Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study
Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study
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DOI：
10.1016/s2214-109x(16)30130-9
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发表时间：
2016-08-01
影响因子：
34.3
通讯作者：
Thursz, Mark R.
中科院分区：
文献类型：
--
作者：
Lemoine, Maud;Shimakawa, Yusuke;Thursz, Mark R.
背景尽管在20世纪90年代引入了针对B型肝炎病毒（HBV）的免疫接种，但在撒哈拉以南非洲，HBV相关的发病率和死亡率仍然很高。识别和治疗慢性HBV感染的无症状人群应减少疾病负担。因此，我们评估了在西非冈比亚开展乙肝病毒感染筛查和治疗项目的可行性，并估计了患有严重肝病需要治疗的乙肝病毒感染者的比例。方法2011年12月7日至2014年1月24日，随机选择冈比亚西部社区的居民，通过即时检测进行B型肝炎表面抗原（HBsAg）筛查。这项测试也提供给在首都班珠尔中心医院就诊的潜在献血者。HBsAg阳性者被邀请进行全面的肝脏评估，并根据国际指南提供治疗。我们将与护理的联系定义为至少一次访问肝脏诊所。根据2012年欧洲肝脏研究协会指南判断治疗资格。结果5980人接受HBsAg筛查（加权估计值68.9%，95%CI 65.0-72.4），来自27个农村和27个城市社区的8170名成年人和6832名献血员中的5559名（81.4%，80.4-82.3）。社区人群HBsAg阳性率为8.8%（7.9-9.7），献血员HBsAg阳性率为13.0%（12.1-13.9）。男性（2328名男性中有239名[10.5%，8.9-12.1] vs 3652名女性中有256名[7.6%，6.5-8.7]; p=0.004）和中年参与者的患病率较高。在社区中，与护理的联系很高，495名HBsAg阳性者中有402人（81.3%）到诊所就诊。然而，在血库筛查的721名HBsAg阳性者中，只有300人（41.6%）与护理有关。在参加门诊的患者中，18名（4.4%，2.5-7.7）来自社区的患者和29名（9.7%，6.8-13.6）来自血库的患者符合治疗条件。男性与治疗资格密切相关（比值比4.35，1.50-12.58; p=0.007）。解释HBV感染在冈比亚仍然非常普遍。基于社区的筛查覆盖率高，与护理的联系良好，以及需要治疗的HBsAg携带者比例小，表明大规模筛查和治疗方案在撒哈拉以南非洲是可行的。版权所有（C）作者。由Elsevier Ltd.发布。这是CC BY许可下的开放获取文章。
Background Despite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity and mortality remain high in sub-Saharan Africa. Identification and treatment of asymptomatic people with chronic HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who had significant liver disease in need of treatment.Methods Between Dec 7, 2011, and Jan 24, 2014, individuals living in randomly selected communities in western Gambia were offered hepatitis B surface antigen (HBsAg) screening via a point-of-care test. The test was also offered to potential blood donors attending the central hospital in the capital, Banjul. HBsAg-positive individuals were invited for a comprehensive liver assessment and were offered treatment according to international guidelines. We defined linkage to care as visiting the liver clinic at least once. Eligibility for treatment was judged in accordance with the 2012 European Association for the Study of the Liver guidelines.Findings HBsAg screening was accepted by 5980 (weighted estimate 68.9%, 95% CI 65.0-72.4) of 8170 adults from 27 rural and 27 urban communities and 5559 (81.4%, 80.4-82.3) of 6832 blood donors. HBsAg was detected in 495 (8.8%, 7.9-9.7) individuals in communities and 721 (13.0%, 12.1-13.9) blood donors. Prevalence was higher in men (239 [10.5%, 8.9-12.1] of 2328 men vs 256 [7.6%, 6.5-8.7] of 3652 women; p=0.004) and middle-aged participants. Linkage to care was high in the communities, with 402 (81.3%) of 495 HBsAg-positive individuals attending the clinic. However, only 300 (41.6%) of 721 HBsAg-positive people screened at the blood bank linked into care. Of those who attended the clinic, 18 (4.4%, 2.5-7.7) patients from the communities and 29 (9.7%, 6.8-13.6) from the blood bank were eligible for treatment. Male sex was strongly associated with treatment eligibility (odds ratio 4.35, 1.50-12.58; p=0.007).Interpretation HBV infection remains highly prevalent in The Gambia. The high coverage of community-based screening, good linkage into care, and the small proportion of HBsAg carriers who need treatment suggest that large-scale screening and treatment programmes are feasible in sub-Saharan Africa. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.