• Communicable Disease Control
• Epidemiology
• Public Health

• Swiss Agency for Development and Cooperation
• EU Horizon 2020 MSCA grant through SSPH+ GlobalP3HS
• World Diabetes Foundation
• Swiss National Science Foundation

• Chronic
• Emigrants and immigrants
• Hepatitis B
• Public health
• Virus

• Senegal
• chronic hepatitis B virus (HBV) infection
• linkage to care

• Humans
• Senegal/epidemiology
• Female
• Male
• Rural Population
• Adult
• Middle Aged
• Hepatitis B/diagnosis
• Hepatitis B/epidemiology
• Mass Screening/methods
• Young Adult
• Aged
• Adolescent
• Cohort Studies
• Hepatitis B virus/genetics
• Hepatitis B virus/isolation & purification

• Agence Nationale de la Recherche
• Excellence Initiative of Aix-Marseille University - A*MIDEX
• Agence Nationale de Recherches sur le Sida et les Hépatites Virales

• ALP, alkaline phosphatase
• ALT, alanine transaminase
• APRI, AST-to-platelet ratio index
• AST, aspartate aminotransferase
• Africa
• Diagnosis
• GGT, gamma-glutamyl transferase
• HBsAg, hepatitis B surface antigen
• HCC, hepatocellular carcinoma
• Hepatitis B
• LSM, liver stiffness measurement
• POC, point of care
• PROLIFICA, Prevention of Liver Fibrosis and Cancer in Africa
• Screening
• TDF, tenofovir disoproxil fumarate
• Treatment
• WHO, World Health Organization
• aOR, adjusted odds ratio
• cOR, crude odds ratio
• eGFR, estimated glomerular filtration rate
• qPCR, quantitative polymerase chain reaction
• sSA, sub-Saharan Africa

• 001 World Health Organization
• MR/R015600/1 Medical Research Council

• hepatitis b
• treatment eligibility
• guideline adherence
• antiviral therapy
• public health
• brazil

• Antiviral Agents/therapeutic use
• Brazil
• DNA, Viral
• Hepatitis B e Antigens/therapeutic use
• Hepatitis B virus
• Hepatitis B, Chronic/drug therapy
• Humans
• Public Health

• Adolescent
• Adult
• Condoms
• Cross-Sectional Studies
• Female
• Geography
• Hepatitis B/epidemiology
• Hepatitis C/epidemiology
• Humans
• Middle Aged
• Prevalence
• Sex Workers/statistics & numerical data
• Sexual Behavior
• Togo

• CARESP
• National AIDS and STI control program (Togo)

• chronic hepatitis B
• diagnostic score
• low and middle income countries
• therapy
• validation study

• Hepatitis B/diagnosis
• Hepatitis B/drug therapy
• Hepatitis B e Antigens
• Humans

• R01 AI147727 NIAID NIH HHS
• National Institute of Allergy and Infectious Diseases
• National Institutes of Health

Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited.

We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization’s 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis.

163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1–85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9–63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] were independent predictors of cirrhosis.

Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.

• Cirrhosis
• HBV
• Liver fibrosis
• Resource-limited settings
• Sierra Leone

• Chronic hepatitis B
• Liver fibrosis
• Renal impairment
• Tenofovir Disoproxil fumarate (TDF) therapy
• eGFR

Only a fraction of the estimated tenth or so of Senegalese who are chronically infected with hepatitis B virus (HBV) have been diagnosed. Of these, few have been assessed for their risk of progressing to potentially fatal liver disease (indicating need for treatment), and fewer still are taking antiviral drugs. A massive gap between those needing and getting treatment is widely acknowledged among experts. But given that HBV and its biomedical treatment options are largely invisible in bodies, health data, care practices, public messaging, or mass media, how can we observe, ethnographically, the effects of constraints on and inequalities in treatment? What are the stakes of access to drugs, when this access is not being sought out, claimed, or enacted? This article tackles these questions by examining how HBV is being enacted in Senegal, but not necessarily in relation to antiviral treatment. I first describe the emergence, over the past decade and a half, of an exclusionary topography of HBV diagnosis and treatment. I introduce the notion of “filtration” to describe the effects of this topography on the formation of potential “subjects of access.” The diagnostic therapies and expertise required to determine need for treatment are expensive, urban, and largely privatized. Moreover, knowledge about HBV and its possibilities of care circulates in narrow and sparsely distributed channels. Only a tiny minority of persons are effectively “filtered into” care, while issues of access remain largely outside of public debate. I then move onto small-scale efforts, led by rural primary health workers and community associations, to raise awareness of and expand screening for HBV. Those driving information and screening either do not reveal that effective drugs exist or locate these beyond the reach of most of their audiences or patients. Why then do they do it? I examine the logics and effects of their work to identify the forms of inclusion, care, efficacy, and explanation these open up. At the same time, I seek to discern the indirect effects of unequal access to knowledge and resources in the ambivalence, uncertainties, and contradictions that pervade these efforts to inform, diagnose, and advise.

