Hepatitis B Virus Risk Factors Research Articles

Seroprevalence and risk factors of HBV, HCV and HIV among hemodialysis patients: a multicenter cross-sectional study from Damascus Syria

ObjectiveThe aim of this study is to determine the prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among hemodialysis (HD) patients as well as to identify associated risk factors.MethodologyA multicenter cross-sectional study involved patients who had been on HD for at least three months. The study was conducted at five HD centers in Damascus, Syria from August 2019 to September 2021. HBsAg, HCV-Ab and HIV (antibody/antigen) seropositivity were identified using the third generation ELISA technique. Patients’ information was extracted from their records and by face-to-face interview. Multiple logistic regression models were applied to identify risk factors associated with HBV or HCV seropositivity. The significance level was set at 5%.ResultsA total of 637 patients were included in the study with a mean age (SD) of 50.5 (15.6) years and 56.7% of them were men. The dialytic age ranged from one to thirty years with a mean (SD) of 6.10 (5.6) years. The prevalence of positive hepatitis B surface antigen, anti-HCV, co-infection of HBV and HCV, and anti-HIV (antibody/antigen) were 3.2%, 22.1%, 0.7%, and 0%, respectively. After controlling for co-variables, hepatitis B vaccine was the only predictor of seropositivity of HBV (OR: 0.15, 95% CI: 0.057–0.393, P < 0.001), as it significantly protected against contracting HBV. On the other hand, the dialytic age (OR: 1.42, 95% CI: 1.12–1.94, P = 0.032) and the dialysis center were significant factors affecting the prevalence of HCV.ConclusionsThe prevalence of HCV and HBV infections among HD patients in Damascus, Syria has decreased remarkably compared with the results from 2001. Nevertheless, it is still considered relatively high. Thus, there is an urgent need to strengthen the prevention and control measures for viral infection transmission in HD centers in Damascus.

Opportunistic screening using point-of-care testing leads to successful linkage to care of HBV-infected migrant populations in a low endemic country

Background and aimsIn low endemic countries, screening for hepatitis B surface antigen (HBsAg) in migrants is cost-effective in reducing the disease burden of hepatitis B virus (HBV) infections, but linkage to care (LTC) remains a challenge. This study aims to guide future screening initiatives, with 3 objectives: 1. to compare LTC between different ethnic groups screened for HBsAg with point-of-care testing (POCT) in an outreach setting; 2. to estimate the proportion of HBsAg seropositivity for ethnic minorities; and 3. to investigate the association between seropositivity and HBV risk factors. MethodsOpportunistic outreach screenings using finger prick HBsAg tests were performed at civic integration programmes between 11/2017 and 09/2022. If an individual tested positive, an appointment was given immediately at the outpatient hepatology clinic for follow-up and confirmation of HBsAg positivity in blood. Dedicated personnel contacted these individuals to motivate them for further LTC, which was defined as being assessed by a hepatologist, a blood test and an abdominal ultrasound. ResultsA total of 677 people from different ethnicities (Asian, Middle Eastern and African) were serologically screened using POCT. The observed positivity for HBsAg was 3.4 % (95% CI 2.17-5.05, 23/677). Apart from ethnicity and male sex, none of the surveyed HBV risk factors were associated with HBsAg seropositivity. All HBsAg positive individuals were linked to care and assessed by a hepatologist, despite the COVID-19 pandemic increase in time to follow-up of 82 days (95% CI 51–112 days) vs. 24 days (95% CI 5–43 days, p = 0.008)).Among HBV-infected patients, 31.8% (7/22), 100 % (22/22) and 26.1% (6/23) met the criteria for treatment indication, intrafamilial transmission risk and need for hepatocellular carcinoma surveillance, respectively. ConclusionThe proportion of HBsAg seropositivity in ethnic minorities was 3.4%. POCT and commitment of dedicated personnel can overcome previously identified barriers resulting in a 100% LTC.

Seroprevalence of hepatitis B virus infection (HBsAg) and associated factors among antenatal clinic attendees in a secondary-level facility in southern Ghana

IntroductionVertical transmission of Hepatitis B Virus (HBV) infection is the predominant mode of HBV transmission in highly endemic settings worldwide where the HBV seroprevalence is above 8%. Newborns who contract HBV at birth have a higher risk of chronic infections that can result in liver cancer and liver cirrhosis. Preventing mother-to-child transmission of HBV through screening of pregnant women during the antenatal period and universal vaccination of newborns are important strategies for eliminating new childhood HBV infections. This study sought to estimate the prevalence of HBV infection among pregnant women in the study area and to determine the factors associated with a positive HBV disease status. The findings from this study will help in obtaining a baseline for comparing future trends and identifying risk factors for HBV that need to be eliminated in southern Ghana. MethodsThis was a cross-sectional hospital-based analytic study in which 225 pregnant women were surveyed using a semi structured questionnaire. Blood samples were taken and analysed qualitatively for HBsAg. The data were entered into Epi-data version 3.1 and exported into STATA version 17 for analysis, with a significance level set at <0.05. ResultsThis study revealed that the seroprevalence of HBV infection (HBsAg positivity) was 8.0% CI (5%–12.4%) among the pregnant women. The HBV vaccination coverage was 50.2%. Pregnant women with a history of sexually transmitted diseases were six times more likely to test positive for HBsAg aOR: 6.36 (CI = 0.35–2.92, p = 0.019). Additionally, women who had received at least one dose of the HBV vaccine had lower odds of having HBV infection than did those who failed to vaccinate (aOR = 0.08, 95% CI = 0.01–0.66, P = 0.020). ConclusionsThe prevalence of HBV infection is relatively high in this population. HBV vaccination and sexually transmitted infections play significant roles in HBV infection and transmission in the study area. Interventions to promote HBV vaccination among the adult population as well as among newborns and STI prevention strategies are needed to reverse the trend of HBV infections in the study area.

Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China

BackgroundWhile mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years.MethodsData was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT.ResultsFrom 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of − 3.50 (95% CI -6.28 ~ − 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk.ConclusionsThe implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.

Hepatitis B and Hepatitis C Infections among Female Inmates in a Prison in Jeddah, Saudi Arabia.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major health concerns worldwide. Recent data indicate a decline in prevalence in the Saudi population; however, there are no data on the prevalence in prisoners. This study is the first to investigate the prevalence of viral hepatitis in female inmates in Jeddah, Saudi Arabia. This study aimed to explore the prevalence of HBV and HCV infections and to assess the knowledge and attitudes related to these infections among inmates. Inmates were interviewed using a pre-designed questionnaire, and their blood samples were tested for HBV and HCV infections using serology, PCR, and phylogenetic analysis. The overall prevalence of HBV infection in the study population was 4.4%. The age group > 25 years was predominantly affected; 11.1% of the infected cases were Saudi nationals, and 88.9% were non-Saudis. The prevalence of HCV infection was 2.4%. Among the studied variables, age and previous employment were significantly associated with positive HBV PCR, while conviction, knowledge about protection from sexually transmitted infections (STIs), knowledge about condom use for protection against STIs, and condom use for protection against STIs were significantly associated with HCV infection. This study shows higher HBV and HCV prevalence in the female prisoners in Briman prison compared to the general population. Uneducated prisoners, over 25 years old, and convicted of prostitution are more associated with both HBV and HCV infection. Future preventive plans should include screening new prisoners with these risk factors for HBV and HCV at the time of entry.

Beyond transmission: exploring the knowledge of risk factors and myths of Hepatitis B and C among undergraduate medical students

Hepatitis B virus (HBV) and hepatitis C virus (HCV) have significant impacts on global public health, necessitating a deep understanding of their transmission dynamics and risk factors. Given the high prevalence in Pakistan and the critical role of healthcare education, this study aimed to assess medical students’ knowledge of transmission risk factors and common myths and misconceptions about HBV and HCV. An exploratory study was conducted in May 2022 at Rai Medical College, Sargodha, Pakistan. A total of 376 undergraduate medical students were recruited using a convenient sampling technique. Participants completed self-administered questionnaires to assess their knowledge of HBV and HCV transmission risk factors and associated myths and misconceptions. The data were analyzed for frequencies and percentages with SPSS version 25.00. The majority of students accurately identified traditional transmission pathways for HBV, with 78.72% recognizing transmission during pregnancy and 73.14% during delivery. However, knowledge about nontraditional transmission routes and household practices was less robust, with only 60.64% acknowledging the risks of sharing nail cutters. For HCV, knowledge was generally lower, with 62.77% recognizing the risk associated with tattooing. Misconceptions were also prevalent; for instance, 53.99% of students mistakenly believed that HBV could be transmitted through the home care of patients. This study highlights significant knowledge gaps and pervasive misconceptions among medical students regarding HBV and HCV transmission. Despite a good grasp of traditional risk factors, the widespread misunderstanding of nonbloodborne transmission routes underscores the urgent need for enhanced educational interventions. The findings suggest that targeted improvements in curriculum design could better equip future healthcare providers to combat hepatitis effectively.

Hepatitis B Virus Reactivation in Kidney Transplant Recipients Treated With Belatacept

Hepatitis B virus (HBV) reactivation in kidney transplant recipients has been reported in 3% to 9% of anti-HBc antibody (HBcAb)-positive HBs antigen (HBsAg)-negative patients. It has not been studied in patients receiving belatacept, a selective costimulation blocker. We performed a retrospective study of all transplant recipients receiving belatacept in 2 kidney transplantation centers in France. Among HBcAb-positive patients, we analyzed HBV reactivation rate, outcomes, and risk factors. A total of 135 patients treated with belatacept were included: 32 were HBcAb-positive and 2 were HBsAg-positive. Seven patients reactivated HBV (21.9% of HBcAb-positive patients), including 5 HBsAg-negative patients (16.7% of HBcAb-positive HBsAg-negative patients). Reactivation occurred 54.8 (± 70.9) months after transplantation. One patient presented with severe hepatitis and 1 patient developed cirrhosis. There was no significant difference in survival between patients that reactivated HBV and patients that did not: 5-year patient survival of 100% (28.6; 100) and 83.4% (67.6; 100), respectively (P= 0.363); and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively (P= 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation. HBV reactivation rate was high in patients treated with belatacept when compared with previous transplantation studies. HBV reactivation did not impact survival. Further studies are needed to confirm these results. A systematic antiviral prophylaxis for these patients should be considered and evaluated.

