiffness measurement >12.2kPa with sensitivity and specificity of 56.2% (50.5-62.2) and 90.0% (89.0-91.0), and an optimised rule-out threshold (<0.36) with sensitivity and specificity of 80.6% (76.1-85.1) and 64.3% (62.8-65.8). Here we show that the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index threshold is inappropriately high in sub-Saharan Africa; improved rule-in and rule-out thresholds can optimise treatment recommendations in this setting.
Collapse
Affiliation(s)
- Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Alexander J Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Edith Okeke
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Moussa Seydi
- Service de Maladies Infectieuses et Tropicales, Centre Regional de Recherche et de Formation, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - Hailemichael Desalegn
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fatou Fall
- Department of Hepatology and Gastroenterology, Hopital Principal de Dakar, Dakar, Senegal
| | - Nicholas Riches
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Pantong Davwar
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Mary Duguru
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Tongai Maponga
- Division of Medical Virology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Francis Crick Institute, London, UK
- University College London, London, UK
| | - Monique Andersson
- Division of Medical Virology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Souleyman Mboup
- L'Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formations (IRESSEF), Dakar, Senegal
| | - Roger Sombie
- Yalgado Ouédraogo University Hospital Center, Ouagadougou, Burkina Faso
| | - Yusuke Shimakawa
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology section, Imperial College London, London, UK
| |
Collapse
|
19
|
Darré T, Djiwa T, Kogoe RML, Eklu KE, Alassani F, Simgban P, Bombone M, Sama B, Tchangai B, Bagny A, Napo-Koura G. Factors Associated With Esophagus Cancers in Togo, Sub-Saharan Africa. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X231195238. [PMID: 37655069 PMCID: PMC10467178 DOI: 10.1177/2632010x231195238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023]
Abstract
Background Esophagus cancer is cancer of poor prognosis, of often late diagnosis. The objective of this study was to describe the factors associated with esophagus cancers in the Togolese population. Methods It was a retrospective descriptive, cross-sectional study, on esophagus cancers histologically diagnosed at the Pathological Laboratory of Lomé over a period of 31 years (1990-2021). Results We have collected 144 cases of esophagus cancer. The average age of patients was 57 ± 12 years, and the sex ratio was 2.34. The most applicant service was the service of Hepato Gastroenterology of CHU Campus (30.6%). Alcohol (57.6%), tobacco (45.8%) were the most present risk factors. Biopsies were the most addressed (97.2%). The average duration of symptom evolution was 6.42 months and the main symptom at the time of diagnosis was dysphagia (36.8%). The location of cancer was the lower third for 71.5% of cases. At histology, epidermoid carcinoma was the dominant type (90.3%). Male sex was statistically associated with the occurrence of epidermoid carcinoma and female sex with the occurrence of adenocarcinoma (P < .001). Alcohol, smoking, and consumption of hot foods were statistically associated with the occurrence of epidermoid carcinoma in this study (P < .05). Conclusion Esophagus cancer remains a serious condition for late diagnosis. These are mainly epidermoid carcinomas and having alcohol and tobacco as risk factors. The awareness of the population on the main risk factors would reduce the incidence of oesophagus cancers within the Togolese population.
Collapse
Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | | | - Kodjo Eugene Eklu
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Fousseni Alassani
- Department of Visceral Surgery, University Teaching Hospital, Lome, Togo
| | - Panakinao Simgban
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mayi Bombone
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bagassam Sama
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Boyodi Tchangai
- Department of Visceral Surgery, University Teaching Hospital, Lome, Togo
| | - Aklesso Bagny
- Department of Gastroenterology, University Teaching Hospital, Lome, Togo
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| |
Collapse
|
20
|
Vincent JP, Ndow G, Ogawa S, Ceesay A, Njie R, Sanneh B, Baldeh I, D’Alessandro U, Mendy M, Thursz M, Chemin I, Tanaka Y, Lemoine M, Shimakawa Y. Mac-2 binding protein glycosylation isomer (M2BPGi) to evaluate liver fibrosis and cancer in HBV-infected patients in West Africa. J Glob Health 2022; 12:04076. [PMID: 36370422 PMCID: PMC9653177 DOI: 10.7189/jogh.12.04076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background To reduce mortality associated with hepatitis B virus (HBV) infection, timely detection of cirrhosis and early-stage hepatocellular carcinoma (HCC) is essential. In low-income countries, however, HBV-infected people have limited access to liver histopathology, a reference test. Recently, Asian studies have suggested the usefulness of an inexpensive serum biomarker called Mac-2 binding protein glycosylation isomer (M2BPGi) in staging liver fibrosis and predicting HCC in HBV-infected patients. Methods We systematically searched PubMed for studies examining the performance of M2BPGi in staging liver fibrosis in HBV-infected people, published up to September 21, 2021, to elucidate the knowledge gap. We then conducted a cross-sectional study of 339 HBV-infected patients in The Gambia (cirrhosis = 65, HCC = 73, non-cirrhosis non-HCC = 201). We evaluated the association of M2BPGi with cirrhosis and HCC by computing odds ratios (ORs) derived from logistic regression. We also assessed the performance of M2BPGi to stage liver fibrosis in 49 patients who underwent liver biopsy (derivation set) and 217 patients with transient elastography (validation set). Using the derivation set we drew the receiver operating characteristics (ROC) curves to identify optimal M2BPGi thresholds to indicate significant fibrosis and cirrhosis using biopsy as a reference. We then applied these cut-offs to the validation set to obtain its sensitivity and specificity for indicating significant fibrosis and cirrhosis using transient elastography as a reference. Results The systematic review identified 13 studies, all of which were conducted in East Asia and none in Africa. In The Gambia, positive M2BPGi was significantly associated with both cirrhosis (adjusted OR = 7.8, 95% CI = 3.1-19.7) and HCC (adjusted OR = 10.1, 2.6-40.2). The areas under the ROC curve (AUROC) in the derivation and validation set were 0.62 and 0.78, respectively, to diagnose significant fibrosis, and 0.80 and 0.89, respectively, to diagnose cirrhosis. By applying the optimal cut-offs, the sensitivity and specificity in the validation set were 61.5% and 93.4%, respectively, to diagnose significant fibrosis, and 72.5% and 92.2%, respectively, for cirrhosis. Conclusions To the best of our knowledge, this is the first evaluation of M2BPGi in HBV-infected African population. The findings supported its accuracy in the diagnosis of cirrhosis in HBV-infected patients in West Africa.
Collapse
Affiliation(s)
| | - Gibril Ndow
- Division of Digestive Diseases, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
- Disease Control & Elimination, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Shintaro Ogawa
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Amie Ceesay
- Disease Control & Elimination, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ramou Njie
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine & Allied Health Sciences, University of The Gambia, Serekunda, The Gambia
| | - Bakary Sanneh
- National Public Health Laboratories, Ministry of Health, Serekunda, The Gambia
| | - Ignatius Baldeh
- National Public Health Laboratories, Ministry of Health, Serekunda, The Gambia
| | - Umberto D’Alessandro
- Disease Control & Elimination, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Mark Thursz
- Division of Digestive Diseases, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Isabelle Chemin
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Maud Lemoine
- Division of Digestive Diseases, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
- International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| |
Collapse
|
21
|
Tazinkeng NN, Teuwafeu DG, Asombang AW, Agbor VN, Bloom SM, Nkhoma AN, Mohareb AM, Luma HN. Factors associated with hepatitis B and C among adults in Buea, Cameroon: A community-based cross-sectional study. Liver Int 2022; 42:2396-2402. [PMID: 35946051 DOI: 10.1111/liv.15390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Viral hepatitis is a major cause of death in Africa. A paucity of community-based studies on the determinants of viral hepatitis in Africa impedes efforts to appropriately target prevention, screening, and treatment interventions. We assessed factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) in a semi-urban health district in Cameroon. METHODS We conducted a community-based, cross-sectional study from 28 February to 15 May 2021 in the Buea Health District in Buea, Cameroon. We recruited a sample of consenting individuals aged over 15 years old. Participants were surveyed for factors associated with HBV/HCV and were screened for HBV surface antigen (HBsAg) and HCV antibody using rapid point-of-care tests. We performed univariable and multivariable logistic regression analyses to identify factors associated with HBsAg and HCV seropositivity. RESULTS We screened 1144 participants (66% female) with a median age of 30 years (IQR: 23-44). HBsAg prevalence was 5.7% (95%CI: 4.5-7.2%) and HCV seropositivity was 1.9% (95%CI: 1.3-2.9%). Three people (0.3%) were seropositive for both HBsAg and HCV antibody. Male sex (adjusted OR [aOR] = 2.31; 95%CI: 1.28-4.18) and a history of traditional operation or scarification (aOR = 2.87; 95%CI: 1.67-4.92) were associated with HBsAg. None of the assessed factors was significantly associated with HCV antibody. CONCLUSION Men and participants with a history of traditional operation and scarification had higher odds of HBsAg. We did not observe any associations with HCV seropositivity. Prevention and screening efforts among adults in this setting should prioritize men and those with a history of traditional operation and scarification.
