Molecular Epidemiology of Hepatitis B Virus Among HIV Co-Infected and Mono-Infected Cohorts in Northwest Ethiopia

Background Hepatitis B virus (HBV) infection is a particular concern in human immunodeficiency virus (HIV) infected individuals. In Ethiopia, detailed clinical and virological descriptions of HBV prevailing during HIV co-infection and symptomatic liver disease patients are lacking. The aim of this study was to investigate HBV virological characteristics from Ethiopian HBV/HIV co-infected and HBV mono-infected individuals. Methods A total of 4105 sera from HIV positive individuals, liver disease patients, and blood donors were screened serologically for HBV. The overlapping polymerase/surface genome region of HBV from 180 infected individuals was extracted, amplified, and sequenced for genotypic analysis. Results The HBsAg seroprevalence was detected 43% in liver disease patients, 8.4% in blood donors, and 6.7% in HIV/HBV co-infected individuals. The occult HBV prevalence was 3.7% in HIV/HBV co-infected individuals and 2.8% in blood donors with an overall prevalence rate of 3.4%. A phylogenetic analysis showed three HBV genotypes; A (61.1%), D (38.3%) and E (0.6%). Genotype A belongs to subtypes A1 (99.1%) and A9 (0.9%), but genotype D showed heterogeneous subtypes; D2 (63.8%) followed by D4 (21.7%), D1 (8.7%), D3 (4.3%), and D10 (1.4%). Conclusions The HIV/HBV co-infected individuals and blood donors showed lower HBsAg seroprevalence compared to liver diseases patients. Occult HBV prevalence showed no difference between HIV/HBV co-infected and blood donor groups. This study demonstrated predominance distribution of HBV subtypes A1 and D2 in northwest Ethiopia. The observed virological characteristics could contribute for evidence-based management of viral hepatitis in Ethiopia where antiretroviral therapy guidelines do not cater for viral hepatitis screening during HIV co-infection.

Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis

OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: “hepatitis B” AND (“informal recycling” OR “waste picker” OR “recyclable waste collectors” OR “solid waste segregator”) AND (“recyclable waste” OR “solid waste”) AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%–22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

Prevalence of Hepatitis B Serum Markers in Young Military Recruits in Greece: A Comparison Study between 2005 and 2019 Cohorts

Background: The prevalence of hepatitis B (HBV) varies among countries. Although an overall reduction has been described in Greece, data are limited. Methods: We reviewed the HBsAg/anti-HBc/anti-HBs seroprevalence among military recruits and compared data between 2005 and 2019. The study included 2001 (group 1) and 1629 (group 2) male recruits in 2019 and 2005, respectively. Age and descent were recorded. Results: The prevalence of HBsAg, anti-HBc and anti-HBs positivity in group1 vs. group 2 was estimated as: 0.2%, 1.3% and 67% vs. 0.4%, 1.6% and 62%, respectively. Only anti-HBs positivity achieved a statistically significant difference between the two groups (p = 0.007). HBsAg and anti-HBc were more frequently positive in non-Greeks than in Greeks (9/237 (4%) vs. 2/3393 (0.06%), p < 0.001), (26/237 (11%) vs. 26/3393 (0.8%), p < 0.001 respectively), while anti-HBs was more frequently positive in Greeks than in non-Greeks (84/164 (51%) vs. 1461/2213 (66%), p < 0.001). Conclusions: Our data suggest a further reduction in HBV prevalence in Greece about 20 years after the adoption of the National HBV Immunization Program, with Greek participants experiencing a more effective HBV Immunization Program than non-Greeks.

916. Finding the Missing Millions and Addressing Health Disparities: Automated Hepatitis B Screening and Linkage to Care

Background Globally, HBV is the most common blood-borne infection. An estimated 1.2 million people in the US and 350 million worldwide lived with HBV, a primary driver of liver cancer. It is endemic in many parts of the world and is a major health disparity in immigrant communities, including the US, which has the largest immigrant population in the world. Asian American Pacific Islanders are 5% of the total population in the US, but represent 50% of people living with HBV. In 2016, WHO set a goal of hepatitis elimination by 2030 but with only 10% of those living with HBV diagnosed, screening must be scaled up. Methods Modifications were made in the electronic medical record (EMR) to automate screening, with HBV (HBsAg) orders triggered by a patient’s country of birth or race. The began in the Emergency Department and later expanded to the Inpatient setting. Automated notifications are sent to nurse for eligible patients and then to the patient navigator (PN) for positive tests. The PN contacts the patient to provide education and arrange linkage-to-care (LTC) for evaluation and care. Results From Mar 2018 to Mar 2021, we conducted 23,883 HBV screenings. The patients originated from 173 countries based on registration; top 5 countries of origin were Haiti, Jamaica, Ecuador, Guyana, and Portugal. We found 228 (1.0%) patients with HBV infection, 101 (47%) were newly diagnosed and 182 (85%) were linked to care. We examined race and insurance status for any association with those previously tested versus newly diagnosed. Blacks were more likely to be newly identified HBV versus Asians (61.6% vs. 28.9%, p&lt; .001), as were self-pay (uninsured) versus insured patients (66.7% vs 47.2%, p=0.043). Compared to the approximately 0.4% HBV prevalence in the US, the HBV prevalence in several towns around our hospital in Essex County is two to four times higher. Table 1. The HBV Prevalence in Towns of Essex County Conclusion Our community is diverse and social determinants of health, like race and insurance status, may contribute to provider behaviors of HBV screening with blacks receiving less screening than Asians. Automated testing programs can address health disparities and scale up screening. Such micro-elimination approaches are important for achieving global hepatitis elimination by 2030. Disclosures Su Wang, MD MPH, Gilead Sciences (Grant/Research Support)Gilead Sciences (Grant/Research Support)

Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020

Background The epidemiology of hepatitis B virus (HBV) in the general population in east Africa is not well documented. In this meta-analysis, we examined 37 full published research articles to synthesise up-to-date data on the prevalence and predictors of the HBV burden for the effective prevention and management of the virus in our region. Methods We examined 37 full published research articles found using PubMed, Scopus, African Journal Online (AJOL), and Google Scholar between May and October 2020. Dichotomous data on HBV prevalence and predictors of infection were extracted from the individual studies. The HBV prevalence, test of proportion, relative risk, and I2 statistics for heterogeneity were calculated using MedCalc software version 19.1.3. Begg’s tests was used to test for publication bias. Sources of heterogeneity were analysed through sensitivity analysis, meta-regression, and sub-group analysis at 95% CI. P < 0.05 was considered significant for all analyses. Results The prevalence of HBV was generally high (6.025%), with publications from Kenya (8.54%), Uganda (8.454%) and those from between 2011 and 2015 (8.759%) reporting the highest prevalence (P < 0.05). Blood transfusion, scarification, promiscuity, HIV seropositivity, and being male were independent predictors significantly associated with HBV infection (P < 0.05), with the male sex being the most strongly associated predictor of HBV infection. Meta-regressions for the pooled HBV prevalence and sample size, as well as the year of publication, lacked statistical significance (P > 0.05). Omitting the study with the largest sample size slightly increased pooled HBV prevalence to 6.149%, suggesting that the studies are robust. Begg’s test showed no evidence of publication bias for overall meta-analysis (p > 0.05). Conclusion The burden of HBV is still high, with the male sex, blood transfusion, body scarification, and HIV seropositivity being potential predictors of infection. Thus, it is important to scale up control and prevention measures targeting persons at high risk.

1439Hepatitis B prevalence in the Indian Subcontinent: a systematic review and meta-analysis

Background Hepatitis B virus (HBV) infections are a major global health burden. Although a vaccine exists for HBV, some developing nations still struggle to reduce prevalence. While the countries within the Indian Subcontinent have vaccination programs, HBV prevalence varies. It is important to identify population groups at risk. Methods Several databases were systematically searched for papers appropriate studies. Studies were included if the sample population lived within one of the selected countries and had no other existing health issues. The studies were assessed for risk of bias, and pooled estimates were created. Subgroups which were assessed included countries, sex, rural and urban populations. Results The pooled prevalence of all studies (N = 56) was 4%. For the countries with multiple included studies, the prevalence for India, Pakistan, Bangladesh and Nepal were calculated as 3%, 6%, 5% and 1% respectively. Most of the studies were assessed as being of reasonable quality. There was a chance that publication bias was present. Conclusions While some of the populations had the expected prevalence for the country in which the study was set, other subpopulations had higher prevalence. The highest HBV prevalence was found in displaced persons and those engaging in risk taking behaviours, however some high prevalence groups did not have a clear reason. Key messages Although HBV prevalence in general is lower at present than in the past, there are still at-risk groups with higher prevalence than the general population.

Prevalence of HBV and HCV among Pregnant Women Attending Kumasi South Hospital (KSH), Ghana

