Hepatitis B Virus Screening Research Articles

Prevention, control, and management of HBV infection among pregnant women in China: from a life-cycle perspective.

Hepatitis B virus (HBV) infection is a global public health problem, causing a high disease burden worldwide.[1] As a country previously with a high burden of hepatitis, about 70 million people in China are infected with HBV now, and mother-to-child transmission (MTCT) is still a predominant mode of HBV infection in China.[2] Preventing mother-to-child transmission is the key to eliminating HBV infection, and standardized management of HBV-infected pregnant women and their newborns can effectively cut off the mother-to-child transmission.[3] Neonatal hepatitis B immune globulin and hepatitis B vaccine can effectively reduce neonatal HBV infection in infants of HBV-positive pregnant women. Peripartum antiviral prophylaxis after 28 pregnant weeks is proved to be highly effective at reducing the risk of HBV (MTCT).[4] Furthermore, controlling hepatitis B infection in pregnant women not only reduces the risk of transmission within the family and vertical transmission from mother to child,[5] but also might reduce the risk of adverse pregnancy outcomes.[6] Therefore, understanding the epidemiological characteristics of HBV infection in pregnant women in China and better regulating the prevention, diagnosis, and treatment of this population is of great significance for realizing the goal of “eliminating viral hepatitis as a major public health threat by 2030” proposed by World Health Organization (WHO). Based on recent data from the first nationwide observational study on HBV infection among pregnant women in China, the prevalence of HBV infection among pregnant women in China continued to decline from 2015 to 2020.[7] Data were obtained from the National Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B (iPMTCT) Program. From 2015 to 2020, a total of 90.87 million pregnant women in 2853 counties of China were tested for HBV, of which about 5.6 million tested positive for HBV infection (defined as a positive outcome for hepatitis B surface antigen). The prevalence of HBV infection among pregnant women decreased from 7.30% in 2015 to 5.44% in 2020, which is at the moderate epidemic level defined by WHO.[7] It reflected the effectiveness of comprehensive prevention and control measures, mainly hepatitis B vaccination for newborns, in reducing the prevalence of HBV infection among adults in China.[7] Compared with 2015, the prevalence of HBV infection among pregnant women in eastern, central, and western China all decreased, from 8.72% to 6.04% (a relative decline of 30.73%) in eastern China and from 6.76% to 4.93% (a relative decline of 20.07%) in central China. In the west, it dropped from 6.40% to 5.43% with a relative decline of 14.48%. The regional gap also narrowed, and the prevalence of HBV infection decreased in most provinces (90.30%) and counties (76.96%) from 2015 to 2020.[7] The study suggests that provinces with a relatively high burden of HBV infection should be given more investment in health resources and more attention in the future. This is the first study on the status quo and trend of HBV infection among pregnant women in China at the national level, which is of great significance.[7] The results provide important basic data for understanding the current burden of hepatitis B among pregnant women in China and realizing the goal of eliminating hepatitis B. The findings also prove the great achievements of hepatitis B prevention and control in China over the years. The results of this study provide scientific evidence for China to better achieve the 2030 goal of eliminating hepatitis B as a public health threat proposed by WHO. How to achieve the WHO 2030 goal of eliminating the public health threat caused by hepatitis B on time is a global common concern.[1,2] From the perspective of life-cycle management, countries can integrate existing public health and medical services to establish a comprehensive prevention and control system covering the whole life cycle of HBV infection prevention, screening, diagnosis, and treatment.[2,7] For example, the integration of the National Free Pre-Pregnancy Health Examination Project and the iPMTCT Program provides a unique opportunity and management platform to better achieve the goal of eliminating hepatitis B by 2030. Through this platform, we can recognize the HBV infection in reproductive women and their family members at risk in the early stages of the disease. The life-cycle management of HBV prevention and control could be implemented in positive families, that is, prevention and treatment management of HBV infection and disease is carried out from pre-pregnancy, during pregnancy, infanthood, childhood, adolescent, child-bearing age, and old age, to achieve the goal of reducing the incidence and mortality of hepatitis B infection, and contribute to China's achievement goal of eliminating the public health threat posed by hepatitis B by 2030. Funding This study was supported by grants from the National Natural Science Foundation of China (Nos. 71874003, 72122001, and 71934002). Conflicts of interest None.