Collapse
Affiliation(s)
- Nkengeh N Tazinkeng
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Pan-African Organization for Health, Education and Research, Manchester, Missouri, USA.,Department of Population Health Research, Health Education and Research Organization (HERO), Buea, Cameroon.,Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Denis G Teuwafeu
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Department of Internal Medicine, Buea Regional Hospital, Buea, Cameroon
| | - Akwi W Asombang
- Pan-African Organization for Health, Education and Research, Manchester, Missouri, USA.,Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Valirie N Agbor
- Department of Population Health Research, Health Education and Research Organization (HERO), Buea, Cameroon.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Seth M Bloom
- Pan-African Organization for Health, Education and Research, Manchester, Missouri, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Alick N Nkhoma
- Pan-African Organization for Health, Education and Research, Manchester, Missouri, USA.,University Hospital of the North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Amir M Mohareb
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
22
|
Viral Diagnosis of Hepatitis B and Delta: What We Know and What Is Still Required? Specific Focus on Low- and Middle-Income Countries. Microorganisms 2022; 10:microorganisms10112096. [PMID: 36363693 PMCID: PMC9694472 DOI: 10.3390/microorganisms10112096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
To achieve the World Health Organization's (WHO) goals of eradicating viral hepatitis globally by 2030, the regional prevalence and epidemiology of hepatitis B virus (HBV) and hepatitis delta virus (HDV) coinfection must be known in order to implement preventiveon and treatment strategies. HBV/HDV coinfection is considered the most severe form of vira l hepatitis due to it's rapid progression towards cirrhosis, hepatocellular carcinoma, and liver-related death. The role of simplified diagnosticsis tools for screening and monitoring HBV/HDV-coinfected patients is crucial. Many sophisticated tools for diagnoses have been developed for detection of HBV alone as well as HBV/HDV coinfection. However, these advanced techniques are not widely available in low-income countries and there is no standardization for HDV detection assays, which are used for monitoring the response to antiviral therapy. More accessible and affordable alternative methods, such as rapid diagnostic tests (RDTs), are being developed and validated for equipment-free and specific detection of HBV and HDV. This review will provide some insight into both existing and diagnosis tools under development, their applicability in developing countries and how they could increase screening, patient monitoring and treatment eligibility.
Collapse
|
23
|
Sow A, Lemoine M, Toure PS, Diop M, Lo G, De Veiga J, Pape OT, Seck K, Ndow G, Bojang L, Kane A, Oudiane M, Howell J, Nayagam S, Moutchia J, Chemin I, Mendy M, Toure-Kane C, Thursz M, Ka M, Shimakawa Y, Mboup S. HBV continuum of care using community- and hospital-based screening interventions in Senegal: Results from the PROLIFICA programme. JHEP Rep 2022; 4:100533. [PMID: 36052221 PMCID: PMC9424572 DOI: 10.1016/j.jhepr.2022.100533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background & Aims Strategies to implement HBV screening and treatment are critical to achieve HBV elimination but have been inadequately evaluated in sub-Saharan Africa (sSA). Methods We assessed the feasibility of screen-and-treat interventions in 3 real-world settings (community, workplace, and hospital) in Senegal. Adult participants were screened using a rapid HBsAg point-of-care test. The proportion linked to care, the proportion who had complete clinical staging (alanine transaminase [ALT], viral load, and FibroScan®), and the proportion eligible for treatment were compared among the 3 intervention groups. Results In 2013-2016, a total of 3,665 individuals were screened for HBsAg in the community (n = 2,153) and in workplaces (n = 1,512); 199/2,153 (9.2%) and 167/1,512 (11%) were HBsAg-positive in the community and workplaces, respectively. In the hospital setting (outpatient clinics), 638 HBsAg-positive participants were enrolled in the study. All infected participants were treatment naïve. Linkage to care was similar among community-based (69.9%), workplace-based (69.5%), and hospital-based interventions (72.6%, p = 0.617). Of HBV-infected participants successfully linked to care, full clinical staging was obtained in 47.5% (66/139), 59.5% (69/116), and 71.1% (329/463) from the community, workplaces, and hospitals, respectively (p <0.001). The proportion eligible for treatment (EASL criteria) differed among community- (9.1%), workplace- (30.4%), and hospital-based settings (17.6%, p = 0.007). Acceptability of antiviral therapy, adherence, and safety at 1 year were very good. Conclusions HBV screen-and-treat interventions are feasible in non-hospital and hospital settings in Senegal. However, the continuum of care is suboptimal owing to limited access to full clinical staging. Improvement in access to diagnostic services is urgently needed in sSA. Lay summary Hepatitis B infection is highly endemic in Senegal. Screening for infection can be done outside hospitals, in communities or workplaces. However, the hepatitis B continuum of care is suboptimal in Senegal and needs to be simplified to scale-up diagnosis and treatment coverage.
Collapse
Key Words
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- APRI, AST-to-platelet ratio index
- AST, aspartate aminotransferase
- Africa
- Diagnosis
- GGT, gamma-glutamyl transferase
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- Hepatitis B
- LSM, liver stiffness measurement
- POC, point of care
- PROLIFICA, Prevention of Liver Fibrosis and Cancer in Africa
- Screening
- TDF, tenofovir disoproxil fumarate
- Treatment
- WHO, World Health Organization
- aOR, adjusted odds ratio
- cOR, crude odds ratio
- eGFR, estimated glomerular filtration rate
- qPCR, quantitative polymerase chain reaction
- sSA, sub-Saharan Africa
Collapse
Affiliation(s)
- Amina Sow
- Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF) Laboratoire CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
- Laboratoire de Virology, Hopital Le Dantec, Dakar, Senegal
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Section of Hepatology, St Mary’s Hospital, Imperial College London, London, UK
- Medical Research Council the Gambia Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Papa Souleymane Toure
- UFR des Sciences de la Sante, Thies, Senegal
- Centre hospitalier de Tivaoaune, Service de Medecine interne, Thies, Senegal
| | - Madoky Diop
- UFR des Sciences de la Sante, Thies, Senegal
| | - Gora Lo
- Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF) Laboratoire CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
- Laboratoire de Virology, Hopital Le Dantec, Dakar, Senegal
| | - Jean De Veiga
- Hopital Saint Jean de Dieu, Service d’Hepatologie et Gastroenterologie, Thies, Senegal
| | - Omar Thiaw Pape
- Hopital Saint Jean de Dieu, Laboratoire d’analyse biochimique et hématologique, Thies, Senegal
| | - Khady Seck
- Centre hospitalier régional de Thies, Service de Medecine interne, Thies, Senegal
| | - Gibril Ndow
- Medical Research Council the Gambia Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Lamin Bojang
- Medical Research Council the Gambia Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Arame Kane
- UFR des Sciences de la Sante, Thies, Senegal
- Centre hospitalier de Tivaoaune, Service de Medecine interne, Thies, Senegal
| | - Marina Oudiane
- UFR des Sciences de la Sante, Thies, Senegal
- Centre hospitalier de Tivaoaune, Service de Medecine interne, Thies, Senegal
| | - Jess Howell
- Disease Elimination, Burnet Institute, Department of Gastroenterology, St. Vincent's Hospital Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Melbourne, Victoria, Australia
| | - Shevanthi Nayagam
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Section of Hepatology, St Mary’s Hospital, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Jude Moutchia
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur Paris, France
| | - Isabelle Chemin
- INSERM U1052, CNRS 5286, Université Lyon, Université Claude Bernard Lyon 1, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, F-69000, Lyon, France
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Coumba Toure-Kane
- Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF) Laboratoire CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
- Laboratoire de Virology, Hopital Le Dantec, Dakar, Senegal
| | - Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Section of Hepatology, St Mary’s Hospital, Imperial College London, London, UK
| | - Mourtalla Ka
- UFR des Sciences de la Sante, Thies, Senegal
- Centre hospitalier de Tivaoaune, Service de Medecine interne, Thies, Senegal
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur Paris, France
| | - Souleymane Mboup
- Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF) Laboratoire CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
- Laboratoire de Virology, Hopital Le Dantec, Dakar, Senegal
| |
Collapse
|
24
|
Ndow G, Cessay A, Cohen D, Shimakawa Y, Gore ML, Tamba S, Ghosh S, Sanneh B, Baldeh I, Njie R, D’Alessandro U, Mendy M, Thursz M, Chemin I, Lemoine M. Prevalence and Clinical Significance of Occult Hepatitis B Infection in The Gambia, West Africa. J Infect Dis 2022; 226:862-870. [PMID: 34160616 PMCID: PMC9470103 DOI: 10.1093/infdis/jiab327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/21/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prevalence and clinical outcomes of occult hepatitis B infection (OBI) have been poorly studied in Africa. METHODS Using the PROLIFICA cohort, we compared the prevalence of OBI between hepatitis B surface antigen (HBsAg)-negative healthy adults screened from the general population (controls) and HBsAg-negative patients with advanced liver disease (cases), and estimated the population attributable fraction for the effect of OBI on advanced liver disease. RESULTS OBI prevalence was significantly higher among cases (15/82, 18.3%) than controls (31/330, 9.4%, P = .03). After adjusting for age, sex, and anti-hepatitis C virus (HCV) serology, OBI was significantly associated with advanced liver disease (odds ratio, 2.8; 95% confidence interval [CI], 1.3-6.0; P = .006). In HBsAg-negative people, the proportions of advanced liver disease cases attributable to OBI and HCV were estimated at 12.9% (95% CI, 7.5%-18.1%) and 16.9% (95% CI, 15.2%-18.6%), respectively. CONCLUSIONS OBI is endemic and an independent risk factor for advanced liver disease in The Gambia, West Africa. This implies that HBsAg-negative people with liver disease should be systematically screened for OBI. Moreover, the impact of infant hepatitis B immunization to prevent end-stage liver disease might be higher than previous estimates based solely on HBsAg positivity.