Hepatitis B vaccination status and knowledge, attitude, and practice of hepatitis B among medical students at a medical college in central India

Background: Hepatitis B virus (HBV) infection imposes a major public health problem with an increased risk of occupational exposure among unvaccinated health care workers (HCWs). This study was conducted to determine the Hepatitis B vaccination status, along with the knowledge, attitude, and practice regarding Hepatitis B, among medical students at a medical college in a central India. Methods: A cross-sectional study was conducted from February 2022 to July 2022. A total of 477 students of health care professions were included into the study using a whole sampling technique. Data were collected using self-administered structured questionnaire and analyzed by using statistical package for the social sciences (SPSS) version 26. Results: Response rate was 91.61% (437). Majority of the students (&gt;80%) had an adequate knowledge on risk factors for HBV, its mode of transmissions, and preventions. About 192 of 437 (43.9%) participants had positive attitude towards following infection control guidelines, and 310 (70.9%) respondents believe that all HCWs should take HBV vaccine. However, only 11.2% students had completed the three doses schedule of HBV vaccination. Whereas, a significant number of students, 142 (32.5%), had been exposed to blood/body fluid via needle stick injury at least once since they started their training in the health facility. Conclusions: Study found that trainees in health profession are at a very high risk of contracting HBV infection during their training due to the low HBV vaccine uptake rate and high rate of accidental exposure to blood. We recommend that all students in the health profession should be vaccinated prior to their entry into professional practices.

A booster hepatitis B vaccine for children with maternal HBsAg positivity before 2 years of age could effectively prevent vaccine breakthrough infections

BackgroundThe long-term protective effect of hepatitis B vaccine (HepB), the incidence of hepatitis B virus (HBV) vaccine breakthrough infections (VBIs), and whether a booster HepB is necessary remain to be clarified in children born to mothers with chronic HBV infection.MethodsBased on a long-term follow-up prospective cohort of 1177 hepatitis B surface antigen (HBsAg)-positive mothers and their paired infants which was established from 2009 to 2011, total 454 children with immunoprophylaxis success as determined by postvaccination serologic testing (PVST) at 7 months old were included in this study. Among the 454 children, 246 never had a booster HepB, and 208 children received a booster HepB from 1 to 5 years of age. Multivariate logistic regression analysis was used to analyse the risk factors for HBV VBIs.ResultsThe hepatitis B surface antibody (anti-HBs) levels declined sharply from 7 months to 2 years old, and the anti-HBs seronegative rate in the children increased significantly from 2 years old. A total of 31 (6.83%) of the 454 children experienced VBIs, of which 7 had overt and 7 had occult HBV infections. Notably, 14 (45.16%) of the 31 children with VBIs were diagnosed at 2 years old, and all of them had anti-HBs positivity (> 10 mIU/mL) at 1 year old. Maternal hepatitis B e antigen (HBeAg) positivity, higher HBV DNA and HBsAg levels, lower initial infant anti-HBs levels and not receiving a booster HepB were independent risk factors for VBIs. The incidence of VBIs was significantly lower in children with a booster HepB than in nonboosted children (0.50 vs. 11.90%, P < 0.001), and none of the boosted children developed overt or occult HBV infection. The anti-HBs levels of 76.67% for the children with VBIs in the nonboosted group indicated positivity before VBIs was detected.ConclusionsAfter the primary full immunization with HepB, children born to mothers with chronic HBV infection, especially the children with maternal HBeAg positivity, high HBV DNA levels, high HBsAg levels and/or low initial infant anti-HBs levels, were at a high risk of VBIs, and a booster HepB for these children before 2 years old, instead of when their anti-HBs level is < 10 mIU/mL, could reduce the incidence of VBIs.

Hepatitis B screening to reduce the risk of viral reactivation in gynecologic oncology patients receiving chemotherapy at a regional tertiary cancer center: A quality improvement initiative.