Protective Role of Rheumatic Diseases Against Hepatitis B Virus Infection and Human Leukocyte Antigen B27 Highlighted.

BackgroundBy determining the hepatitis B virus (HBV) surface antigen (HBsAg) positive rate postexposure and HBV-specific antigen/antibody (Ag/Ab) level in patients with rheumatic diseases, we aimed at exploring the rheumatic link to HBV control.MethodsPatients who underwent HBV screening in the Ruijin Hospital from 2020 to 2021 were enrolled for the exposure rate estimation. Among antibody to HBV core antigen (HBcAb)-positive patients, we adopted propensity score matching (PSM) to study the impact of rheumatism on HBsAg seroprevalence after exposure. A second PSM evaluated the Ag/Ab differences. We also had HBsAg prevalence in human leukocyte antigen B2 (HLA-B27) tested patients studied.ResultsWith 33,989 screened patients, exposure rates remained comparable between rheumatic and non-rheumatic patients: 48.94 vs. 49.86%. PSM first yielded 2,618 balanced pairs. We observed significantly fewer patients with rheumatic diseases in HBsAg positive cases than negative ones (p < 0.001). In the second round, PSM matched 279 pairs, HBsAg (p < 0.001) and HBeAg (p < 0.05) positivity rates were significantly lower in the rheumatic patients, whereas HBsAb positivity rate (p < 0.001) and level (p < 0.01) were significantly higher. Though the value of HBcAb was overall significantly lower (p < 0.001) within the realm of rheumatic diseases, patients with ankylosing spondylitis (AS) demonstrated a significantly higher value than other rheumatic diseases. We saw significantly fewer HBV infections in HLA-B27 positive subjects than in the negative ones (p < 0.001).ConclusionIn this propensity score-matched study, rheumatic patients had an advantage in HBV control. In rheumatic patients, HBcAb levels, together with the beneficial role of HLA-B27, were highlighted.

Enduring Challenges despite Progress in Preventing Mother-to-Child Transmission of Hepatitis B Virus in Angola.

Sub-Saharan Africa has one of the highest rates of hepatitis B virus (HBV) infection globally, with an incidence of 1.5 million and 0.8 million yearly deaths, which drives synergistic efforts towards its elimination. To assess the risk of mother-to-child transmission of HBV infection, a cross-sectional study was conducted on 1012 pregnant women in Angola to investigate HBV serological and molecular profiles. The prevalence of HBV was 8.7% (n = 88), with hepatitis B core IgM antibody (anti-HBc IgM) positivity identified in 12.8%, hepatitis B “e” antigen (HBeAg) positivity in 30%, and HBV DNA ≥ 200,000 IU/mL in 28.2%. Family tracking studied 44 children, of which 11 (25%) received at least two doses of the hepatitis B vaccine. HBV was detected in 10/44 (22.7%) children, with vaccination reported in one infected child. Further testing identified anti-HBc IgM positivity in 3/10 (30%), HBeAg positivity in 55%, and both seromarkers in 20%. The results revealed the importance of antenatal HBV screening, antiviral prophylaxis for mothers with high viral loads or HBeAg positivity, and timely first-dose hepatitis B vaccines in newborns. Anti-HBc IgM positivity among pregnant women and children highlights prophylactic measures worth considering, including antenatal hepatitis B vaccination and catch-up vaccination to young children.

Ways to promote screening for hepatitis B virus and accelerated vaccination schedule in prison: Training, information, peer education