Collapse
Affiliation(s)
- Gibril Ndow
- Division of Digestive Diseases, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
- Disease Control and Elimination, Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Amie Cessay
- Disease Control and Elimination, Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Damien Cohen
- INSERM U1052, CNRS UMR5286, Center de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Yusuke Shimakawa
- Unité D’Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Mindy L Gore
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Saydiba Tamba
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Sumantra Ghosh
- INSERM U1052, CNRS UMR5286, Center de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Bakary Sanneh
- National Public Health Laboratories, Ministry of Health, Kotu, The Gambia
| | - Ignatius Baldeh
- National Public Health Laboratories, Ministry of Health, Kotu, The Gambia
| | - Ramou Njie
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Umberto D’Alessandro
- Disease Control and Elimination, Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Maimuna Mendy
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mark Thursz
- Division of Digestive Diseases, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
| | - Isabelle Chemin
- INSERM U1052, CNRS UMR5286, Center de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Maud Lemoine
- Division of Digestive Diseases, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
| |
Collapse
|
25
|
Yip TCF, Lai JCT, Liang LY, Hui VWK, Wong VWS, Wong GLH. Risk of HCC in Patients with HBV, Role of Antiviral Treatment. CURRENT HEPATOLOGY REPORTS 2022; 21:76-86. [DOI: 10.1007/s11901-022-00588-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 08/08/2023]
|
26
|
Ceesay A, Lemoine M, Cohen D, Chemin I, Ndow G. Clinical utility of the 'Determine HBsAg' Point-of-Care Test for Diagnosis of Hepatitis B Surface Antigen in Africa. Expert Rev Mol Diagn 2022; 22:497-505. [PMID: 35574686 DOI: 10.1080/14737159.2022.2076595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic infection with hepatitis B virus (HBV) is a leading cause of morbidity and death, especially in sub-Saharan Africa (sSSA), where approximately 60 million adults are infected. More than 90% of these patients are unaware of their HBV status. AREAS COVERED Scaling-up of HBV screening programs in SSA are essential to increase diagnosis, linkage to care and access to treatment, and will ultimately reduce HBV disease burden to achieve WHO hepatitis elimination targets. Such scale up will rely on inexpensive rapid point-of-care (POC) tests, especially in remote areas where gold standard serological assays are not routinely available. This review discusses the diagnostic performance and clinical utility of the Determine™ (Abbott, USA) hepatitis B surface Antigen (HBsAg) POC test for improving HBV screening in SSA, in light with others available HBsAg rapid tests. EXPERT OPINION The Determine™ HBsAg POC test has demonstrated relatively good diagnostic accuracy at the low cost, in the African field and laboratory and should be used for large scale mass screening of HBV infection in Africa.
Collapse
Affiliation(s)
- Amie Ceesay
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, P.O. Box 273, Banjul, The Gambia.,Cancer Research Center, INSERM U1052, Lyon, France
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London. St. Mary's Hospital campus, London, UK
| | - Damien Cohen
- Cancer Research Center, INSERM U1052, Lyon, France
| | | | - Gibril Ndow
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, P.O. Box 273, Banjul, The Gambia.,Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London. St. Mary's Hospital campus, London, UK
| |
Collapse
|
27
|
Périères L, Diallo A, Marcellin F, Nishimwe ML, Ba EH, Coste M, Lo G, Halfon P, Touré Kane C, Maradan G, Carrieri P, Diouf A, Shimakawa Y, Sokhna C, Boyer S. Hepatitis B in Senegal: A Successful Infant Vaccination Program but Urgent Need to Scale Up Screening and Treatment (ANRS 12356 AmBASS survey). Hepatol Commun 2022; 6:1005-1015. [PMID: 34918868 PMCID: PMC9035578 DOI: 10.1002/hep4.1879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 12/17/2022] Open
Abstract
Senegal introduced the infant hepatitis B virus (HBV) vaccination in 2004 and recently committed to eliminating hepatitis B by 2030. Updated epidemiological data are needed to provide information on the progress being made and to develop new interventions. We estimated the prevalence of hepatitis B surface antigen (HBsAg) in children and adults living in rural Senegal and assessed hepatitis B treatment eligibility. A cross-sectional population-based serosurvey of HBsAg was conducted in 2018-2019 in a large sample (n = 3,118) of residents living in the Niakhar area (Fatick region, Senegal). Individuals positive for HBsAg subsequently underwent clinical and biological assessments. Data were weighted for age and sex and calibrated to be representative of the area's population. Among the 3,118 participants, 206 were HBsAg positive (prevalence, 6.9%; 95% confidence interval [CI], 5.6-8.1). Prevalence varied markedly according to age group in individuals aged 0-4, 5-14, 15-34, and ≥35 years as follows: 0.0% (95% CI, 0.00-0.01); 1.5% (95% CI, 0.0-2.3); 12.4% (95% CI, 9.1-15.6); and 8.8% (95% CI, 6.1-11.5), respectively. Of those subsequently assessed, 50.9% (95% CI, 41.8-60.0) had active HBV infection; 4 (2.9%; 95% CI, 0.9-9.4) were eligible for hepatitis B treatment. Conclusion: In this first population-based serosurvey targeting children and adults in rural Senegal, HBsAg prevalence was very low in the former, meeting the World Health Organization's (WHO) < 1% HBsAg 2020 target; however, it was high in young adults (15-34 years old) born before the HBV vaccine was introduced in 2004. To reach national and WHO hepatitis elimination goals, general population testing (particularly for adolescents and young adults), care, and treatment scale-up need to be implemented.
Collapse
Affiliation(s)
- Lauren Périères
- Vecteurs-Infections Tropicales et Méditerranéennes (VITROME)Campus Institut de Recherche pour le Développement (IRD)-Universite Cheikh Anta DiopDakarSenegal
| | - Aldiouma Diallo
- Vecteurs-Infections Tropicales et Méditerranéennes (VITROME)Campus Institut de Recherche pour le Développement (IRD)-Universite Cheikh Anta DiopDakarSenegal
| | - Fabienne Marcellin
- Institut National de la Santé et de la Recherche MédicaleIRDSciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleInstitut des Sciences de la Santé Publique - ISSPAMAix-Marseille UniversityMarseilleFrance
| | - Marie Libérée Nishimwe
- Institut National de la Santé et de la Recherche MédicaleIRDSciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleInstitut des Sciences de la Santé Publique - ISSPAMAix-Marseille UniversityMarseilleFrance
| | - El Hadji Ba
- Vecteurs-Infections Tropicales et Méditerranéennes (VITROME)Campus Institut de Recherche pour le Développement (IRD)-Universite Cheikh Anta DiopDakarSenegal
| | - Marion Coste
- Institut National de la Santé et de la Recherche MédicaleIRDSciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleInstitut des Sciences de la Santé Publique - ISSPAMAix-Marseille UniversityMarseilleFrance.,Centre National de la Recherche ScientifiqueÉcole des Hautes Études en Sciences SocialesCentrale MarseilleAix-Marseille School of EconomicsAix-Marseille UniversityMarseilleFrance
| | - Gora Lo
- Institut de Recherche en Santé de Surveillance Epidémiologique et de FormationDakarSenegal
| | | | - Coumba Touré Kane
- Institut de Recherche en Santé de Surveillance Epidémiologique et de FormationDakarSenegal
| | - Gwenaëlle Maradan
- Institut National de la Santé et de la Recherche MédicaleIRDSciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleInstitut des Sciences de la Santé Publique - ISSPAMAix-Marseille UniversityMarseilleFrance.,Observatoire Régional de la Santé Provence-Alpes-Côte d'AzurMarseilleFrance
| | - Patrizia Carrieri
- Institut National de la Santé et de la Recherche MédicaleIRDSciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleInstitut des Sciences de la Santé Publique - ISSPAMAix-Marseille UniversityMarseilleFrance
| | - Assane Diouf
- Vecteurs-Infections Tropicales et Méditerranéennes (VITROME)Campus Institut de Recherche pour le Développement (IRD)-Universite Cheikh Anta DiopDakarSenegal
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies ÉmergentesInstitut PasteurParisFrance
| | - Cheikh Sokhna
- IRDService de santé des arméesVITROMEAix-Marseille UniversityMarseilleFrance
| | - Sylvie Boyer
- Institut National de la Santé et de la Recherche MédicaleIRDSciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleInstitut des Sciences de la Santé Publique - ISSPAMAix-Marseille UniversityMarseilleFrance
| | | |
Collapse
|
28
|
Scarponi CFO, Pedrosa MAF, Mol MPG, Hardman MJM, Greco DB. Low eligibility for hepatitis B treatment in the Brazilian public health system. Rev Soc Bras Med Trop 2022; 55:e02972021. [PMID: 35416869 PMCID: PMC9009889 DOI: 10.1590/0037-8682-0297-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.