332 Background: In 2020, ASCO released a Provisional Clinical Opinion recommending universal hepatitis B virus (HBV) screening prior to systemic chemotherapy to reduce the risk of reactivation and associated morbidities. There is limited data for HBV prevalence and risk factors in gynecologic oncology. In gynecologic oncology patients at the Juravinski Cancer Centre, median baseline screening rate over 6 months was 0%. Our aim was to increase the rate of HBV screening to 70% in gynecologic oncology patients initiating chemotherapy over 6 months and compare real-world efficacy of risk factor-based vs. universal screening. Methods: We performed an interrupted time series study using the Model for Improvement methodology. Four interventions were introduced to address identified screening barriers: provider education, standardization of a testing protocol, integration with existing clinical workflow, and biweekly feedback reports. These were modified in response to outcomes and stakeholder feedback in Plan-Do-Study-Act cycles. Process and outcome measures data were collected by chart review and analyzed on statistical process control and run charts. Retrospective chart review collected demographic and disease data including Centers for Disease Control (CDC) hepatitis risk factors. Results: From Dec 1/20 to Nov 30/21, there were 381 new chemotherapy initiations in gynecology patients. The proportion of physicians screening increased significantly from 0% to 85%, and HBV monthly screening rates increased significantly from 0% to 72.2% by month 8 and were sustained for 4 months at last analysis. The integrated clinic screening protocol and feedback report interventions were each associated with increased screening rates. Of 330 unique patients initiating chemotherapy, 175 were screened (53%). Although ≥95% lacked data for 4 CDC hepatitis risk factors, 60.9% had ≥1 risk factor, and 11.2% had ≥2. HBV surface antigen (HBSAg) was non-reactive in all screened patients, but anti-HBV core (HBc) antibody was reactive in 5 (2.9%), indicative of prior infection. Real world risk factor-based screening in those with ≥1 CDC risk factor would have only identified 3/5 seropositive patients. In the screened population, risk-factor based screening had sensitivity 60%, specificity 38.8%, PPV 2.8%, NPV 97.1%. There were no HBV reactivations. Conclusions: Implementation of 4 interventions to increase HBV screening in gynecologic oncology patients receiving chemotherapy significantly improved screening rates, achieving our target at 8 months with sustained improvement. Risk-factor based screening lacks sensitivity compared to universal screening which may impact management. Lessons learned from this initiative may be applicable to other interventions to reduce infectious morbidity in oncologic populations.

S1193 Differences in Prevalence and Treatment of Hepatitis B Virus Infection in Asian and Black Patients

Introduction: Hepatitis B virus (HBV) infection, an important cause of chronic liver disease, has a prevalence of 4.3% in the United States (US) and causes significant morbidity and mortality. Immigrants and racial/ethnic minorities are disproportionately burdened by HBV. Few studies have investigated characteristics of HBV infection and treatment by race; therefore, we sought to understand and compare risk factors, barriers to care, and treatment patterns in Blacks and Asians, the two most disproportionately impacted groups. Methods: Using informatics, we identified patients with possible HBV based on ICD-10 code B18.1, who were seen between May 2010 and July 2021 at a tertiary referral center. We performed retrospective chart review to confirm infection and captured sociodemographic/clinical data. We used descriptive statistics, Kruskal-Wallis and Pearson’s chi squared tests to evaluate for differences between Black and Asian patients. Analyses were conducted using STATA 17.0(College Station, Texas). Results: Out of 673 patients, 509 had confirmed HBV: 308 Black and 201 Asian patients. Compared to Asians, Blacks were older and more likely to be male and US-born. Top birth countries included Haiti, 22%, US, 18%, China, 16%, and Vietnam, 8% (Fig 1a). Risk factors for HBV differed significantly; 44% of Asians had a family history of HBV compared to 8% of Blacks, p < 0.001 (Table). Clinical notes for Black patients were more likely to document history of injection drug use, blood transfusions and tattoos. The predominant HBV genotype was A in Blacks and B in Asians (Fig 1b). Despite no significant differences in prevalence of cirrhosis or infection phenotype, there were treatment differences; 60 % of Blacks vs. 70% of Asians were treated, p 0.04. More Black patients had concurrent HIV or HCV, 14% and 5%, respectively compared to 0-1% of HIV and HCV in Asians. NAFLD was more common in Asians, 27%, vs 12% in Blacks. While 97% of Blacks and 70% of Asians met Hepatocellular carcinoma (HCC) screening criteria, only 67% of Blacks and 44% of Asians of those meeting criteria were screened in the past twelve months. Conclusion: There are significant differences in risk factors, access to care and treatment between Black and Asian patients in our institution. Future studies should seek to understand barriers to treatment and the determinants of inadequate HCC screening in both Asian and Black patients, given the dire consequences of HBV-related HCC in these communities.Figure 1.: a) Birth Country Distribution of HBV Patients, b) Predominant HBV genotype of Black and Asian Patients Table 1. - Demographics and Clinical Characteristics of Black and Asian Patients with HBV Variable Black Asian p-value (n = 308) (n = 201) Median Age, years (IQR) 56.97 (46.21-65.1) 51.54 (42.63-61.86) 0.003 Male Gender, n (%) 199 (64.8) 103 (51.2) 0.002 Hispanic Ethnicity, n (%) 23 (8.1) 3 (1.5) 0.002 English-speakers, n (%) 266 (86.4) 182 (90.6) < 0.001 US-Born, n (%) 73 (32.9) 9 (5.1) < 0.001 Insurance Type, n (%) < 0.001 Private 185 (63.4) 148 (74.8) Medicaid/Medicare 93 (31.9) 33 (16.7) Uninsured 12 (4.1) 12 (6.1) Married (not separated), n (%) 146 (52.1) 143 (72.6) < 0.001 Risk Factors, n (%) Intravenous Drug Use 4 (1.4) 1 (0.5) < 0.001 Intranasal Cocaine 19 (6.6) 1 (0.5) < 0.001 Non-IV Drug Use 19 (6.6) 1 (0.5) < 0.001 Sexually Transmitted Diseases 34 (11.9) 5 (2.5) < 0.001 Transfusions 54 (19.2) 16 (8.1) < 0.001 Family history of hepatitis 11 (3.9) 6 (3.1) < 0.001 Family history of HBV 22 (7.6) 87 (44.4) < 0.001 Family history of HCC 12 (4.2) 37 (18.9) < 0.001 Tattoos 26 (9) 9 (4.6) < 0.001 Other Medical Conditions, n (%) Non-alcoholic Fatty Liver Disease (NAFLD) 32 (11.6) 53 (27.2) < 0.0001 Human Immunodeficiency Virus (HIV) 39 (13.8) 0 (0) < 0.001 Hepatitis C Virus (HCV) 13 (4.5) 2 (1) < 0.001 Ever Treated for HBV, n (%) 166 (60.4) 136 (69.7) 0.037 Currently Treated for HBV, n (%) 148 (52.5) 105 (55) 0.59 Phenotype, n (%) 0.195 Immune tolerant 2 (0.8) 1 (0.5) HbeAg positive active ( > 20000 DNA) 7 (2.7) 2 (1) HbeAg negative active ( > 2000 DNA) 9 (3.5) 6 (3.1) Inactive carrier 175 (67.6) 117 (60.3) Indeterminate 66 (25.5) 68 (35.1) Met criteria for HCC Screening, n (%) 299 (97.1) 141 (70.2) < 0.0001 HCC Screening < 6 months before visit, n (%) 219 (76.6) 91 (46.7) < 0.001 HCC Screening < 12 months before visit, n (%) 190 (66.7) 86 (44.1) < 0.001 Demographics and Clinical Characteristics of Black and Asian Patients with HBVp value of <0.05 is considered significant).

