Application of Sero-Epidemiology Data to Inform Interventions for HBV in Africa: Should Diagnosis and Treatment Replace Catch-Up Vaccination?

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Background: International goals for hepatitis B virus (HBV) infection set ambitious targets for elimination by 2030. In populations with a high prevalence of infection, catch-up HBV vaccination of adults is sometimes deployed. An alternative approach of 'test and treat' could be applied as a population intervention for HBV. Methods: used a systematic approach to determine the relationship between prevalence of HBV infection (HBsAg) and exposure (anti-HBc) in Africa. applied a mathematical model to compare the impact of catch-up vaccination with a 'test and treat' strategy in a high prevalence setting. Findings: There is a strong relationship between the prevalence of HBsAg and anti-HBc (p<0·0001) across Africa, but the pattern differs between regions. In settings with high prevalence of infection, catch-up vaccination may have a transient effect. However, this intervention does not contribute to a sustained decline in prevalence, because a high proportion of adults are either already infected or immune as a result of prior exposure. In contrast, diagnosing and treating infection has a marked impact on reducing prevalence, equivalent to that of neonatal vaccination. Interpretation: have developed a high-resolution picture of HBV epidemiology across Africa. In combination with robust neonatal vaccination programmes, testing and treating infection is likely to be of more benefit than catch-up vaccination. This alternative not only benefits the infected individual, but also has impact on transmission, thus contributing to sustained reductions in population prevalence. Funding Statement: Wellcome Trust, grant reference 110110. Declaration of Interests: The authors state: We have no conflicts of interest to declare. Ethics Approval Statement: The authors state: Ethics approval was not required for this study, as we only analysed data that are already available in the public domain.