The World Health Organization has suggested prioritizing preventive measures for communicable diseases, including the hepatitis B virus (HBV) infection. To reduce inequalities in health, we have conducted a study on the impact of HBV in prisons located in the region of Tuscany by recording the results of serum screening in clinical medical records, the objective being to increase anti-HBV vaccination in subjects susceptible to infection by means of an accelerated schedule. To further advance disease prevention, we conducted health promotion and education activities prior to a screening/vaccination program in Tuscany prisons; both staff working in the prisons and the prisoners themselves were actively involved. The study started on 11 April 2016 and ended on 10 October 2017. In this paper, we report on the interventions carried out beforehand, such as training, information, and peer education. In addition to information, in a previous study on the overall rate of inmate screening and vaccination, this article incorporates supplemental analysis to differentiate the rate of screening and vaccination among inmates previously present in this setting and those having recently arrived. For health staff, six courses were conducted on Continuing Education in Medicine. A total of 138 inmates of the main nationalities present were selected by justice, health and education staff as peer educators. Out of the 15 prisons participating in the screening and vaccination program, courses for prisoners were conducted in 10 prisons by a medical doctor and the International Organization for Migration cultural mediators, taking into account the multi-ethnic origins of the detainee population and applying a peer education approach. All prisoners received an HBV brochure in various languages. HBV screening was performed by the prisons’ sanitary staffs. Out of the 1075 inmates who needed screening, 70.9% of those previously present and 93.6% of the recently arrived agreed to undergo screening for HBV. Out of the 601 prisoners who required vaccination, 85.2% of those previously present and 72% of the recently arrived received the first dose. In conclusion, training, information, and a peer education approach could explain a high rate of adherence to a screening and vaccination program.

Expanded screening for chronic hepatitis B virus infection in China

Expanded screening for chronic hepatitis B virus infection in China

Cost-effectiveness of universal screening for chronic hepatitis B virus infection in China: an economic evaluation

SummaryBackgroundChina 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.MethodsWe 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.FindingsWith 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.InterpretationThe 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.FundingNational Natural Science Foundation of China.

Construction of Protocol-Based Pharmacotherapy Management (PBPM) Using an Electronic Medical Record Interlocking Support System to Prevent Hepatitis B Virus Reactivation Induced by Cancer Chemotherapy

Patients with overt or resolved hepatitis B virus (HBV) infection undergoing immunosuppressive therapy or chemotherapy for malignant diseases should be screened and monitored for their viral status under the Japan Society of Hepatology Guidelines for the Management of Hepatitis B Virus Infection to prevent the reactivation of HBV. To complete these recommendations, we have adopted a protocol-based pharmacotherapy management for HBV (PBPM-HBV) that allows pharmacists to order additional complementary blood tests on behalf of doctors in our hospital. We also constructed a support system that automatically detects and reports the cases with insufficient examinations by scanning the information of all the chemotherapy patients. By introducing PBPM-HBV, the screening implementation rate was improved significantly from 29.0％ to 81.8％ (P < 0.001). Also, by utilizing this support system, we were able to achieve remarkable labor and time savings compared to the conventional manual process of checking examination results by opening each electronic medical record. The average time taken to complete the checking process for each patient before and after the introduction of the support system was 1.93 minutes (n = 100) and 0.55 minutes (n = 300), respectively. By utilizing this support system, operating efficiency has been remarkably improved and appropriate HBV screening and monitoring for all cancer chemotherapy patients has become possible regardless of injection or oral administration of the drugs. PBPM-HBV using this support system is considered to be a good example of minimizing the increase in the workload of pharmacists as a result of task shifting from doctors.

Hepatitis B virus reactivation in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by proliferative synovitis, which can cause cartilage and bone damage as well as functional limitations. Disease-modifying anti-rheumatic drugs have significantly improved the prognosis of RA patients. However, people with RA, when combined with hepatitis B virus (HBV) infection, may experience reactivation of HBV during treatment with anti-rheumatic drugs. The outcome of HBV reactivation (HBVr) varies from liver inflammation to liver failure, while insufficient HBV screening in RA patients has been reported in various countries. Therefore, it is necessary to identify patients at high risk before starting immunosuppressive therapy. The immune response plays an important role in anti-HBV infection. However, most anti-rheumatic drugs exert an inhibitory effect on the body’s immune system, resulting in HBVr. Therefore, it is necessary to conduct a comprehensive evaluation based on host factors, viral factors, and drug factors. In this paper, we summarize the mechanism of HBVr, the risk of HBVr caused by anti-rheumatic drugs, and the appropriate diagnosis and treatment process for RA patients so that clinicians can have a more comprehensive understanding of HBVr in RA patients.