Hepatitis B screening to reduce the risk of viral reactivation in gynecologic oncology patients receiving chemotherapy at a regional tertiary cancer center: A quality improvement initiative.

e18628 Background: In 2020, ASCO released a Provisional Clinical Opinion recommending universal hepatitis B virus (HBV) screening prior to systemic chemotherapy to reduce the risk of reactivation and associated morbidities. There is limited data for HBV prevalence and risk factors in gynecologic oncology. In gynecologic oncology patients at the Juravinski Cancer Centre, median baseline screening rate over 6 months was 0%. Our aim was to increase the rate of HBV screening to 70% in gynecologic oncology patients initiating chemotherapy over 6 months and compare real-world efficacy of risk factor-based vs. universal screening. Methods: We performed an interrupted time series study using the Model for Improvement methodology. Four interventions were introduced to address identified screening barriers: provider education, standardization of a testing protocol, integration with existing clinical workflow, and biweekly feedback reports. These were modified in response to outcomes and stakeholder feedback in Plan-Do-Study-Act cycles. Process and outcome measures data were collected by chart review and analyzed on statistical process control and run charts. Retrospective chart review collected demographic and disease data including Centers for Disease Control (CDC) hepatitis risk factors. Results: From Dec 1/20 to Nov 30/21, there were 381 new chemotherapy initiations in gynecology patients. The proportion of physicians screening increased significantly from 0% to 85%, and HBV monthly screening rates increased significantly from 0% to 72.2% by month 8 and were sustained for 4 months at last analysis. The integrated clinic screening protocol and feedback report interventions were each associated with increased screening rates. Of 330 unique patients initiating chemotherapy, 175 were screened (53%). Although ≥95% lacked data for 4 CDC hepatitis risk factors, 60.9% had ≥1 risk factor, and 11.2% had ≥2. HBV surface antigen (HBSAg) was non-reactive in all screened patients, but anti-HBV core (HBc) antibody was reactive in 5 (2.9%), indicative of prior infection. Real world risk factor-based screening in those with ≥1 CDC risk factor would have only identified 3/5 seropositive patients. In the screened population, risk-factor based screening had sensitivity 60%, specificity 38.8%, PPV 2.8%, NPV 97.1%. There were no HBV reactivations. Conclusions: Implementation of 4 interventions to increase HBV screening in gynecologic oncology patients receiving chemotherapy significantly improved screening rates, achieving our target at 8 months with sustained improvement. Risk-factor based screening lacks sensitivity compared to universal screening which may impact management. Lessons learned from this initiative may be applicable to other interventions to reduce infectious morbidity in oncologic populations.

Magnitudes and Correlates of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis among Pregnant Mothers Attending Antenatal Care in Addis Ababa, Ethiopia.