Collapse
Affiliation(s)
| | | | | | | | - Dirceu Bartolomeu Greco
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Ciência da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
| |
Collapse
|
29
|
Lemoine M, Ndow G, Shimakawa Y. Improving disease knowledge is critical to eliminate hepatitis B. J Viral Hepat 2022; 29:231-232. [PMID: 34806818 DOI: 10.1111/jvh.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Maud Lemoine
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital, London, UK
| | - Gibril Ndow
- Disease Control & Elimination Theme, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| |
Collapse
|
30
|
Su S, Wong WCW, Zou Z, Cheng DD, Ong JJ, Chan P, Ji F, Yuen MF, Zhuang G, Seto WK, Zhang L. Cost-effectiveness of universal screening for chronic hepatitis B virus infection in China: an economic evaluation. THE LANCET GLOBAL HEALTH 2022; 10:e278-e287. [PMID: 35063115 PMCID: PMC8789560 DOI: 10.1016/s2214-109x(21)00517-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background China has the highest prevalence of hepatitis B virus (HBV) infection worldwide. Universal HBV screening might enable China to reach the WHO 2030 target of 90% diagnostics, 80% treatment, and 65% HBV-related death reduction, and eventually elimination of viral hepatitis. We evaluated the cost-effectiveness of implementing universal HBV screening in China and identified optimal screening strategies. Methods We used a Markov cohort model, inputting parameters based on data from previous studies and public databases, to assess the cost-effectiveness of four HBV serological screening strategies in China in different screening scenarios. We simulated universal screening scenarios in 15 adult age groups between 18 and 70 years, with different years of screening implementation (2021, 2026, and 2031) and compared to the status quo (ie, no universal screening); in total, we investigated 180 different screening scenarios. We calculated the incremental cost-effectiveness ratio (ICER) between the different screening strategies and the status quo (current screening strategy). We performed probabilistic and one-way deterministic sensitivity analyses to assess the robustness of our findings. Findings With a willingness-to-pay level of three times the Chinese gross domestic product (GDP) per capita (US$30 828), all universal screening scenarios in 2021 were cost-effective compared with the status quo. The serum HBsAg/HBsAb/HBeAg/HBeAb/HBcAb (five-test) screening strategy in people aged 18–70 years was the most cost-effective strategy in 2021 (ICER $18 295/quality-adjusted life-years [QALY] gained). This strategy remained the most cost-effective, when the willingness-to-pay threshold was reduced to 2 times GDP per capita. The two-test strategy for people aged 18–70 years became more cost-effective at lower willingness-to-pay levels. The five-test strategy could prevent 3·46 million liver-related deaths in China over the lifetime of the cohort. It remained the most cost-effective strategy when implementation was delayed until 2026 (ICER $20 183/QALY) and 2031 (ICER $23 123/QALY). Screening young people (18–30 years) will no longer be cost-effective in delayed scenarios. Interpretation The five-test universal screening strategy in people aged 18–70 years, implemented within the next 10 years, is the optimal HBV screening strategy for China. Other screening strategies could be cost-effective alternatives, if budget is limited in rural areas. Delaying strategy implementation reduces overall cost-effectiveness. Early screening initiation will aid global efforts in achieving viral hepatitis elimination. Funding National Natural Science Foundation of China.
Collapse
|
31
|
Sonderup MW, Spearman CW. Global Disparities in Hepatitis B Elimination-A Focus on Africa. Viruses 2022; 14:v14010082. [PMID: 35062286 PMCID: PMC8777803 DOI: 10.3390/v14010082] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 02/07/2023] Open
Abstract
In 2016, WHO member states at the World Health Assembly adopted a Global Health Sector Strategy that included a policy of eliminating viral hepatitis. Clear targets were established to assist in achieving this by 2030. The strategy, while achievable, has exposed existing global disparities in healthcare systems and their ability to implement such policies. Compounding this, the regions with most disparity are also those where the hepatitis B prevalence and disease burden are the greatest. Foundational to hepatitis B elimination is the identification of both those with chronic infection and crucially pregnant women, and primary prevention through vaccination. Vaccination, including the birth dose and full three-dose coverage, is key, but complete mother-to-child transmission prevention includes reducing the maternal hepatitis B viral load in the third trimester where appropriate. Innovations and simplified tools exist in order to achieve elimination, but what is desperately required is the will to implement these strategies through the support of appropriate investment and funding. Without this, disparities will continue.
Collapse
|
32
|
Loarec A, Nguyen A, Molfino L, Chissano M, Madeira N, Rusch B, Staderini N, Couto A, Ciglenecki I, Antabak NT. Prevention of mother-to-child transmission of hepatitis B virus in antenatal care and maternity services, Mozambique. Bull World Health Organ 2022; 100:60-69. [PMID: 35017758 PMCID: PMC8722623 DOI: 10.2471/blt.20.281311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
Objective To pilot an intervention on the prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) in an antenatal care and maternity unit in Maputo, Mozambique, during 2017–2019. Methods We included HBV in the existing screening programme (for human immunodeficiency virus (HIV) and syphilis) for pregnant women at their first consultation, and followed mother–child dyads until 9 months after delivery. We referred women who tested positive for hepatitis B surface antigen (HBsAg) for further tests, including hepatitis B e antigen (HBeAg) and HBV viral load. According to the results, we proposed tenofovir for their own health or for PMTCT. We administered birth-dose HBV vaccine and assessed infant HBV status at 9 months. Findings Of 6775 screened women, 270 (4.0%) were HBsAg positive; in those for whom data were available, 24/265 (9.1%) were HBeAg positive and 14/267 (5.2%) had a viral load of > 200 000 IU/mL. Ninety-eight (36.3%) HBsAg-positive women were HIV coinfected, 97 of whom were receiving antiretroviral treatment with tenofovir. Among HIV-negative women, four had an indication for tenofovir treatment and four for tenofovir PMTCT. Of 217 exposed liveborn babies, 181 (83.4%) received birth-dose HBV vaccine, 160 (88.4%) of these < 24 hours after birth. At the 9-month follow-up, only one out of the 134 tested infants was HBV positive. Conclusion Our nurse-led intervention highlights the feasibility of integrating PMTCT of HBV into existing antenatal care departments, essential for the implementation of the triple elimination initiative. Universal birth-dose vaccination is key to achieving HBV elimination.
Collapse
Affiliation(s)
- Anne Loarec
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Aude Nguyen
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | - Lucas Molfino
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Mafalda Chissano
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Natercia Madeira
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Barbara Rusch
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | - Nelly Staderini
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | - Aleny Couto
- Ministry of Health of Mozambique, Maputo, Mozambique
| | - Iza Ciglenecki
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | | |
Collapse
|
33
|
Effect of a Community-Based Hepatitis B Virus Infection Detection Combined with Vaccination Program in China. Vaccines (Basel) 2021; 10:vaccines10010019. [PMID: 35062680 PMCID: PMC8777927 DOI: 10.3390/vaccines10010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022] Open
Abstract
Evidence on the effectiveness of hepatitis B virus (HBV) infection screening and vaccination programs remains rare in China. We used a quasi-experimental method, propensity score matching, to evaluate the effects of a community-based HBV infection detection combined with vaccination (HBVIDV) program in a pilot. Data were retrieved from the HBVIDV program implemented between July 2019 and June 2020. Outcomes were the difference between the treatment and control groups in hepatitis B vaccination (≥1 dose), hepatitis B vaccine series completion (≥3 doses), and serologic evidence of vaccine-mediated immunity. Altogether, 26,180 individuals were included, where 6160 (23.5%) individuals were assigned to the treatment group, and 20,020 (76.5%) individuals were assigned to the control group. After propensity score matching, 5793 individuals were matched. The rates of hepatitis B vaccination, hepatitis B vaccine series completion, and prevalence of vaccine-mediated immunity in the treatment and control groups were 29.0% vs. 17.8%, 22.1% vs. 13.1%, and 38.2% vs. 27.6%, respectively. The HBVIDV program was significantly associated with increased hepatitis B vaccination rate (OR, 1.884, 95% CI 1.725-2.057), hepatitis B vaccine series completion rate (OR, 1.872, 95% CI 1.696-2.065), and prevalence of vaccine-mediated immunity (OR, 1.623, 95% CI 1.501-1.755). The greater magnitude of association between HBVIDV program and outcomes was observed among adults aged 35-54 years and adults who live in rural areas. The HBVIDV program was effective in increasing the hepatitis B vaccination rate, hepatitis B vaccine series completion rate, and prevalence of vaccine-mediated immunity among adults in the pilot. Further focusing the program on special populations and regions may produce more effective results.
