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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

Outline

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✓ Viral hepatitis program structure in Rwanda

✓ Background

✓ Methodology

✓ Results for WHD 2017

✓ Conclusion

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

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

VH response has been a result of strong partnerships

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Civil Society

MoH RBC

Other Partners

Referral Hospitals

Private Sector

TWG

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)

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%

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

WHD 2016 at Car Free zone, Kigali, 2016

photo, new times, 16

WHD campaign at Muhanga , 2017

Free Hep B&C screening

WHD Campaign, 2017

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

Proportion Screening Positive for HBsAg and HCVAb from Rwanda 2016-2017 Campaigns

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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+

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

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

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.

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?