Background Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis are major sexually transmitted infections (STIs) among the general population in Ethiopia, which in turn result in a wide range of adverse pregnancy outcomes. Hence, it is important to determine the seroprevalence and risk factors of HIV, HBV, and syphilis infection among pregnant mothers attending antenatal care in Addis Ababa, Ethiopia. Method A cross-sectional study was conducted among 286 pregnant women from February 1, 2021, to March 30, 2021, in four selected public hospitals in Addis Ababa. Sociodemographic, risky sociocultural, behavioral, and hospital-related factors were collected using an interview-administered questionnaire. Detection of anti-HIV antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis was conducted. A binary logistic regression analysis was used to determine predictors of STIs using SPSS version 25. Result A total of 281 pregnant mothers with a mean age of 27.5 (SD 4.6) completed the study. Among the participants, the seroprevalence rates of HIV, HBV, and syphilis were 15 (5.3%), 9 (3.2%), and 5 (1.8%), respectively. Twenty six (9.3%) of the participants tested positive for any one of the STIs, and 3 (1.1%) of the women had HIV and syphilis coinfections. History of multiple sexual partners (AOR 3.42, 95% CI: 1.6-11.63) and STIs (AOR 3.7; 95% CI: 1.70-13.45) were significantly associated with HIV infection. Likewise, history of abortion (AOR 7.65, 95% CI: 1.17-49.74), tattooing (AOR 9.72, 95% CI: 1.41-66.73), and rape (AOR 9.72, 95% CI: 1.41-66.73) were significantly associated with hepatitis B virus infection. Husband history of multiple sexual partners (AOR 20.9, 95% CI: 1.8-241.8) was significantly associated with syphilis infection. The educational level of participants, history of tattooing (AOR 6.24, 95% CI: 1.79-21.7), and history of multiple sexual partners (AOR 5.15, 95% CI: 1.68-15.7) were independent predictors of infection with any one of the STIs. Conclusion There is still a high burden of HIV, HBV, and syphilis among pregnant mothers in Ethiopia. History of multiple sexual partners, abortion, rape, and tattooing was a significant predictor of STIs.

Incidental hepatitis B virus in Sudanese patients and relative risk factors: Why more screening is needed in primary care?

Hepatitis B virus (HBV) is considered one of the most paternally transmissible viruses. Therefore, education about its risk factors and transmission is vital in decreasing the prevalence of the disease burden in Sudan. The aim of the present study was to investigate the relative risk factors of HBV and its impact on the society. A facility-based, descriptive, cross-sectional study was conducted among those who were incidentally detected with HBV surface antigen (HbsAg) and their contact family members by ICT and enzyme-linked immunosorbent assay (ELISA) in Tropical Diseases Teaching Hospital, Omdurman locality, Khartoum state, Sudan. The study recruited 112 participants, among whom 63 individuals incidentally attended for screening for HBV and this led to contact tracing of 49 individuals (contact relative group). Among 63 patients of the incidental group, there were 83.9% males and 16.1% females. In the contact tracing group consisting of 49 individuals, there were 83.3% males and 16.7% females (odds ratio [OR] = 1.375, 95% confidence interval [CI] = 0.14-13.6; P = 0.000). All the participants were screened for HBsAg. HBV was found to have a significant association with male gender (OR = 1.375, 95% CI = 0.14-13.6; P = 0.000), marital status (OR = 627.084, 95% CI = 48-8195; P = 0.000), working as police officers (OR = 524.2, 95% CI = 43.5-6314; P = 0.000), residing in Khartoum (OR = 520.173, 95% CI = 43-6290; P = 0.000), being illiterate (OR = 558.4, 95% CI = 47.7-6544.7; P = 0.000), vaccination status (OR = 625.4, 95% CI = 48.9-7996.3; P = 0.000), and with some concomitant diseases (OR = 559.193, 95% CI = 47.7-6561.5; P = 0.000). The HBV is still considered a very critical, highly infectious disease; therefore, primary care physicians have an important role in the investigation, prevention, and health education, in order to prevent the viral spread.

Prevalence and Risk Factors of HBV and HCV Co-Infection Among People Living with HIV in an Egyptian Setting.

Human Immune Deficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections constitute a global health concern. They share common modes of transmission, increasing the likelihood of co-infection. Co-infection accelerates viral replication, promotes the progression of chronic liver diseases and challenges antiviral therapy. There are no available data addressing the magnitude of chronic viral hepatitis co-infection in people living with HIV in Egypt. Nor is there a mandate for HCV/HBV screening. This cross-sectional study provides needed data on HBV and/or HCV co-infection in Egyptian people living with HIV. The study was conducted at the HIV clinic in Alexandria Fever Hospital. The investigation included 168 confirmed HIV cases. All cases were interviewed and tested for HCV-Ab and HBsAg by ELISA. There were 52 (31%) persons who were anti-HCV positive. 40 of them had detectable HCV RNA (76.9%). HIV/HCV co-infection was significantly higher among males (40.7%) compared to only (10.9%) among females (OR = 3). History of imprisonment (OR = 4.84, CI: 1.33-17.62), accidental puncture with protruding needle contaminated with blood (OR = 3.35, CI: 0.99-11.72), alcohol use (OR = 3.03, CI: 1.13-8.09) and male gender (OR = 2.96, CI: 0.99-8.88) were all significant predictors for HIV/HCV co-infection. On the other hand, HIV/HCV co-infection was inversely associated with high education level (OR = 0.28, CI: 0.10-0.76). HBsAg was detected in 4 (2.4%), and anti-HBc in 49 (29.2%) of HIV patients. Previous HBV infection (positive anti-HBc/negative anti-HBs) was significantly associated with a history of female genital mutilation circumcision, injection drug use, invasive procedures, non-specific fatigue and HCV-Ab seropositivity. Egyptian people living with HIV have an increased frequency of HCV antibody and HCV infection compared to the general population indicating a higher risk of infection and suggest a higher risk of HCV exposure. Past or present HBV co-infections are also elevated. Routine screening of these viruses in the management protocol of people living with HIV in Egypt is recommended.