• Hepatitis B
• Senegal
• access to treatment
• ethnography
• inequalities in access to healthcare

• Africa
• Diagnosis
• Hepatitis B
• LAMP
• Sensitivity and specificity

• Hepatitis B virus
• Sub-Saharan Africa
• antiviral treatment
• cirrhosis
• liver fibrosis
• systematic review

• Sub-Saharan Africa
• elimination
• hepatitis B
• treatment

• Africa South of the Sahara/epidemiology
• Hepatitis B/drug therapy
• Hepatitis B/epidemiology
• Hepatitis B Vaccines
• Humans
• Vaccination Coverage

• MR/R011117/1 Medical Research Council

• Adult
• Antiviral Agents/therapeutic use
• DNA, Viral/blood
• Female
• HIV Infections/drug therapy
• Hepatitis B Surface Antigens/blood
• Hepatitis B e Antigens/blood
• Hepatitis B, Chronic/blood
• Hepatitis B, Chronic/diagnosis
• Hepatitis B, Chronic/drug therapy
• Hepatitis B, Chronic/epidemiology
• Humans
• Male
• Patient Selection
• Surveys and Questionnaires
• Zambia/epidemiology

• K01 TW009998 FIC NIH HHS
• Fogarty International Center
• Gilead Sciences

• HIV
• Sub-Saharan Africa
• alcohol
• key populations
• tobacco

• Adolescent
• Adult
• Alcohol Drinking/epidemiology
• Binge Drinking/epidemiology
• Cross-Sectional Studies
• Demography
• Drug Users/psychology
• Drug Users/statistics & numerical data
• Female
• HIV Infections/epidemiology
• Homosexuality, Male/psychology
• Homosexuality, Male/statistics & numerical data
• Humans
• Logistic Models
• Male
• Multivariate Analysis
• Prevalence
• Psychological Distress
• Sex Workers/psychology
• Sex Workers/statistics & numerical data
• Sexual and Gender Minorities/psychology
• Sexual and Gender Minorities/statistics & numerical data
• Tobacco Use/epidemiology
• Togo/epidemiology
• Young Adult

• Togo National HIV/AIDS and STI Control Program
• Centre Africain de Recherche en Epidémiologie et en Santé Publique CARESP

• chronic hepatitis b infection
• hiv/aids
• pre-exposure prophylaxis
• tenofovir

• Africa
• Diagnostic score
• Elimination
• Hepatitis B
• Patient care management
• Sensitivity and specificity
• Validation studies

• Adult
• Alanine Transaminase/blood
• Female
• Hepatitis B e Antigens/blood
• Hepatitis B, Chronic/diagnosis
• Hepatitis B, Chronic/drug therapy
• Humans
• Logistic Models
• Male
• Middle Aged
• Patient Selection
• World Health Organization

• MC_UP_A900_1119 Medical Research Council
• MC_UP_A900_1120 Medical Research Council
• MR/L002086/1 Medical Research Council
• MR/R011117/1 Medical Research Council
• 001 World Health Organization
• MR/R015600/1 Medical Research Council

To characterize antiviral therapy eligibility among hepatitis B virus (HBV)-infected adults at a university hospital in Zambia.

Hepatitis B surface antigen-positive adults (n = 160) who were HIV-negative and referred to the hospital after a routine or clinically-driven HBV test were enrolled. Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), platelet count, hepatitis B e-antigen, and HBV DNA were measured. Liver fibrosis/cirrhosis was assessed by physical examination, AST-to-platelet ratio index, and transient elastography. In antiviral therapy-naïve individuals, we described HBV stages and antiviral therapy eligibility per World Health Organization (WHO) and by HBV test (routine vs clinical). Elevated ALT was > 19 in women and > 30 U/L in men. Among treatment-experienced individuals, we described medication side effects, adherence, and viral suppression.

The median age was 33 years, 71.9% were men, and 30.9% were diagnosed with HBV through a clinically-driven test with the remainder identified via routine testing (at the blood bank, community events, etc.). Among 120 treatment-naïve individuals, 2.5% were categorized as immune tolerant, 11.7% were immune active, 35.6% were inactive carriers, and 46.7% had an indeterminate phenotype. Per WHO guidelines, 13 (10.8%) were eligible for immediate antiviral therapy. The odds of eligibility were eight times higher for those diagnosed at clinical vs routine settings (adjusted odds ratio, 8.33; 95%CI: 2.26-29.41). Among 40 treatment-experienced HBV patients, virtually all took tenofovir, and a history of mild side effects was reported in 20%. Though reported adherence was good, 12 of 29 (41.4%) had HBV DNA > 20 IU/mL.

Approximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.

• Hepatitis B virus
• Liver fibrosis
• Treatment
• Tenofovir
• Africa

• R01 AI100748 NIAID NIH HHS
• R01 HD085862 NICHD NIH HHS
• U01 AI069924 NIAID NIH HHS

• Hepatitis B virus
• antiviral therapy
• hepatocellular carcinoma
• liver cirrhosis
• sub-Saharan Africa

• Africa
• HIV
• hepatitis B virus
• hepatitis C virus
• hepatocellular carcinoma