Collapse
|
34
|
Lai JCT, Wong VWS, Yip TCF, Hui VWK, Tse YK, Lee HW, Liang LY, Lui GCY, Chan HLY, Wong GLH. Secular trend of treatment uptake in patients with chronic hepatitis B: A territory-wide study of 135 395 patients from 2000 to 2017. J Gastroenterol Hepatol 2021; 36:3487-3499. [PMID: 34404113 DOI: 10.1111/jgh.15664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The uptake of antiviral treatment for patients with chronic hepatitis B (CHB) has been suboptimal. We aimed to determine the secular trend of treatment uptake in the territory-wide CHB cohort in Hong Kong from 2000 to 2017 and the factors for no treatment despite fulfilling treatment criteria. METHODS Chronic hepatitis B patients under public clinics and hospitals were identified through electronic medical records. The treatment indications were defined according to the Asian-Pacific guidelines published at the time of patients' first appearance in four periods: 2000-2004, 2005-2009, 2010-2013, and 2014-2017. RESULTS There were 135 395 CHB patients were included; 1493/12472 (12.0%), 7416/43426 (17.1%), 10 129/46559 (21.8%), 8051/32 938 (24.4%) patients fulfilled treatment criteria in the four periods, respectively. The treatment uptake rate increased with time: 35.1%, 43.4%, 60.2%, and 68.6% respectively. High fibrosis indices (APRI, FIB-4, and Forns indices) appeared to be the main factors for treatment indication in non-cirrhotic patients, with over 90% fulfilling treatment criteria due to high fibrosis indices alone. Of those fulfilling treatment criteria by high fibrosis indices, less than 60% of patients (25.2%, 36.1%, 46.0%, and 58.9%, respectively) had antiviral treatment initiated. Normal platelet count (odds ratio 0.42, P < 0.001) was the independent factor associated with not initiating antiviral treatment in patients fulfilling treatment criteria. CONCLUSIONS Treatment uptake rates have been increasing over time. Normal platelet count, which reflects less advanced liver disease, precludes patients from receiving antiviral treatment even if treatment indication is fulfilled. Hence, the importance to identify non-cirrhotic patients with significant liver fibrosis should be emphasized.
Collapse
Affiliation(s)
- Jimmy C-T Lai
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong
| | - Vincent W-S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Terry C-F Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong
| | - Vicki W-K Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong
| | - Hye-Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Lilian Y Liang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Grace C-Y Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Henry L-Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Grace L-H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
35
|
In Vivo Bioluminescence Imaging of HBV Replicating Hepatocytes Allows for the Monitoring of Anti-Viral Immunity. Viruses 2021; 13:v13112273. [PMID: 34835079 PMCID: PMC8619421 DOI: 10.3390/v13112273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Immunity against hepatitis B virus (HBV) infection is complex and not entirely understood so far, including the decisive factors leading to the development of chronic hepatitis B. This lack of a mechanistic understanding of HBV-specific immunity is also caused by a limited number of suitable animal models. Here, we describe the generation of a recombinant adenovirus expressing an HBV 1.3-overlength genome linked to luciferase (Ad-HBV-Luc) allowing for precise analysis of the quantity of infected hepatocytes. This enables sensitive and close-meshed monitoring of HBV-specific CD8 T cells and the onset of anti-viral immunity in mice. A high dose of Ad-HBV-Luc developed into chronic hepatitis B accompanied by dysfunctional CD8 T cells characterized by high expression of PD1 and TOX and low expression of KLRG1 and GzmB. In contrast, a low dose of Ad-HBV-Luc infection resulted in acute hepatitis with CD8 T cell-mediated elimination of HBV-replicating hepatocytes associated with elevated sALT levels and increased numbers of cytotoxic HBV-specific CD8 T cells. Thus, the infectious dose was a critical factor to induce either acute self-limited or chronic HBV infection in mice. Taken together, the new Ad-HBV-Luc vector will allow for highly sensitive and time-resolved analysis of HBV-specific immune responses during acute and chronic infection.
Collapse
|
36
|
Stockdale AJ, Meiring JE, Shawa IT, Thindwa D, Silungwe NM, Mbewe M, Kachala R, Kreuels B, Patel P, Patel P, Henrion MYR, Bar-Zeev N, Swarthout TD, Heyderman RS, Gordon SB, Geretti AM, Gordon MA. Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi. J Infect Dis 2021; 226:871-880. [PMID: 34752631 PMCID: PMC9470106 DOI: 10.1093/infdis/jiab562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response. METHODS We conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, was estimated by binomial log-linear regression comparing individuals born before and after vaccine implementation. In HBsAg-positive adults, eligibility for antiviral therapy was assessed. RESULTS Of 97,386 censused individuals, 6,073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% CI 4.3-6.1) among adults and 0.3% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (70.3-99.4). Of HBsAg-positive adults, 26% were HIV-positive. Among HIV-negative individuals, 3%, 6% and 9% were eligible for hepatitis B treatment by WHO, European and American hepatology association criteria, respectively. CONCLUSIONS Infant HBV vaccination has been highly effective in reducing HBsAg prevalence in urban Malawi. Up to 9% of HBsAg-positive HIV-negative adults are eligible, but have an unmet need, for antiviral therapy.
Collapse
Affiliation(s)
- Alexander J Stockdale
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - James E Meiring
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Isaac T Shawa
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,University of Malawi College of Medicine, Faculty of Biomedical Science and Health Professions Blantyre, Malawi
| | - Deus Thindwa
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Maurice Mbewe
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Rabson Kachala
- Malawi Ministry of Health, Capitol Hill, Lilongwe, Malawi
| | - Benno Kreuels
- University of Malawi College of Medicine, Faculty of Medicine, Blantyre, Malawi.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and.,1st Department of Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | | | - Priyanka Patel
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Todd D Swarthout
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Robert S Heyderman
- NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Anna Maria Geretti
- Department of Infectious Diseases, Fondazione PTV, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
37
|
Lakoh S, Firima E, Jiba DF, Kamara MN, Gashau W, Deen GF, Adekanmbi O, Yendewa GA. Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with Hepatitis B virus infection in Freetown, Sierra Leone: a cross-sectional study. BMC Gastroenterol 2021; 21:320. [PMID: 34372775 PMCID: PMC8353767 DOI: 10.1186/s12876-021-01892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited. Methods We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization’s 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis. Results 163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1–85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9–63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] were independent predictors of cirrhosis. Conclusion Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Sulaiman Lakoh
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Switzerland. .,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Switzerland.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Darlinda F Jiba
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Switzerland
| | - Matilda N Kamara
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Switzerland
| | - Wadzani Gashau
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Gibrilla F Deen
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Switzerland.,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Switzerland
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
38
|
Challenges for hepatitis B virus cure in resource-limited settings in sub-Saharan Africa. Curr Opin HIV AIDS 2021; 15:185-192. [PMID: 32141888 DOI: 10.1097/coh.0000000000000619] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to highlight the unique challenges for hepatitis B virus (HBV) cure faced in resource-limited settings (RLS) in sub-Saharan Africa (SSA), where access to disease prevention measures, medical testing, and treatment are limited. RECENT FINDINGS SSA RLS face challenges, which need to be anticipated as HBV cure research advances. There is a paucity of data because of lack of HBV surveillance and limited access to laboratories. Interruption of transfusion-transmitted infections, perinatal mother-to-child-transmissions, and transmission in people-who-infect-drug networks has not been achieved fully. Although RLS in SSA are within the epicenter of the HIV pandemic, unlike for HIV, there is no population-based testing for HBV. Public health response to HBV is inadequate with concomitant political inertia in combatting HBV infection. SUMMARY A functional HBV cure will improve the diagnosis/treatment cascade, decrease costs and accelerate HBV elimination. There is a concerted effort to find a HBV cure, which will be finite, not require life-long treatment, adherence, and continued monitoring. Increased research, improved financial, infrastructural and human resources will positively impact on implementation of HBV cure, when available. We can emulate major strides made in tackling HIV and the strength of advocacy groups in soliciting policymakers to take action.
Collapse
|
39
|
Kedar Mukthinuthalapati VVP, Sewram V, Ndlovu N, Kimani S, Abdelaziz AO, Chiao EY, Abou-Alfa GK. Hepatocellular Carcinoma in Sub-Saharan Africa. JCO Glob Oncol 2021; 7:756-766. [PMID: 34043413 PMCID: PMC8457845 DOI: 10.1200/go.20.00425] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.
