HBV continuum of care using community- and hospital-based screening interventions in Senegal: Results from the PROLIFICA programme

Sow, Amina; Lemoine, Maud; Touré, Papa Souleymane; Diop, M; Lô, Gora; Veiga, Jean De; Pape, Omar Thiaw; Seck, Khady; Ndow, Gibril; Bojang, Lamin; Kane, Arame; Oudiane, Marina; Howell, Jess; Nayagam, Shevanthi; Moutchia, Jude; Chemin, Isabelle; Mendy, Maimuna; Touré-Kâne, Coumba; Thursz, Mark; Ka, Mourtalla; Shimakawa, Yusuke; Mboup, Souleymane

doi:10.1016/j.jhepr.2022.100533

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…Finally, 30 articles met our inclusion criteria, and all the authors of these articles agreed to share the IPD 13 , 15 – 43 . We additionally included IPD data from yet unpublished cohorts from South Africa (Spearman & Sonderup, 2021) and Dakar, Senegal (Seydi & Wandeler, 2021), and from one cohort which has subsequently been published (Thiès, Senegal) 44 .…”

Section: Resultsmentioning

confidence: 99%

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

et al. 2023

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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.

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Section: Resultsmentioning

confidence: 99%

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

et al. 2023

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“…The large population-level health gains in this study were also dependent on high levels of uptake of the intervention at all stages of care like those achieved in the PROLIFICA study [ 6 ]. In reality, this may be infeasible outside of a research context with active outreach, especially in countries with less diagnostic capacity [ 44 ]. Other practical considerations and barriers to implementation that were not addressed include the logistics involved with reaching rural populations, delivering clinical assessments, setting up reliable data linkage systems and minimising loss to follow-up with less frequent monitoring, which depend on local health care infrastructure and staff.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of different monitoring strategies in a screening and treatment programme for hepatitis B in The Gambia

et al. 2023

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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.

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Investigating linkage to care following community‐based screening for hepatitis B virus in rural Senegal: A mixed methods study

Coste,

Diouf,

Ndong

et al. 2024

Journal of Viral Hepatitis

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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.

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HBV continuum of care using community- and hospital-based screening interventions in Senegal: Results from the PROLIFICA programme

Cited by 4 publications

References 30 publications

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

Cost-effectiveness of different monitoring strategies in a screening and treatment programme for hepatitis B in The Gambia

Investigating linkage to care following community‐based screening for hepatitis B virus in rural Senegal: A mixed methods study

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