Conference Proceeding

Prevalence and factors associated with hepatitis B and C infection in persons living with HIV enrolled in care in Rwanda

Dr. Justine Umutesi,
University of Rwanda, Rwanda

Ms. Justine Umutesi is presently pursuing her Masters in field of Epidemiology and Laboratory Management at University of Rwanda. She completed her Bachelor’s Degree in Public Health at Saint Josephs University. She has membership in many professional bodies such as Member of Association of Nurses in AIDS care, Akron/Ohio. Member and secretary of Alumni Network of Field Epidemiologist of Rwanda. Her key qualifications are Field epidemiologist, Academic degree in public health, Academic Degree in Mid-Wifely etc.

Background: Hepatitis B (HBV) and C (HCV) are important causes of morbidity and mortality in people living with human immunodeficiency virus (PLHIV). However the burden of these co-infections in Rwanda is still unclear. We estimated the prevalence of the hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCVAb) among PLHIV in Rwanda and identified factors associated with infection.
Methods: Between January 2016 and June 2016, systematic screening for HBsAg and HCVAb was performed in PLHIV enrolled at public and private HIV facilities across Rwanda; 117,258 individuals were reached, 65% of total PLHIV enrolled to care. Results were analyzed to determine marker prevalence overall and by demographic factors. Multivariate logistic regression models were performed, applying survey weighting to ensure representative estimates. Odds ratios (ORs) were used as the measure of association and were considered significant at p<0.05.
Results: Overall, the prevalence of HBsAg and HCVAb was 4.3% (95%CI 4.2-4.4) and 4.6% (95%CI 4.5-4.7) respectively; 182 (0.2%) HIV+ individuals were co-infected with HBsAg and HCVAb. Prevalence was higher in males (HBsAg, 5.4% [5.1-5.6] vs. 3.7% [3.5-3.8]; HCVAb, 5.0% [4.8-5.2] vs. 4.4% [4.3-4.6]) and increased with age; HCVAb prevalence was dramatically higher in people aged ≥65 years (17.8% [16.4-19.2]). In multivariate analysis, male gender (1.47 [1.20-1.80]) was associated with HBsAg positivity; being <15 years was protective against HBsAg (0.42 [0.23-0.75], ref. age 35-44). For HCVAb, older age was associated with positivity (age 45-54, 1.25 [1.01-1.54]; age 55-64, 2.46 [1.96-3.10]; age ≥65, 5.49 [3.85-7.83]) and younger age was protective (age <15, 0.39 [0.23-0.67]; age 15-24, 0.46 [0.26-0.81]). Compared with living in Kigali, living in the Western province was associated with lower odds of HCVAb (0.77 [0.60-1.00]).
Conclusion: HBV and HCV co-infections are common in PLHIV in Rwanda. It is important that viral hepatitis prevention and treatment activities are scaled-up to control further transmission and reduce the burden in PLHIV. Special efforts should be made to conduct targeted screening of males and the older population. Further assessment is required to determine rates of HBV and HCV chronicity among PLHIV and to outline strategies to link individuals to care.

Published: 05 May 2017