Collapse
Affiliation(s)
| | - Vikash Sewram
- Department of Global Health, Faculty of Medicine and Health Sciences, African Cancer Institute, Stellenbosch University, Cape Town, South Africa
| | - Ntokozo Ndlovu
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Stephen Kimani
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Medical College at Cornell University, New York, NY
| |
Collapse
|
40
|
Imam A, Wariri O, Dibbasey T, Camara A, Mendy A, Sanyang AN, Ceesay M, Jallow S, Jallow AE, Bah K, Johnson N, Trawally E, Sowe D, Darboe A, Kampmann B, Idoko OT. Conducting clinical research in a resource-constrained setting: lessons from a longitudinal cohort study in The Gambia. BMJ Glob Health 2021; 6:e006419. [PMID: 34400549 PMCID: PMC8370547 DOI: 10.1136/bmjgh-2021-006419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Clinical research conducted to Good Clinical Practice (GCP) standards is increasingly being undertaken in resource-constrained low-income and middle-income countries (LMICs) settings. This presents unique challenges that differ from those faced in high-income country (HIC) contexts, due to a dearth of infrastructure and unique socio-cultural contexts. Field experiences by research teams working in these LMIC contexts are thus critical to advancing knowledge on successful research conduct in these settings. The Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine has operated in The Gambia, a resource-constrained LMIC for over 70 years and has developed numerous research support platforms and systems. The unit was the lead clinical collaborator in a recently completed Expanded Program on Immunization Consortium (EPIC) study, involving a multicountry collaboration across five countries including the USA, Canada, Belgium, Papua New Guinea and The Gambia. The EPIC study recruited and completed follow-up of 720 newborn infants over 2 years. In this paper, we provide in-depth field experience covering challenges faced by the Gambian EPIC team in the conduct of this study. We also detail some reflections on these challenges. Our findings are relevant to the international research community as they highlight practical day-to-day challenges in conducting GCP standard clinical research in resource-constrained LMIC contexts. They also provide insights on how study processes can be adapted early during research planning to mitigate challenges.
Collapse
Affiliation(s)
- Abdulazeez Imam
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Oghenebrume Wariri
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Tida Dibbasey
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Abdoulie Camara
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Anthony Mendy
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Assan N Sanyang
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Masaneh Ceesay
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Samba Jallow
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Abdoulie E Jallow
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Kaddijatou Bah
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Njilan Johnson
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ebrima Trawally
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Dawda Sowe
- Department of Expanded Programme on Immunisation, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Alansana Darboe
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Beate Kampmann
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Olubukola T Idoko
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| |
Collapse
|
41
|
Chang TS, Chang KC, Chen WM, Hsu NT, Lee CY, Lin YC, Huang WC, Chiu WN, Hu JH, Huang TJ, Chen MY, Lu SN. Village-to-village screening for hepatitis B and C using quantitative HBsAg and anti-HCV testing with reflex HCV core antigen tests in the remote communities of a resource-rich setting: a population-based prospective cohort study. BMJ Open 2021; 11:e046115. [PMID: 34233977 PMCID: PMC8264874 DOI: 10.1136/bmjopen-2020-046115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Community-based screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) is essential for hepatitis elimination. This study attempted to increase screening accessibility and efficacy by using alternative tools. DESIGN Population-based prospective cohort study. SETTING Hepatitis elimination program at Yunlin County, Taiwan. PARTICIPANTS All 4552 individuals participated in 60 screening sessions of a community-based HBV and HCV screening project in five rural townships with approximately 95 000 inhabitants in central-western Taiwan. INTERVENTIONS To increase accessibility, 60 outreach screening sessions were conducted in 41 disseminative sites. Quantitative HBV surface antigen (qHBsAg) and anti-HCV testing with reflex HCV core antigen (HCV Ag) tests were employed as alternative screening tools. MAIN OUTCOME MEASURES Calculate village-specific prevalence of HBsAg, anti-HCV and HCV Ag and establish patient allocation strategies according to levels of qHBsAg HCV Ag and alanine aminotransferase (ALT). RESULTS Of 4552 participants, 553, 697 and 290 were positive for HBsAg, anti-HCV and HCV Ag, respectively; 75 of them had both HBsAg and anti-HCV positivity. The average (range) number of participants in each screening session was 98 (31-150). The prevalence rates (range) of HBsAg, anti-HCV and HCV Ag were 12.1% (4.3%-19.4%), 15.3% (2.6%-52.3%) and 6.4% (0%-30.2%), respectively. The HCV Ag positivity rate among anti-HCV-positive participants was 42% (0%-100%). Using cut-off values of >200 IU/mL for qHBsAg, >3 fmol/L for HCV Ag and >40 IU/mL for ALT as criteria for patient referral, we noted an 80.2% reduction in referral burden. Three villages had high anti-HCV prevalences of 52.3%, 53.8% and 63.4% with corresponding viraemic prevalences of 23.2%, 30.1% and 22% and thus constituted newly identified HCV-hyperendemic villages. CONCLUSION Outreach hepatitis screening increases accessibility for residents in rural communities. Screening HBV and HCV through qHBsAg and HCV Ag tests provides information concerning viral activities, which might be conducive to precise patient allocation in remote communities.
Collapse
Affiliation(s)
- Te-Sheng Chang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kao-Chi Chang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Wei-Ming Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Nien-Tzu Hsu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Chih-Yi Lee
- Department of Laboratory Medicine, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Yu-Chih Lin
- Department of Family Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Wei-Cheng Huang
- Department of Geriatric, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Wen-Nan Chiu
- Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Jin-Hung Hu
- Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Tung-Jung Huang
- Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Gueishan, Taiwan
| | - Sheng-Nan Lu
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| |
Collapse
|
42
|
Post G, Howell J, Sow A, Ndow G, Chemin I, Lo G, Cessay A, Cohen D, Njie R, Toure S, Diop M, Sombie R, Nana J, Leroy V, Lacombe K, Bojang L, Tacke F, Toure-Kane C, Ka M, Mendy M, Mboup S, Thursz M, Shimakawa Y, Ingiliz P, Lemoine M. Clinical utility of quantifying hepatitis B surface antigen in African patients with chronic hepatitis B. J Viral Hepat 2021; 28:1003-1010. [PMID: 33749097 DOI: 10.1111/jvh.13499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022]
Abstract
The clinical utility of quantifying hepatitis B surface antigen (qHBsAg) levels in African subjects with chronic hepatitis B virus (HBV) infection has been poorly documented. From a multicentre cohort of 944 HBV-infected African patients, we aimed to assess whether qHBsAg alone can accurately identify i) those in a HBeAg-negative chronic HBV infection phase at low risk of liver disease progression and ii) those in need of antiviral therapy according to the 2017 EASL guidelines. We analysed 770 HBV mono-infected treatment-naïve patients, mainly males (61%) from West Africa (92%), median age 35 years (IQR: 30-44), median HBV DNA: 95.6 IU/ml (10.0-1,300.0), median qHBsAg 5,498 IU/ml (1,171-13,000) and HBeAg-pos 38 (5%). A total of 464/770 (60.2%) patients were classified as HBeAg-negative chronic infection (median age 36 years (31-46), median ALT 23 IU/l (18-28), median HBV-DNA 33.5 IU/ml (3.8-154.1), median LSM 4.8 kPa (4.1-5.8)) and qHBsAg levels had poor accuracy to identify these subjects with an AUROC at 0.58 (95%CI: 0.54-0.62), sensitivity 55.0% and specificity 55.6%; 118/770 (15.3%) patients were eligible for treatment according to the 2017 EASL criteria. qHBsAg correlated poorly with HBV DNA and had poor accuracy to select patients for antiviral therapy with an AUROC at 0.54 (0.49-0.60), sensitivity 46.6% and specificity 46.9%. In African treatment-naïve HBV-infected subjects, the clinical utility of qHBsAg to identify subjects in HBeAg-negative infection phase or subjects eligible for antiviral therapy seems futile. Whether qHBsAg levels can be used as a predictor of long-term liver complications in Africa needs to be further investigated.