Background and Aim: Both HBV and HCV infections have for decades remained serious public health concerns infecting thousands of people and claiming the lives of millions. The detrimental effects of these viral agents on the gravid women, the infants and the general population are well known and cannot be underestimated. Adequate and quality information on the disease prevalence remain one of the surest ways to tackling the infection head-on. This study therefore assessed the seroprevalence of HBV and HCV among pregnant women who received antenatal care services from the Kumasi South Hospital of the Kumasi Metropolis in the Ashanti Region of Ghana. Materials and Methods: A semi-structured questionnaire designed to capture participant’s demographic and gestational data including age, occupation, marital status, educational status and gestational period was administered by the researcher to 200 pregnant women to collect the data for this study. About 2-3mls of whole blood was drawn into an ethylenediamine tetraacetic acid (EDTA) and tested for HBsAg using Alere Determine HBsAg® test strip (sensitivity=95-100% and specificity=96-100%; Abbott Japan Co., Ltd.) and HCV antibodies using Serodia® HCV (sensitivity=100% and specificity=91.5%; Serodia, Fujirebio Inc., Tokyo, Japan) following standard procedures. Due to the lack of more advanced testing facilities such as PCR, each positive test result was repeated in order to reduce the possibility of false positive results. Data was analyzed using Microsoft Excel 2016 and IBM SPSS vs 25. Chi-square and Fisher’s exact test statistic were used to determine statistical associations between explanatory and outcome variables. Logistics regression was employed to determine potential demographic and gestational risk factors of HBV and HCV infection among the pregnant women. P-value of less than 0.05 was considered statistically significant. Results: Seroprevalence of HBV and HCV infection was 20.0% and 2.5% respectively. HBV infection increased with advancement in age from the least 7.1% among pregnant women aged < 20 years to the highest 22.0% among pregnant women aged 30-39 years until a sharp decline among those forty years and above. HCV prevalence generally declined with increase in age with the highest prevalence (14.3%) recorded among the <20 years old group. Unemployed (22.2%), married (20.3%), basic level educated (20.9%) and multiparous (21.3%) pregnant women recorded the highest HBV prevalence rates whereas unemployed (11.1%), unmarried (5.8%), basic level educated (3.4%) and multiparous (3.2%) pregnant women recorded the highest HCV prevalence rates. None of the demographic or gestational risk parameters was significantly associated with HBV infection in this study (p>0.05) however, age was significantly associated with HCV infection yet posed not significantly high likelihood to HCV infection among the pregnant women. Conclusion: The HBV prevalence as recorded is highly endemic and therefore requires urgent round table discussions to be properly addressed. Despite the low HCV prevalence, the futuristic detrimental effects it may pose to the general wellbeing of the citizenry cannot be in doubt owing to the high prevalence dominating among the younger pregnant women. Measures such as intensified public education coupled with mass screening and vaccination and treatment of HBV seronegative and positive individuals respectively is therefore advised to mitigate further spread of the disease.

Hepatitis B virus infection among men who have sex with men and transgender women living with or at risk for HIV: a cross sectional study in Abuja and Lagos, Nigeria

Background Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. We estimated the prevalence of HBV and associated factors for MSM and TGW living with or without HIV in Nigeria. Methods Since March 2013, TRUST/RV368 has recruited MSM and TGW in Abuja and Lagos, Nigeria using respondent driven sampling. Participants with HIV diagnosis, enrollment as of June 2015, and available plasma were selected for a cross-sectional study and retrospectively tested for hepatitis B surface antigen and HBV DNA. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with prevalent HBV infection. Results A total of 717 MSM and TGW had a median age of 25 years (interquartile range [IQR]: 21–27), 5% self-reported HBV vaccination, 61% were living with HIV, 10% had prevalent HBV infection and 6% were HIV-HBV co-infected. HIV mono-infected as compared to HIV-HBV co-infected had a higher median CD4 T cell count [425 (IQR: 284–541) vs. 345 (IQR: 164–363) cells/mm3, p = 0.03] and a lower median HIV RNA viral load [4.2 (IQR: 2.3–4.9) vs. 4.7 (IQR: 3.9–5.4) log10copies/mL, p < 0.01]. The only factor independently associated with HBV was self-report of condomless sex at last anal intercourse (OR: 2.2, 95% CI: 1.3, 3.6). HIV infection was not independently associated with HBV (OR: 1.0, 95% CI: 0.7–1.6). Conclusion HBV prevalence was moderately high but did not differ by HIV in this cohort of MSM and TGW. Recent condomless sex was associated with elevated HBV risk, reinforcing the need to increase communication and education on condom use among key populations in Nigeria. Evaluating use of concurrent HIV antiretroviral therapy with anti-HBV activity may confirm the attenuated HBV prevalence for those living with HIV.

Vaccination status and Seroprevalence of Hepatitis B surface Antigen among Health Care Workers in Taiz, Yemen Republic

Background: Exposure to Hepatitis B virus (HBV) infection is one of the most common occupational diseases among the providers of the health care services. During the course of their clinical work; Health Care Workers (HCWs) are at risk of acquitting HBV infection or transmitting it to their patients. Vaccination for medical personnel against HBV in Yemen Republic is recommended but not strictly enforced. Detection of the viral hepatitis B surface antigens (HBsAg) is one of the accurate and cheap methods to assess HBV prevalence. This method is used in this study to assess HBV prevalence among HCWs in Taiz; to in order to improve on methods of interventions to control this infection among them. Objectives: The objective of this study was to assess the vaccination status and the seroprevalence of HBsAg among HCWs in Taiz; Yemen republic. Methods: This cross sectional study was conducted through the period between January and March, 2018, and from April and July, 2019, in the part of Taiz City; Yemen Republic belonging to legitimate authorities. 362 HCWs were included in this study and are selected through repeated casual visits to hospitals and medical centers. A questioner was made to get information on the participants’ characteristics and their vaccination status, medical hestory and risk factors for HBV transmission. Five ml venous blood was then collected from every participant to assess HBsAg. Results: the overall vaccination percentage was 21.54% (27.5% in male and 17.9% of female). The seroprevalence of HBsAg was 2.76%, all vaccinated participants were HBsAg negative. Needle stick and sharp object injury was an important risk factor of HBV infection.