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 of Occult Hepatitis B Virus Infection in Blood Donors with Negative ID-NAT in Switzerland

Introduction: Screening of hepatitis B surface antigen (HBsAg) and individual-donation nucleic acid amplification testing (ID-NAT) of blood donors have become standard to detect hepatitis B virus (HBV) infection. However, there is still a residual risk of HBV transmission by blood components of donors suffering from occult HBV infection (OBI). Therefore, many countries implemented universal testing of anti-HBV core antigen (anti-HBc) antibodies in order to increase blood safety. In Switzerland, anti-HBc testing is not part of the routine blood donor-screening repertoire. Therefore, we sought to assess prevalence of donors with OBI in a Swiss blood donor collective. Methods: Blood donations were prospectively investigated for the presence of anti-HBc antibodies during two time periods (I: all donors, March 2017; II: first-time donors only, April 2017 until February 2018). Anti-HBc-positive findings were confirmed by an anti-HBc neutralization test. Discarded plasma samples of anti-HBc-confirmed positive donors were ultracentrifuged and subsequently retested by regular HBV-ID-NAT to search for traces of HBV. Results: During time period I, 78 (1.6%) individuals out of 4,923 donors were confirmed anti-HBc-positive. Sixty-nine (88%) anti-HBc-positive samples were available and processed by ultracentrifugation followed by repeat HBV-ID-NAT. Four samples (5.8%) were found positive for HBV DNA. Sixty-five (94.2%) samples remained HBV NAT-negative upon ultracentrifugation. During time period II, 56 (0.9%) donor samples out of 6,509 exhibited anti-HBc-confirmed positive. Fifty-five (98%) samples could be reassessed by HBV-ID-NAT upon ultracentrifugation. Three (5.5%) samples contained HBV DNA and 52 (94.5%) samples remained HBV NAT-negative. Conclusion: Overall, we detected 7 viremic OBI carriers among 11,432 blood donors, which tested negative for HBV by standard HBV-ID-NAT and HBsAg screening. In contrast, OBI carriers showed positive anti-HBc findings which could be confirmed in 83.8% of the cases. Thus, OBI might be missed by the current HBV screening process of Swiss blood donors. We suggest to review current HBV screening algorithm. Extended donor screening by anti-HBc testing may unmask OBI carriers and contribute to blood safety for the recipient of blood products.

Prevalence of Hepatitis B Virus (HBV) among Antenatal Clinic Attendees in Karu Local Government Area, Nasarawa State, Nigeria

The aim of this research was to determine the prevalence of Hepatitis B virus (HBsAg) among antenatal clinic attendees in Massaka, Karu Local Government Area of Nassarawa State, North Central Nigeria. Formal consent was obtained from the State Hospital Board to carry out the survey. The study which involved 200 pregnant women aged 18-45 years randomly selected using a systematic random sampling technique was conducted between the months of May-June was a cross sectional health facility-based study. Structured questionnaire was used to generate data from respondents, after which blood samples aseptically collected were screened for hepatitis B surface antigen. Socio-demographic characteristics as well as some of the factors that influence infection were evaluated. Results obtained from the study revealed a 6.5% prevalence rate of infection in the studied population. Prevalence of infection among the subjects within the age range of 35-45 years was lowest (5.8%). However, while it was 5.2% for the married, it was 6.6% for the unmarried. Prevalence of infection was higher among the category with no formal education. Similarly, prevalence was higher among the rural dwellers (6.8%) than their urban counterparts (5.6%). Factors examined were not statistically significant predisposing to HBV infection. In conclusion, the prevalence of HBsAg among ante-natal clinic attendees in Masaka was (6.5%) lower than the reported national prevalence (14.1%). Owing the outcome of this study, it is recommended that improved surveillance for HBV infection and screening of women attending ANC be instituted.

Hepatitis B virus prevalence, immunization and immune response in people living with HIV/AIDS in Istanbul, Turkey: a 21-year data analysis.

