Division of Global HIV&TB, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.
National AIDS and STI Control Program (NASCOP), Ministry of Health, Nairobi, Kenya.
PLoS One. 2024 Nov 14;19(11):e0310923. doi: 10.1371/journal.pone.0310923. eCollection 2024.
Sub-Saharan Africa region bears the highest chronic hepatitis B virus (HBV) infection burden worldwide. National estimates of HBV burden are necessary for a viral hepatitis program planning. This study estimated the national prevalence of HBV infection in Kenya among people aged 15-64 years.
Of 27,745 participants age 15-64 years in the Kenya Population-based HIV Impact Assessment (KENPHIA) 2018 household survey, we analyzed data for all persons living with HIV (PLHIV; n = 1,521) and a random sample of HIV-negative persons (n = 1,551), totaling to 3,072 participants. We tested whole blood samples for hepatitis B surface antigen (HBsAg) using Determine™ HBsAg rapid test and used population projections to estimate national disease burden. Pearson chi square was performed and the weighted prevalence proportions presented.
Of the 3,072 participants,124 tested HBsAg positive, resulting in a weighted national HBV prevalence of 3.0% (95% CI: 2.2-3.9%). This translated to an HBV infection burden of 810,600 (95% CI: 582,700-1,038,600) persons age 15-64 years in Kenya. Distribution of HBV prevalence varied widely (p<0.001) by geography, ranging from 0.1% in Eastern Kenya regions to over 5% in northern and western Kenya. Prevalence of HBV infection was higher in PLHIV (4.7%; 95% CI: 3.3-6.0%) compared to HIV-negative persons (3.0%; 95% CI: 2.1-3.9%), and was highest among persons: age 45-54 years (6.4%; 95% CI: 3.3-9.5%), those who reported no formal education (10.7%; 95% CI: 5.1-16.4%), in polygamous marriages (6.8%; 95% CI: 1.7-11.8%), and in the lowest wealth quintile (5.3%; 95% CI: 2.8-7.7). When adjusted for covariates, lack of formal education (aOR = 4.2; 95% CI: 1.5-12.6) was significantly associated with HBV infection. In stratified analysis by HIV status, residing in rural areas and history of blood transfusion were independently associated with HBV infection among PLHIV, while lack of formal education and no history of blood transfusion were associated with HBV infection among HIV-negative participants (p<0.05).
HBV prevalence among persons aged 15-64 years in Kenya was 3.0%. Higher prevalence was documented among persons without formal education, in the lowest wealth quintile, and those living in Kenya's North-Eastern, Rift Valley-North and Nyanza regions. Targeted programmatic measures to strengthen interventions against HBV infections including newborn vaccination and treatment of infected adults to limit mother-to-child transmission, would be helpful in reducing burden of HBV-associated viral hepatitis.
撒哈拉以南非洲地区是全球慢性乙型肝炎病毒（HBV）感染负担最重的地区。为了进行病毒性肝炎规划，有必要对 HBV 负担进行国家估计。本研究估计了肯尼亚 15-64 岁人群中 HBV 感染的全国流行率。
在肯尼亚基于人群的艾滋病毒影响评估（KENPHIA）2018 年家庭调查中，我们对 27745 名 15-64 岁的参与者进行了分析，包括所有艾滋病毒感染者（PLHIV；n=1521）和随机选择的艾滋病毒阴性者（n=1551），共计 3072 名参与者。我们使用 Determine™HBsAg 快速检测试剂盒对全血样本进行了乙型肝炎表面抗原（HBsAg）检测，并使用人口预测来估计国家疾病负担。进行了 Pearson chi 平方检验，并给出了加权流行率比例。
在 3072 名参与者中，有 124 名 HBsAg 阳性，加权全国 HBV 流行率为 3.0%（95%CI：2.2-3.9%）。这相当于肯尼亚 15-64 岁人群中有 810600 人（95%CI：582700-1038600）感染了 HBV。HBV 流行率的分布差异很大（p<0.001），从肯尼亚东部地区的 0.1%到北部和西部地区的超过 5%不等。PLHIV 中的 HBV 感染率（4.7%；95%CI：3.3-6.0%）高于艾滋病毒阴性者（3.0%；95%CI：2.1-3.9%），年龄在 45-54 岁的人群（6.4%；95%CI：3.3-9.5%）、没有接受过正规教育的人群（10.7%；95%CI：5.1-16.4%）、处于多配偶婚姻的人群（6.8%；95%CI：1.7-11.8%）和最贫困的五分位数人群（5.3%；95%CI：2.8-7.7%）感染率最高。在调整了混杂因素后，缺乏正规教育（调整比值比[aOR]=4.2；95%CI：1.5-12.6）与 HBV 感染显著相关。在按 HIV 状态分层分析中，居住在农村地区和有输血史与 PLHIV 中的 HBV 感染独立相关，而缺乏正规教育和没有输血史与 HIV 阴性参与者中的 HBV 感染相关（p<0.05）。
肯尼亚 15-64 岁人群中 HBV 的流行率为 3.0%。在没有接受过正规教育的人群、最贫困的五分位数人群以及肯尼亚东北部、东非大裂谷-北部和奈瓦沙地区，HBV 流行率更高。为了减少与 HBV 相关的病毒性肝炎负担，需要采取有针对性的方案措施，加强针对 HBV 感染的干预措施，包括新生儿疫苗接种和治疗感染成年人，以限制母婴传播。