Collapse
Affiliation(s)
- Gerrit Post
- Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
- Center for Infectiology, Berlin, Germany
| | - Jess Howell
- Disease Elimination, Burnet Institute, Department of Gastroenterology, St. Vincent's Hospital, Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia
| | - Amina Sow
- Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
| | - Gibril Ndow
- Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
| | - Isabelle Chemin
- INSERM U1052, CNRS 5286, Univ Lyon, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Gora Lo
- Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
| | - Amie Cessay
- Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
| | - Damien Cohen
- INSERM U1052, CNRS 5286, Univ Lyon, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Ramou Njie
- International Agency for Research on Cancer (IARC, Lyon, France
| | - Souleymane Toure
- Unite de Formation et de Recherche (UFR) des sciences de la santé de l'Universite de Thies, Senegal
| | - Madoky Diop
- Unite de Formation et de Recherche (UFR) des sciences de la santé de l'Universite de Thies, Senegal
| | - Roger Sombie
- Service d'hépatogastro-entérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Jean Nana
- Department of Hepatology & Gastroenterology, Université Grenoble Alpes, Grenoble, France
| | - Vincent Leroy
- Department of Hepatology & Gastroenterology, Université Grenoble Alpes, Grenoble, France
| | - Karine Lacombe
- Department of infectious diseases and tropical medicine, hôpital Saint-Antoine, SorbonneUniversité, Inserm IPLESP, APHP, Sorbonne, France
| | - Lamin Bojang
- Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
| | - Frank Tacke
- Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
| | - Coumba Toure-Kane
- Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
| | - Mourtalla Ka
- Unite de Formation et de Recherche (UFR) des sciences de la santé de l'Universite de Thies, Senegal
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC, Lyon, France
| | - Souleymane Mboup
- Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
| | - Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology Section, Imperial College London, St Mary's campus, London, UK
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Patrick Ingiliz
- Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
- Center for Infectiology, Berlin, Germany
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology Section, Imperial College London, St Mary's campus, London, UK
| |
Collapse
|
43
|
Bauquier C, Préau M. Contribution of HIV/AIDS-Related Human and Social Sciences Research to a Better Understanding of the Challenges of Hepatitis B Prevention, Diagnosis and Care. Microorganisms 2021; 9:microorganisms9061166. [PMID: 34071536 PMCID: PMC8230355 DOI: 10.3390/microorganisms9061166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 01/05/2023] Open
Abstract
Recent scientific advances in hepatitis B virus research hint at the possibility of finding a cure in the medium term. In this context, the characterization of infected persons constitutes a major public health issue in terms of implementing adapted screening and prevention strategies. Overcoming the current challenges national health systems face in hepatitis B diagnosis is essential if the World Health Organization’s target of treating 80% of infected patients by 2030 is to be reached. These challenges reflect those previously faced in the fight against HIV/AIDS. Using the knowledge produced to date in Human and Social Sciences research in the fight against HIV/AIDS, we propose avenues of reflection to support and guide the development of research in the diagnosis of hepatitis B infection. More specifically, we present theoretical, methodological and epistemological considerations for how HSS research can be optimized in the following three HBV diagnosis-related areas: (i) access to screening; (ii) retention in care; and (iii) the integration of quality of life measurement in clinical trials.
Collapse
|
44
|
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71:209-249. [PMID: 33538338 DOI: 10.3322/caac.21660] [Citation(s) in RCA: 46267] [Impact Index Per Article: 15422.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023] Open
Abstract
This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
Collapse
Affiliation(s)
- Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Mathieu Laversanne
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
45
|
Screening, Vaccination Uptake and Linkage to Care for Hepatitis B Virus among Health Care Workers in Rural Sierra Leone. Trop Med Infect Dis 2021; 6:tropicalmed6020065. [PMID: 33946638 PMCID: PMC8167545 DOI: 10.3390/tropicalmed6020065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
This study reports on the prevalence and risk factors of chronic HBV among health care workers (HCWs) in a rural secondary hospital in Sierra Leone. Additionally, data on the uptake of HBV vaccination among negatively tested HCWs and on the linkage to care among positively tested HCWs are presented. In December 2019, 781 HCWs were invited to a screening and vaccination campaign at Koidu Government Hospital in Kono District. For each HCW, demographic information and data on their HBV risk history were captured, followed by a hepatitis B surface antigen (HBsAg) test. HCWs with a negative test result were offered an HBV vaccine on the same day, after one and six months. HCWs that were HBsAg positive were linked to a free HBV clinic. In total, 80% (632) of HCWs were screened. Among the screened, 97% had never received an HBV vaccine and 10.3% (n = 65) had chronic HBV. The following characteristics were associated with being HBsAg positive: aged less than 30 years old (aOR 2.17, CI 1.16–4.03, p = 0.01), male gender (aOR 2.0, CI 1.06–3.78, p = 0.03), working experience of 1–4 years (aOR 3.99, CI 1.15–13.73, p = 0.03) and over 9 years (aOR 6.16, CI 1.41–26.9, p = 0.02). For HBsAg-negative HCWs (n = 567), 99.8% (n = 566), 97.5% (n = 553) and 82.7% (n = 469) received their first, second and third dose of the vaccine, respectively. For HBsAg-positive HCWs (n = 65), 73.9% (n = 48) were successfully linked to an HBV clinic for further care. Most HCWs are unvaccinated for HBV, and the HBV prevalence amongst this at-risk group is high. Uptake of vaccination and linkage to care was successful.
Collapse
|
46
|
Nayagam S, Chan P, Zhao K, Sicuri E, Wang X, Jia J, Wei L, Walsh N, Rodewald LE, Zhang G, Ailing W, Zhang L, Chang JH, Hou W, Qiu Y, Sui B, Xiao Y, Zhuang H, Thursz MR, Scano F, Low-Beer D, Schwartländer B, Wang Y, Hallett TB. Investment Case for a Comprehensive Package of Interventions Against Hepatitis B in China: Applied Modeling to Help National Strategy Planning. Clin Infect Dis 2021; 72:743-752. [PMID: 32255486 PMCID: PMC7935389 DOI: 10.1093/cid/ciaa134] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background In 2016, the first global viral hepatitis elimination targets were endorsed. An estimated one-third of the world’s population of individuals with chronic hepatitis B virus (HBV) infection live in China and liver cancer is the sixth leading cause of mortality, but coverage of first-line antiviral treatment was low. In 2015, China was one of the first countries to initiate a consultative process for a renewed approach to viral hepatitis. We present the investment case for the scale-up of a comprehensive package of HBV interventions. Methods A dynamic simulation model of HBV was developed and used to simulate the Chinese HBV epidemic. We evaluated the impact, costs, and return on investment of a comprehensive package of prevention and treatment interventions from a societal perspective, incorporating costs of management of end-stage liver disease and lost productivity costs. Results Despite the successes of historical vaccination scale-up since 1992, there will be a projected 60 million people still living with HBV in 2030 and 10 million HBV-related deaths, including 5.7 million HBV-related cancer deaths between 2015 and 2030. This could be reduced by 2.1 million by highly active case-finding and optimal antiviral treatment regimens. The package of interventions is likely to have a positive return on investment to society of US$1.57 per US dollar invested. Conclusions Increases in HBV-related deaths for the next few decades pose a major public health threat in China. Active case-finding and access to optimal antiviral treatment are required to mitigate this risk. This investment case approach provides a real-world example of how applied modeling can support national dialog and inform policy planning.
Collapse
Affiliation(s)
- Shevanthi Nayagam
- Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London,UK
| | - Polin Chan
- World Health Organization China office, Beijing, China
| | - Kun Zhao
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Elisa Sicuri
- Health Economics Group, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Xiaochun Wang
- National Center for AIDS Control and Prevention (NCAIDS), China Center for Disease Control and Prevention, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Nick Walsh
- World Health Organization regional office for the Western Pacific, Manila, Philippines
| | | | - Guomin Zhang
- National Immunization Programme, China Center for Disease Control and Prevention, Beijing, China
| | - Wang Ailing
- National Center for Women and Children's Health, China Center for Disease Control and Prevention, Beijing, China
| | - Lan Zhang
- World Health Organization China office, Beijing, China
| | - Joo H Chang
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - WeiWei Hou
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Yingpeng Qiu
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Binyan Sui
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Yue Xiao
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, Peking University Health Science Center, Beijing, China
| | - M R Thursz
- Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
| | - Fabio Scano
- World Health Organization China office, Beijing, China
| | | | | | - Yu Wang
- China Center for Disease Control and Prevention, Beijing, China
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London,UK
| |
Collapse
|
47
|
Surial B, Wyser D, Béguelin C, Ramírez-Mena A, Rauch A, Wandeler G. Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis. Liver Int 2021; 41:710-719. [PMID: 33220137 PMCID: PMC8048614 DOI: 10.1111/liv.14744] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Chronic hepatitis B virus (HBV) infection accounts for 30%-50% of cirrhosis related deaths in sub-Saharan Africa (SSA). Since HBV-related cirrhosis is an indication for immediate antiviral therapy and cancer surveillance, we aimed to estimate the prevalence of cirrhosis among treatment-naïve patients with chronic HBV infection in SSA. METHODS We performed a systematic review of published articles which evaluated liver fibrosis stage among treatment-naïve HBV-infected individuals who presented to care in SSA. Our primary outcome was the prevalence of cirrhosis in HBsAg-positive persons, which was estimated using random-effects meta-analysis. Risk factors for cirrhosis were explored using subgroup-analyses and multivariable meta-regression. RESULTS Of 2129 articles identified, 17 met our eligibility criteria. The studies described 22 cohorts from 13 countries, including 13 cohorts (3204 patients) with chronic HBV mono-infection and nine cohorts (688 patients) with HIV/HBV-coinfection. Liver fibrosis was assessed using transient elastography (10 cohorts), APRI score (11 cohorts), and Fibrotest (one cohort). The pooled prevalence of cirrhosis was 4.1% (95% confidence interval [CI] 2.6-6.4) among studies from primary care facilities or general population, compared to 12.7% (95% CI 8.6-18.3) in studies performed in referral or tertiary care facilities (adjusted odds ratio 0.29, 95% CI 0.15-0.56). We found no association between cirrhosis and age, gender, fibrosis test used or HIV-coinfection. CONCLUSIONS Depending on the setting, between 4% and 13% of HBV-infected individuals in SSA have cirrhosis and need immediate antiviral therapy. These estimates should be considered when planning HBV treatment strategies and resource allocation.