We aimed to determine Hepatitis B virus (HBV) prevalence, immune status, and the prevalence of antibody response in people living with HIV/AIDS (PLWHA) in Istanbul, Turkey. The study includes PLWHA aged 18 years and older who were followed-up for at least 6 months from 1997 to 2018. Of the 653 patients with PLWHA, 99 (15.2%) were both antiHBc-IgG and antiHBs positive, 120 (18.3%) were antiHBc-IgG positive/antiHBs negative. HBsAg was positive in 40 (6.1%) patients. HBsAg positive coinfection (≤40 years 4.6% vs. >40 years 21.7%, p<0.001) and antiHBc-IgG positivity/antiHBs negativity (≤40 years 14.0% vs. >40 years 26.5, p<0.001) were higher in PLWHA older than 40 years. The prevalence of HIV/HBV coinfection reached a peak level of 22.2% in 2004, and it decreased to 3.3% in 2018. The prevalence of immunization before HIV diagnosis was low (15.6%). The prevalence of antibody response (anti-HBs>10 IU/L) after immunization for HBV was 50%. A higher protective response was associated with CD4+≥350 cell/mm3 (59.3%, p=0.014). HBV coexistence in PLWHA remains an imperatively important problem. The most conclusive methods in solving this problem are to prevent transmission by immunization and control measures. Also, HBV screening should in no manner be neglected in PLWHA.

The compliance of our practice of hepatitis B virus screening with the current guidelines in patients undergoing chemotherapy for hematological malignancies

Background/Aim: The reactivation of Hepatitis B virus (HBV) among cancer patients is a critical issue which is preventable by precise detection of risky cases prior to the administration of chemotherapy drugs. This study aimed to investigate whether the evaluated serological tests for HBV screening before chemotherapy in adults with newly diagnosed hematological malignancies follow the guidelines. Methods: In this retrospective cohort study, all patients with hematological malignancies who visited our hematology clinic between January 01, 2018-January 01, 2020, were examined and adult patients referred to the outpatient clinic for combined chemotherapy were included. All clinical data and laboratory results were obtained from the electronic hospital information system. Serological tests performed for HBV screening and their results were noted. The compliance of our clinical practice with the current guidelines was analyzed assuming that there are three mandatory serological tests for screening, HBsAg, anti-HBs and anti-HBc, recommended in the guidelines. Results: A total of 91 newly diagnosed cases were included for analysis. HBV screening completely lacked in 10% of the patients and it did not follow the current guidelines in 30%. The most neglected serological test was anti-HBc. Regarding different hematological malignancies, the results were best in lymphoma patients (76% compliance with guidelines) and worst in MM (only 40% compliance with guidelines). The serological test results of eighty-two cases were also examined and the seropositivity rates for HBsAg and anti-HBc were 2%, and 41%, respectively. Conclusion: We observed that the risk of reactivation was not adequately evaluated by serological screenings for HBV in adult patients receiving chemotherapy for hematological malignancy. To protect patients from this mostly preventable complication, it is necessary to increase the awareness on the subject and encourage more compliance with the related guidelines.

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria.

BackgroundNigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria.MethodsFour electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg.ResultsFrom the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant.ConclusionsThere is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

The global health challenge posed by hepatitis B virus (HBV) and hepatitis C virus (HCV) persists, especially in low-and-middle-income countries (LMICs), where underdiagnosis of these viral infections remains a barrier to the elimination target of 2030. HBV and HCV infections are responsible for most liver-related mortality worldwide. Infected individuals are often unaware of their condition and as a result, continue to transmit these viruses. Although conventional diagnostic tests exist, in LMIC they are largely inaccessible due to high costs or a lack of trained personnel, resulting in poor linkage to care and increased infections. Timely and accurate diagnosis is needed to achieve elimination of hepatitis B and C by the year 2030 as set out by the World Health Organization Global Health Sector Strategy. In this review rapid diagnostic tests allowing for quick and cost-effective screening and diagnosis of HBV and HCV, are discussed, as are their features, including suitability, reliability, and applicability in LMIC, particularly those within Africa.

Prevalence of Overt and Occult Hepatitis B Virus Infection among HIV-Positive People Referring to Consultation Center for Behavioral Diseases, Kurdistan Province, Iran

