prevalence of hbv and hcv infections ... - virology...
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Prevalence of HBV and HCV infections in screened people in Rwanda during WHD 2017 campaign
By MAKUZA Jean Damascene, MD, MSc.
Rwanda Biomedical Center
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Outline
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✓ Viral hepatitis program structure in Rwanda
✓ Background
✓ Methodology
✓ Results for WHD 2017
✓ Conclusion
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Viral Hepatitis Program Structure in Rwanda
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RBC
IHDPC
HIV, AIDS, STIs &OBBI Division
HIV Prevention Unit
HIV C&T Unit
EpidemiologicalSurveillance and
Research UnitOBBI&STIs Unit
TB Division ...
BIOS
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2011• Hepatitis unit created
within RBC
• National TWG created• Viral load testing
introduced in 1st facility
2012
2013• Guidelines for prevention and
treatment• ROFAH created• Screening introduced at 2 facilities• Treatment available at 4 referral
centers
• Guidelines updated• National Policy adopted• NOP developed • HCWs trainings• Media coverage WHD activities• Price negotiations with pharmaceutical
companies• Limited coverage of treatment by health
insurances• First patient’s treated with SOF/Ribavirin
2015
2016• Sensitizing high risk groups• Screening of ~117,000
PLHIV• ELISA used at 13 sites• 1st patients treated with
SOF/LDV • Standardized patient file
introduced
2017-2018• Campaigns: ~438k
people screened and ~427k vaccinated
• Screening: remaining ~26k PLHIV and high risk population like prisoners, FSW and MSM
• 1st patients treated with SOF/DCV
• 8505 patients treated (SOF/LDV &SOF/DCV)
Screening Site at Muhanga, Southern Province, June 2017 4
Milestones in Viral Hepatitis Program
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VH response has been a result of strong partnerships
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Civil Society
MoH RBC
Other Partners
Referral Hospitals
Private Sector
TWG
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HBVAg Prevalence Estimates in different groups
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a. General population not well known
b. From Rwanda Blood Transfusion
Center 1.9-3.2% (2000-2012)
c. Pregnant women in sentinel sites 3.5%
(2011)
d. HCWs at CHUB 2.9% (2015)
e. HIV-positive : 4.3% (2017)
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HCV Prevalence Estimates in different groups
General population
Not known
Rwanda Blood Transfusion Center
0.8-3.2%
(2000-2012)
Pregnant women in sentinel sites
2.6%
(2011)
PLWHIV
4.7%
(2017)
01 02 03 04
WHO estimates . Prevalence for hepatitis in Rwanda= 4%
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Methodology
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✓ Screening targeted individuals:
✓ aged >45 years in lower socio-economic groups
✓ FSWs
✓ Diabetics
✓ HCWS
✓ Sensitization done through multimedia announcements and local church leaders
✓ Healthcare workers introduced and trained in VH screening, diagnosis and patient
counseling
✓ Sample testing for HBV & HCV using Murex Elisa (Spe:100%, Se: 99.9%)
✓ Bivariate and multivariate logistic regressions used to assess factors associated
with HBSAg and HCVAb positivity
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WHD 2016 at Car Free zone, Kigali, 2016
photo, new times, 16
WHD campaign at Muhanga , 2017
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Free Hep B&C screening
WHD Campaign, 2017
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World Hepatitis Day (WHD) Campaign, 2017 Results
✓ Started from June 2017
✓ Covered 30 districts
✓ Screened population for HBV & HCV : 126,215
✓ HCV antibody positive: 11,006(8.86%)
✓ PCR for HCVAb +: 48.2% HCV VL were detectable
✓ Positivity were increased with age at both HCV antigen
and HCV VL
✓ HBs antigen positive: 4,923
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Proportion Screening Positive for HBsAg and HCVAb from Rwanda 2016-2017 Campaigns
12
3,9
4,54,2
3,1
8,9
6,5
4,7 4,6
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
9,0
10,0
General Population (N=124214) Prisoners (N=52082) PLHIV (N=135895) Female Sex Workers (N=3660)
%P
osi
tive
Population Group
% HBsAg+ % HCVAb+
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HBV Antigen and HCV Antibody Positivity by Age Group(N=126215)
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3.5
5.1 5.3
43.3
2.2 2.3
3.3
4.8
16.5
0
2
4
6
8
10
12
14
16
18
<25 25-34 35-44 45-54 >55
%Sc
ree
ned
Age group(yrs)
HBV %Positive HCV %Positive
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HBV Antigen and HCV Antibody Positivity by District Screened
% HBV Ag Positive % Anti-HCV Positive
*Sample size=126215 of general population screened at 1-2 screening site per district in the 2017 campaign
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Conclusion
✓ Results from the campaign serve as preliminary evidence
for variations in prevalence across different populations.
✓ Rwanda’s experience serves as important evidence for
other low and middle-income countries.
✓ campaign results will be used to plan national services for
future integration and decentralization of screening into
routine care at lower-level health centers.
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Acknowledgment
✓ RBC staff especially HIV Division for their support
✓ Partners organizations which supported this activity
✓ Healthcare Workers who supported the collection of
samples and information needed
✓ Patients who participated in screening campaign
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ANY QUESTIONS?