An appraisal of the WHO hepatitis B treatment guidelines applicability to Africans

Dusheiko, Geoffrey; Lemoine, Maud

doi:10.1016/j.jhep.2019.03.009

Cited by 12 publications

(7 citation statements)

References 12 publications

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“…HBV infections in healthcare settings usually result from needle prick injuries and failure to adhere to universal infection prevention precautions [ 9 ]. The public health challenge of HBV infections in healthcare settings in many resource-constrained countries is accelerated by limited access to diagnosis and treatment for hepatitis B [ 1 , 10 ]. In addition, a lack of awareness of HBV and precautionary measures to take against blood-borne infections among HCPs has been reported to be a risk factor for infection [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B screening and vaccination status of healthcare providers in Wakiso district, Uganda

et al. 2020

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Background Screening and vaccination against Hepatitis B virus (HBV) infection remains the most effective intervention in curbing the disease. However, there is limited evidence on the factors associated with the uptake of these services in Uganda. This study determined the uptake of HBV screening and vaccination status, and associated factors among Healthcare Providers (HCPs) in Wakiso district, Uganda. Materials and methods This cross-sectional study was conducted among 306 HCPs, randomly selected from 55 healthcare facilities. Prevalence ratios (PR) were used to determine the factors associated with HBV screening and vaccination status of HCPs. Results Of the 306 HCPs, 230 (75.2%) had ever screened for HBV infection while 177 (57.8%) were fully vaccinated. Being male was positively associated with 'ever been screened' for HBV infection (Adjusted PR = 1.27, 95%CI 1.13-1.41). Working in a public healthcare facility (Adjusted PR = 0.78, 95%CI 0.68-0.90) was negatively associated with ever been screened. Male sex (Adjusted PR = 1.21, 95%CI 1.01-1.46), the belief that the HBV vaccine was safe (Adjusted PR = 1.72, 95%CI 1.03-2.89) and ever been screened (Adjusted PR = 2.28, 95%CI 1.56-3.34) were positively associated with being fully vaccinated. However, working in a public healthcare facility (Adjusted PR = 0.79, 95%CI 0.64-0.98), self-perceived risk of HBV infection (Adjusted PR = 0.72, 95% CI:0.62-0.84), and working in a

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Section: Introductionmentioning

confidence: 99%

Hepatitis B screening and vaccination status of healthcare providers in Wakiso district, Uganda

et al. 2020

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“…The overriding implication of these ndings is that a signi cant number of patients in this cohort who were in the gray zone (0.5-2 points); they may have cirrhosis or signi cant brosis. To further extrapolate, the lower number of treatment eligible patients in cohorts in the WHO -Afro region potentially re ects the underdiagnosis of signi cant brosis or cirrhosis (43). Reiterating this problem, Dusheiko and Lamoine noted in an editorial letter that the use of the WHO guideline raises several major concernsthe poor concordance between the EASL and WHO criteria (Cohen's kappa 0.518, p-value <0.001) and its under-performance among young males and low overall sensitivity (49%).…”

Section: Discussionmentioning

confidence: 99%

Real-world experience with nucleos (t) ide analogue therapy and patient survival rates in chronic viral hepatitis B Treatment Centers in Asmara, Eritrea: A multicenter retrospective observational cohort study

Solomon,

Ghebremeskel,

Achila

et al. 2024

Preprint

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Background Real-world data on treatment outcomes or the quality of large-scale chronic hepatitis B (CHB) treatment programs in sub-Saharan Africa is extremely difficult to obtain. In this study, our aim was to present data on the clinical characteristics of CHB patients and to evaluate results in patients on nucleos(t)ide analogue (NUC) in multiple treatment sites in Asmara, Eritrea. Methodology: A multicenter retrospective cohort study was conducted on CHB patients in government-funded follow-up programs in Asmara, Eritrea (period: 2016–2021). Demographic, clinical, and laboratory information was collected from patients’ cards using a structured check-list. Relevant parametric and nonparametric statistics were employed to evaluate differences between groups. Kaplan–Meier (K-M) estimates and multivariate Cox proportional hazard models were used to explore risk factors for lost follow-up (LTFU). Results A total of 413 patients with HBV (median age (IQR) at diagnosis: 39 (IQR: 28–50 years, females: 118(28.6%) followed for a total of 22,921 person days of follow-up). Baseline ALT and AST were elevated in 99(31.2%) and 101(32.8%), respectively. Importantly, FIB-4 score and APRI score estimates suggested that prevalence of cirrhosis plus indeterminate and /or cirrhosis possible was 33(14%) + 49(20.8%) and 26(10.6%) + 65(26.4%), respectively. During the follow-up period, 4.6% (95%CI: 2.5–6.6%) died, while 23.9% (95%CI: 19.8–28%) were LTFU. The dominant reasons for treatment eligibility were cirrhosis and elevated HBV-DNA. After 12 weeks of treatment, the overall virologic response (VR) was 50.8% (95%CI: 46.9–74.6). Importantly, VR in TDF vs TDF + LAM were similar, 14/31(45.2%) vs 17/31(54.4%), respectively, p-value = 0.3. However, significant changes in biochemical parameters (ALT, AST, FIB-4, and APRI) were observed in both treatment groups following treatment. In adjusted Cox proportional hazards model, LTFU was independently associated with baseline serum HBV DNA (IU/mL) (aHR = 1.3, 95% CI 1.04–1.7; p-value = 0.02); Not initiated on NUC (aHR = 3.9, 95% CI: 1.1–13.7, p-value = 0.02); and FIB-4 Score (aHR = 1.05, 95% CI: 1-1.1; p-value = 0.01). Conclusion This study uncovered multiple system- and patient-centered gaps in the three HBV treatment programs in Asmara, Eritrea. Interventions should target improvements in laboratory infrastructure, adherence to patient monitoring guidelines, HBV literacy, better tracking of patients, and documentation of patients’ information.

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“…The underlying lack of validation of current guidelines in these patients potentially justifies the need for specific guidelines to be developed in this population, while examining the utility and relevance of current guidelines. 44 Leaving patients with chronic HBV and evidence of hepatic inflammation untreated for a prolonged period is unethical. Therefore, selection of patients from SSA for treatment will have to be reasonably based on guidelines derived from data in other populations until (and if) definite evidence teaches us otherwise.…”

Section: Antiviral Treatmentmentioning

confidence: 99%

An appraisal of the WHO hepatitis B treatment guidelines applicability to Africans

Cited by 12 publications

References 12 publications

Hepatitis B screening and vaccination status of healthcare providers in Wakiso district, Uganda

Hepatitis B screening and vaccination status of healthcare providers in Wakiso district, Uganda

Real-world experience with nucleos (t) ide analogue therapy and patient survival rates in chronic viral hepatitis B Treatment Centers in Asmara, Eritrea: A multicenter retrospective observational cohort study

Health inequalities in the management of chronic hepatitis B virus infection in patients from sub-Saharan Africa in high-income countries

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