919. Rates of False-Positive Hepatitis B Surface Antigen Is Low in Cancer Patients

BackgroundAccurate interpretation of hepatitis B virus (HBV) laboratory testing is paramount in avoiding inaccurate diagnosis and incorrect management that could lead to unnecessary and overtreatment. This is particularly relevant in patients with cancer where universal testing is recommended in order to avoid HBV reactivation. Hepatitis B surface antigen testing (HBsAg) positivity indicates chronic or acute HBV infection. The rates and outcomes of a false-positive HBsAg have not been established for patients with cancer.MethodsThree hundred and ninety-seven patients with any type of cancer and positive HBsAg seen at MD Anderson Cancer Center from January 2016 – January 2021 were retrospectively reviewed in this study approved by the institutional review board. Cases of false-positive HBsAg were defined as those patients with a positive HBsAg but negative HBsAg quantitative, negative HBV core antibody (total Ig), and undetectable HBV DNA within 30 days of positive HBsAg testing. Serum samples from patients were tested for HBsAg using Vitros Enhanced Chemiluminescent Immunoassay (Ortho-Clinical Diagnostics, Raritan, NJ, USA). Data collection includes demographics, past medical history, underlying cancer and its stage, prior cancer treatment, risk factors for HBV, co-infections (hepatitis C, HIV), symptoms, liver function tests, anti-HBV treatment, and interruptions on cancer treatment.ResultsOut of 397 patients with a positive HBsAg, 33 were excluded as they did not meet the diagnostic criteria or have insufficient HBV data. Of them, 3 cases (0.8%) were identified as false positive HBsAg. All 3 patients were female, white, and had progressive malignancy (Table 1). No prior history of liver disease or liver function abnormalities were noted with these 3 patients. Initially, antiviral treatment was started on 1 patient which was discontinued shortly after confirmation of false-positive HBsAg. All 3 patients had additional workup and evaluation by an HBV specialist. In 2 patients, cancer treatment was canceled or delayed. ConclusionAlthough uncommon, cancer patients with false-positive HBsAg need further workup to avoid overtreatment and unnecessary interruptions in cancer careDisclosures Jessica P. Hwang, MD, MPH , Merck (Grant/Research Support)

Burden and Transmission Risks of Viral Hepatitis in Southern Ethiopia: Evidence Needed for Prevention and Control Measures.

BackgroundHepatitis B virus (HBV) and hepatitis C virus (HCV) are significant causes of liver-associated morbidity and mortality for millions of people globally. Ethiopia is one of the viral hepatitis–endemic countries with no national strategy for surveillance and limited data. As such, this study aimed to investigated the extent and associated risk factors of HBV and HCV among community members in southern Ethiopia.MethodsA community-based cross-sectional study was conducted from January 2020 to August 2020. A structured questionnaire was used to collect behavioral and sociodemographic data. Serum samples were collected and assayed for seromarkers of HBV (HBsAg, anti-HBc, and anti-HBs) and HCV (anti-HCV) using ELISAs. In HBsAg-positive samples, HBV DNA was further quantified using RT-PCR. Data were entered into EpiData 3.1 and analyzed using SPSS 21.0. Descriptive statistics and logistic regression analysis were employed.ResultsThe study included 693 participants. Seromarkers for HBsAg, anti-HCV, anti-HBc, and anti-HBs were found to be 9.5%, 1.4%, 31.1%, and 14.3%, respectively. In 66 HBsAg positives, 57 (86.4%) had quantifiable HBV DNA. Prevalence of current HBV infection (HBsAg+, anti-HBc+, anti-HBs–) and lifetime exposure (positive for either HBsAg or anti-HBc) to HBV were 8.7% and 31.9%, respectively, and 63.1% of participants were vulnerable or had no evidence of prior HBV infection (HBsAg–, anti-HBc–, anti-HBs–). On multivariate logistic regression analysis, multiple sexual contacts, family history of hepatitis infection, alcohol consumption, and khat chewing were significantly associated with HBV. The seroprevalence of HBV was relatively high in this study area.ConclusionThis study showed high prevalence of HBV infection, but low prevalence of HCV. This indicates that HBV is a major health problem in this community. Population-based surveillance, care, and treatment, as well as behavioral change and education programs, should be enhanced to minimize risk exposure.

Prevalence and Risk Factors Associated with Hepatitis B and Hepatitis C Infections among Patients Undergoing Hemodialysis: A Single-Centre Study in Somalia.