Based on evidence, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) have common transmission routes; co-infection of HBV/HIV can dramatically increase disease progression. The present study aimed to determine the prevalence of overt HBV infection and occult hepatitis B virus infection (OBI) in HIV-positive people. In this descriptive study, whole blood samples were collected from 184 HIV-positive subjects referring to the Consultation Center for Behavioral Diseases, Sanandaj, Iran, during 2014 to 2016. ELISA was used for the determination of HBV serologic markers (hepatitis B surface antigen [HBsAg] and antibodies to hepatitis B virus core antigen [anti-HBc]). To evaluate OBI, DNA was extracted only from HBsAg-negative and anti-HBc-positive samples and tested for HBV DNA by real-time PCR. Test results and patients’ data were analyzed by SPSS software. The mean age of the study population was 39.2 ± 9.4 (SD) years, of whom 140 (76%) were male. Overall, 43 (23.3%) samples were positive for HBsAg (overt HBV infection), and 50 (27.2%) for anti-HBc. Among 31 HBsAg-negative and anti-HBc-positive samples (suspected OBI), one (3.2%) sample was positive for HBV DNA (verified seropositive OBI). HBV infection was higher among males (n = 37; 86.05%), jobless people (n = 23; 53.49%), and those with an injection HIV transmission route (n = 32; 74.43%). We observed a high prevalence of overt HBV and one OBI among the study population. A serologic marker such as anti-HBc indicates resolved or past HBV infection. Molecular screening for HBV is valuable for the management of HIV-infected people.

Assessment of Hepatitis B Virus Screening Behaviors among Asian-Americans through the Lens of Social Cognitive Theory.

Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions. Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted. About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening. HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors.

Kidney transplant from donors with hepatitis B: A challenging treatment option.

Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation. However, the risk of hepatitis B virus (HBV) transmission remains a challenge that undermines the chance of organs being used. This is particularly true with hepatitis B surface antigen (HBsAg) positive donors despite the comparable long-term outcomes when compared with standard donors. To reduce the risk of HBV transmission, a comprehensive approach is needed. This includes assessment of donor risk, optimal allocation to the proper recipient, appropriate immunosuppressive regimen, optimizing the prophylactic therapy, and post-transplant monitoring. This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment. The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening, optimal recipient selection, importance of hepatitis B immunity, role of nucleos(t)ide analogues, and hepatitis B immunoglobulin. A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.

A novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain

Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the WHO elimination targets. The Hepatitis B Virus Community Screening and Vaccination in Africans (HBV-COMSAVA) study aims to use point-of-care testing and simplified diagnostic tools to identify, link to care, or vaccinate African migrants in Barcelona during the COVID-19 pandemic. From 21/11/20 to 03/07/2021, 314 study participants were offered HBV screening in a community clinic. Rapid tests for HBsAg screening were used and blood samples were collected with plasma separation cards. Patients received results and were offered: linkage to specialist care; post-test counselling; or HBV vaccination in situ. Sociodemographic and clinical history were collected and descriptive statistics were utilized. 274 patients were included and 210 (76.6%) returned to receive results. The HBsAg prevalence was 9.9% and 33.2% of people had evidence of past resolved infection. Overall, 133 required vaccination, followed by post-test counselling (n = 114), and linkage to a specialist (n = 27). Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools, HBV-COMSAVA demonstrated that it was possible to diagnose, link to care, and vaccinate African migrants in community-based settings.

Antenatal hepatitis B screening in Nigeria: A comparative analysis with syphilis and HIV.

Nigeria has adopted routine screening of pregnant women for hepatitis B virus (HBV) as part of the interventions to eliminate its vertical transmission. However, there is a dearth of evidence on the coverage of routine antenatal HBV screening as recommended in the national guidelines. This study examined the antenatal HBV screening rate and the positivity rate compared with syphilis and HIV. We conducted a descriptive analysis of the 2019 national HIV/AIDS health sector data. The study included approximately 2.8 million pregnant women who received antenatal care (ANC) in over 6000 health facilities providing prevention of mother-to-child transmission of HIV services in Nigeria. Of the ANC clients, 0.2 million (7.2%) were screened for HBV. At the zonal level, the South West had the highest HBV screening rate (19%), while the lowest rate was in the North East (2.5%). The percentage of pregnant women screened for HBV was lower than those screened for syphilis (16.3%) and HIV (90.3%). Among those screened for HBV, the positivity rate was 5%. The HBV positivity rate ranged from 8.5% in the North Central zone to 1.3% in the South East zone. The positivity rates for syphilis and HIV were 0.4% and 0.5%, respectively. Our results indicate a low antenatal HBV screening rate and a wide disparity compared with HIV and syphilis. This finding highlights the need to understand and address the barriers affecting routine antenatal HBV screening and to strengthen the integration of HBV services into the HIV program in Nigeria.