Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa

For the IeDEA collaboration

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Background: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. Methods: A medical chart review was conducted in large urban HIV treatment centers in Côte d'Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. Results: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4-14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p<0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p=0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02-4.79) had a confirmed HCV infection. Conclusions: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.

Original languageEnglish (US)
Article number706
JournalBMC Infectious Diseases
Volume17
DOIs
StatePublished - Nov 1 2017

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Africa South of the Sahara
Practice Management
Hepatitis B virus
HIV
Surface Antigens
Virus Diseases
Therapeutics
Tenofovir
Kenya
South Africa
Togo
Confidence Intervals
Burkina Faso
Benin
Zambia
Senegal
Cameroon
Hepatitis C Antibodies
Uganda
Hepatitis B Surface Antigens

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa. / For the IeDEA collaboration.

In: BMC Infectious Diseases, Vol. 17, 706, 01.11.2017.

Research output: Contribution to journalReview article

@article{80944bbdf71a4990bfc1a90a6847c0ee,
title = "Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa",
abstract = "Background: Approximately 8{\%} of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. Methods: A medical chart review was conducted in large urban HIV treatment centers in C{\^o}te d'Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. Results: Overall, 3579 charts of patients initiating ART (64.4{\%} female, median age 37years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8{\%} in 2010 to 24.4{\%} in 2012 overall, and ranged from 0.7{\%} in Kenya to 96{\%} in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6{\%}; 95{\%} confidence interval [CI] 9.4-14.1) were HBV-infected, of whom 71 (80.7{\%}) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7{\%} vs. 40.3{\%}, p<0.001). The proportion of patients on TDF-containing ART increased from 57.9{\%} in 2010 to 90.2{\%} in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p=0.01). Only 114 (5.0{\%}) patients were screened for anti-HCV antibodies and one of them (0.9{\%}, 95{\%} CI 0.02-4.79) had a confirmed HCV infection. Conclusions: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90{\%} of HIV/HBV-coinfected patients receiving this drug in 2012.",
author = "{For the IeDEA collaboration} and Coffie, {Patrick A.} and Matthias Egger and Vinikoor, {Michael J.} and Marcel Zannou and Lameck Diero and Akouda Patassi and Kuniholm, {Mark H.} and Moussa Seydi and Guillaume Bado and Ponsiano Ocama and Andersson, {Monique I.} and Eug{\`e}ne Messou and Albert Minga and Philippa Easterbrook and Kathryn Anastos and Fran{\cc}ois Dabis and Gilles Wandeler",
year = "2017",
month = "11",
day = "1",
doi = "10.1186/s12879-017-2768-z",
language = "English (US)",
volume = "17",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa

AU - For the IeDEA collaboration

AU - Coffie, Patrick A.

AU - Egger, Matthias

AU - Vinikoor, Michael J.

AU - Zannou, Marcel

AU - Diero, Lameck

AU - Patassi, Akouda

AU - Kuniholm, Mark H.

AU - Seydi, Moussa

AU - Bado, Guillaume

AU - Ocama, Ponsiano

AU - Andersson, Monique I.

AU - Messou, Eugène

AU - Minga, Albert

AU - Easterbrook, Philippa

AU - Anastos, Kathryn

AU - Dabis, François

AU - Wandeler, Gilles

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. Methods: A medical chart review was conducted in large urban HIV treatment centers in Côte d'Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. Results: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4-14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p<0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p=0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02-4.79) had a confirmed HCV infection. Conclusions: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.

AB - Background: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. Methods: A medical chart review was conducted in large urban HIV treatment centers in Côte d'Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. Results: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4-14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p<0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p=0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02-4.79) had a confirmed HCV infection. Conclusions: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.

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U2 - 10.1186/s12879-017-2768-z

DO - 10.1186/s12879-017-2768-z

M3 - Review article

C2 - 29143625

AN - SCOPUS:85017497619

VL - 17

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

M1 - 706

ER -