Introduction Hemodialysis patients have the highest risk for developing hepatitis B virus (HBV) and hepatitis C virus (HCV) than the general population. There is no study available for HBV and HCV in this population in Somalia. The main objective of this study is to determine the prevalence and risk factors of HBV and HCV infections among hemodialysis patients in Somalia. Methods A cross-sectional assessment of hemodialysis patients from January 2021 to June 2021 was used in this study. 220 patients were included in this study. Age, sex, duration of hemodialysis, number of hemodialysis sessions per week, history of blood transfusion, HbsAg, and anti-HCV antibodies were examined. Results Out of the 220 patients, males were predominant (113 (51.4%)). The mean age of the participants was 52.70. The prevalence of HBV was 7.3% (16 respondents), while the prevalence of HCV was 3.2% (7 respondents). 1 respondent (0.5%) had both HBV and HCV. There is a positive correlation between the duration of hemodialysis and the prevalence of HBV and HCV (r(218) = 0.298, p value <0.001), blood transfusion and prevalence of HBV and HCV (r(218) = 0.347, p value <0.001), and the number of hemodialysis sessions per week and prevalence of HBV and HCV (r(218) = 0.402, p value <0.001). The regression model of the combined predictors of history of blood transfusion, duration of hemodialysis, and number of dialysis sessions per week is R2 = 0.25, which indicates a 25% variance in the prevalence of HBV and HCV with a significance of F (3,216) = 23.67, p < 0.001. Conclusions The prevalence of HBV and HCV among hemodialysis patients in this study was 7.3% and 3.2%, respectively. 0.5% of the respondents had both HBV and HCV. History of blood transfusion, duration of hemodialysis, and number of hemodialysis sessions per week appear to have a strong correlation with the prevalence of HBV and HCV.

Study on Hepatitis B Virus Infection and Risk Factors among Children in a Community, North Central Nigeria

Background: Hepatitis B Virus (HBV) is a worldwide health issue and a source of major concern around the globe. Infections caused by hepatitis B virus pose a major challenge to public health. This study evaluates the prevalence and transmission rate of Hepatitis B Virus infection among children of primary school age at our study location.&#x0D; Method: Three hundred and three (303) volunteer subjects were screened.Structured questionnaire were administered to consenting participants to determine demographic and other risk factors for HBV infection.Samples obtained were analysed using a Laboratory-based immunoassay-HBsAg rapid diagnostic test (RDTs) in lateral flow assays formats. Sera samples obtained were stored at -20oc prior use.&#x0D; Results: Overall result showed that 46 (15.2%) were sero-positive for HBV infection. Considering age factor, Children aged 10 – 12 years showed a higher prevalence of 16(5.3%) [P-value 0.736; (P &gt;0.05)]. Based on gender of subjects screened, a prevalence of 34(11.2%) was recorded among the males subjects compared to females with 12(4.0%) positivity, [(P &lt; 0.05)]. Risk factors on family history recorded 13(4.3%) positivity, considering place of circumcision as risk factors among male subjects; result showed that subjects circumcised using traditional methods recorded 17 (11.7%) positivity. [P-value 0.856 (P&gt;0.05)].Respondents with history of cuts recorded a prevalence of 29(9.6%) positivity; [P-Value 0.362 (P&gt;0.05)] considering enzyme assay of positive subjects, 13 (4.3%) subjects recorded an elevated Alanine transaminases.&#x0D; Conclusion: The transmission rate of HBV infection among the family members was found to be high in this study. This upsurge calls for an urgent vaccination of the population by relevant healthcare providers.

A Noninvasive Prediction Model for Hepatitis B Virus Disease in Patients with HIV: Based on the Population of Jiangsu, China.

Objective To establish a machine learning model for identifying patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through two sexual transmission routes in Jiangsu, China. Methods A total of 14197 HIV cases transmitted by homosexual and heterosexual routes were recruited. After data processing, 12469 cases (HIV and HBV, 1033; HIV, 11436) were left for further analysis, including 7849 cases with homosexual transmission and 4620 cases with heterosexual transmission. Univariate logistic regression was used to select variables with significant P value and odds ratio for multivariable analysis. In homosexual transmission and heterosexual transmission groups, 10 and 6 variables were selected, respectively. For identifying HIV individuals coinfected with HBV, a machine learning model was constructed with four algorithms, including Decision Tree, Random Forest, AdaBoost with decision tree (AdaBoost), and extreme gradient boosting decision tree (XGBoost). The detective value of each variable was calculated using the optimal machine learning algorithm. Results AdaBoost algorithm showed the highest efficiency in both transmission groups (homosexual transmission group: accuracy = 0.928, precision = 0.915, recall = 0.944, F − 1 = 0.930, and AUC = 0.96; heterosexual transmission group: accuracy = 0.892, precision = 0.881, recall = 0.905, F − 1 = 0.893, and AUC = 0.98). Calculated by AdaBoost algorithm, the detective value of PLA was the highest in homosexual transmission group, followed by CR, AST, HB, ALT, TBIL, leucocyte, age, marital status, and treatment condition; in the heterosexual transmission group, the detective value of PLA was the highest (consistent with the condition in the homosexual group), followed by ALT, AST, TBIL, leucocyte, and symptom severity. Conclusions The univariate logistics regression combined with the AdaBoost algorithm could accurately screen the risk factors of HBV in HIV coinfection without invasive testing. Further studies are needed to evaluate the utility and feasibility of this model in various settings.