Collapse
Affiliation(s)
- Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Wyser
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Charles Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrià Ramírez-Mena
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
48
|
Howell J, Pedrana A, Schroeder SE, Scott N, Aufegger L, Atun R, Baptista-Leite R, Hirnschall G, ‘t Hoen E, Hutchinson SJ, Lazarus JV, Olufunmilayo L, Peck R, Sharma M, Sohn AH, Thompson A, Thursz M, Wilson D, Hellard M. A global investment framework for the elimination of hepatitis B. J Hepatol 2021; 74:535-549. [PMID: 32971137 PMCID: PMC7505744 DOI: 10.1016/j.jhep.2020.09.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS More than 292 million people are living with hepatitis B worldwide and are at risk of death from cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals. METHODS To catalyse political commitment and to encourage domestic and international financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination. RESULTS The framework utilises a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from their investments - in the context of the WHO's 2030 viral elimination targets. CONCLUSION Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost saving by 2030. LAY SUMMARY Hepatitis B infection is a major cause of death from liver disease and liver cancer globally. To reduce deaths from hepatitis B infection, we need more people to be tested and treated for hepatitis B. In this paper, we outline a framework of activities to reduce hepatitis B-related deaths and discuss ways in which governments could pay for them.
Collapse
Affiliation(s)
- Jessica Howell
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital Melbourne, Australia.
| | - Alisa Pedrana
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia E. Schroeder
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nick Scott
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ricardo Baptista-Leite
- Universidade Catolica Portuguesa, Lisbon, Portugal,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gottfried Hirnschall
- Strategic Information, Global Hepatitis Programme, World Health Organization,Formerly Department of HIV and Global Hepatitis Programme, World Health Organization
| | - Ellen ‘t Hoen
- Global Health Unit, University Medical Centre, Groningen, the Netherlands,Medicines Law & Policy, Amsterdam, The Netherlands
| | - Sharon J. Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK,Health Protection Scotland, Meridian Court, Cadogan St, Glasgow, UK
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lesi Olufunmilayo
- Department of Medicine, Medicine, College of Medicine, University of Lagos, Nigeria
| | | | - Manik Sharma
- Division of Gastroenterology and Hepatology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Annette H. Sohn
- TREAT Asia/amfAR, Foundation for AIDS Research, Bangkok, Thailand
| | - Alexander Thompson
- Department of Medicine, University of Melbourne, Melbourne, Australia,Department of Gastroenterology, St Vincent's Hospital Melbourne, Australia
| | - Mark Thursz
- Department of Hepatology, Imperial College London, London, UK
| | - David Wilson
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Infectious Diseases, The Alfred and Monash University, Australia
| |
Collapse
|
49
|
Yoshida K, Desbiolles A, Feldman SF, Ahn SH, Alidjinou EK, Atsukawa M, Bocket L, Brunetto MR, Buti M, Carey I, Caviglia GP, Chen EQ, Cornberg M, Enomoto M, Honda M, Zu Siederdissen CH, Ishigami M, Janssen HLA, Maasoumy B, Matsui T, Matsumoto A, Nishiguchi S, Riveiro-Barciela M, Takaki A, Tangkijvanich P, Toyoda H, van Campenhout MJH, Wang B, Wei L, Yang HI, Yano Y, Yatsuhashi H, Yuen MF, Tanaka E, Lemoine M, Tanaka Y, Shimakawa Y. Hepatitis B Core-Related Antigen to Indicate High Viral Load: Systematic Review and Meta-Analysis of 10,397 Individual Participants. Clin Gastroenterol Hepatol 2021; 19:46-60.e8. [PMID: 32360825 DOI: 10.1016/j.cgh.2020.04.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS To eliminate hepatitis B virus (HBV) infection, scale-up of testing and treatment in resource-limited countries is crucial. However, access to nucleic acid testing to quantify HBV DNA, an essential test to examine treatment eligibility, remains severely limited. We assessed the performance of a novel immunoassay, HBV core-related antigen (HBcrAg), as a low-cost (less than US $15/assay) alternative to nucleic acid testing to indicate clinically important high viremia in chronic HBV patients infected with different genotypes. METHODS We searched Medline, Embase, Scopus, and Web of Science databases through June 27, 2018. Three reviewers independently selected studies measuring HBV DNA and HBcrAg in the same blood samples. We contacted authors to provide individual participant data (IPD). We randomly allocated each IPD to a derivation or validation cohort. We applied optimal HBcrAg cut-off values derived from the derivation set to the validation set to estimate sensitivity/specificity. RESULTS Of 74 eligible studies, IPD were obtained successfully for 60 studies (81%). Meta-analysis included 5591 IPD without antiviral therapy and 4806 treated with antivirals. In untreated patients, the pooled area under the receiver operating characteristic curve and optimal cut-off values were as follows: 0.88 (95% CI, 0.83-0.94) and 3.6 log U/mL to diagnose HBV DNA level of 2000 IU/mL or greater; and 0.96 (95% CI, 0.94-0.98) and 5.3 log U/mL for 200,000 IU/mL or greater, respectively. In the validation set, the sensitivity and specificity were 85.2% and 84.7% to diagnose HBV DNA level of 2000 IU/mL or greater, and 91.8% and 90.5% for 200,000 IU/mL or greater, respectively. The performance did not vary by HBV genotypes. In patients treated with anti-HBV therapy the correlation between HBcrAg and HBV DNA was poor. CONCLUSIONS HBcrAg might be a useful serologic marker to indicate clinically important high viremia in treatment-naïve, HBV-infected patients.
Collapse
Affiliation(s)
- Kyoko Yoshida
- Department of Surgery and Cancer, Liver Unit, Imperial College London, Paddington, London, United Kingdom
| | - Alice Desbiolles
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Sarah F Feldman
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Enagnon K Alidjinou
- Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Masanori Atsukawa
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Laurence Bocket
- Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Maurizia R Brunetto
- Hepatology Unit, Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa PI, Italy
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ivana Carey
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | | | - En-Qiang Chen
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka City University Medical School, Osaka, Japan
| | - Masao Honda
- Department of Gastroenterology, Department of Advanced Medical Technology, Kanazawa University Graduate School of Health Medicine, Ishikawa, Japan
| | | | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Takeshi Matsui
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Akihiro Matsumoto
- Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Margo J H van Campenhout
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, GD Rotterdam, The Netherlands
| | - Bo Wang
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Lai Wei
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People's Hospital, Beijing, China
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yoshihiko Yano
- Center for Infectious Diseases, Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Yatsuhashi
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Eiji Tanaka
- Department for the Promotion of Regional Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, Imperial College London, Paddington, London, United Kingdom
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
| |
Collapse
|
50
|
Woldemedihn GM, Rueegg CS, Desalegn H, Aberra H, Berhe N, Johannessen A. Validity of a point-of-care viral load test for hepatitis B in a low-income setting. J Virol Methods 2020; 289:114057. [PMID: 33359613 DOI: 10.1016/j.jviromet.2020.114057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
The recent launch of the first point-of-care Xpert® hepatitis B virus (HBV) viral load kit from Cepheid could help to scale up treatment for chronic hepatitis B (CHB) in resource-limited settings. This study aimed to assess the performance of the Xpert kit under field conditions in Ethiopia. One-hundred-and-thirty CHB patients with viral loads ranging from <1 log10 to>7 log10 IU/mL were randomly sampled. The viral load was assessed with both the Xpert and the gold standard Abbott RealTime HBV Viral Load assay in each patient. There was a high correlation between the viral loads assessed by Xpert and Abbott (r = 0.948, p < 0.001). The Bland-Altman plot showed a small bias between the two assays, with an on average 0.23 log10 IU/mL higher viral load result of the Xpert kit; 4 samples differed by>1 log10 IU/mL. Using the treatment threshold of 2000 IU/mL in both tests, Xpert had a sensitivity of 94 %, specificity of 71 %, positive predictive value of 70 %, and negative predictive value of 95 %. In conclusion, the Xpert kit demonstrated good validity for the measurement of HBV viral load in a real-life setting.
Collapse
Affiliation(s)
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, PO Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Hanna Aberra
- Medical Department, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Nega Berhe
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Regional Centre for Imported and Tropical Diseases, Oslo University Hospital Ullevål, PO Box 4956, Nydalen, 0424, Oslo, Norway.
| | - Asgeir Johannessen
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital Ullevål, PO Box 4956, Nydalen, 0424, Oslo, Norway; Department of Infectious Diseases, Vestfold Hospital Trust, PO Box 2168, 3103, Tønsberg, Norway.
| |
Collapse
|