Partners In Health, Freetown, Sierra Leone.
Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Viral Hepat. 2023 May;30(5):455-462. doi: 10.1111/jvh.13812. Epub 2023 Feb 12.
Despite a high prevalence, there are few successful models for de-centralizing diagnosis and treatment of chronic hepatitis B virus (HBV) infection among rural communities in Sub-Saharan Africa. We report baseline characteristics and 1 year retention outcomes for patients enrolled in a HBV clinic integrated within chronic disease services in a rural district hospital in Sierra Leone. We conducted a retrospective cohort study of patients with HBV infection enrolled between 30 April 2019 and 30 April 2021. Patients were eligible for 1 year follow-up if enrolled before 28 February 2020. Treatment eligibility at baseline was defined as cirrhosis (diagnosed by clinical criteria of decompensated cirrhosis, ultrasonographic findings or aspartate-aminotransferase-to-platelet ratio >2) or co-infection with HIV or HCV. Retention in care was defined as a documented follow-up visit at least 1 year after enrolment. We enrolled 623 individuals in care, median age of 30 years (IQR 23-40). Of 617 patients with available data, 97 (15.7%) had cirrhosis. Treatment was indicated among 113 (18.3%) patients and initiated among 74 (65.5%). Of 39 patients eligible for 1 year follow-up on treatment at baseline, 20 (51.3%) were retained at 1 year, among whom 12 (60.0%) had documented viral suppression. Among the 232 patients not initiated on treatment eligible for 1 year follow-up, 75 (32.3%) were retained at 1 year. Although further interventions are required to improve outcomes, our findings demonstrated feasibility of retention and treatment of patients with HBV infection in a rural district in Sub-Saharan Africa, when integrated with other chronic disease services.
尽管慢性乙型肝炎病毒（HBV）感染在撒哈拉以南非洲农村社区的去中心化诊断和治疗方面取得了一些成功模式，但仍存在许多挑战。我们报告了在塞拉利昂农村地区一家区医院的慢性病服务中整合的 HBV 诊所中入组的患者的基线特征和 1 年随访保留结果。我们对 2019 年 4 月 30 日至 2021 年 4 月 30 日期间入组的 HBV 感染患者进行了回顾性队列研究。如果在 2020 年 2 月 28 日之前入组，则患者有资格进行 1 年随访。基线时的治疗资格定义为肝硬化（根据失代偿性肝硬化的临床标准、超声检查结果或天冬氨酸转氨酶与血小板比值>2 诊断）或合并感染 HIV 或 HCV。保留在护理中定义为在入组后至少 1 年进行了有记录的随访就诊。我们共纳入 623 名患者接受治疗，中位年龄为 30 岁（IQR 23-40）。在 617 名有可用数据的患者中，97 名（15.7%）患有肝硬化。在 113 名（18.3%）患者中需要治疗，其中 74 名（65.5%）开始治疗。在基线时有 1 年随访治疗资格的 39 名患者中，有 20 名（51.3%）在 1 年后得到保留，其中 12 名（60.0%）的病毒得到了抑制。在未开始治疗但有 1 年随访资格的 232 名患者中，有 75 名（32.3%）在 1 年后得到保留。尽管需要进一步干预才能改善结果，但我们的研究结果表明，当将 HBV 感染患者的治疗与其他慢性病服务整合在一起时，在撒哈拉以南非洲的农村地区保留和治疗患者是可行的。
