Said Sanaa S, Shadaker Shaun, McMahon Brian J, Armstrong Paige A, Beckett Geoff A, Kamili Saleem, Harris Aaron M
The State University of Zanzibar, Zanzibar, Tanzania.
Mnazi Mmoja Hospital, Zanzibar, Tanzania.
J Viral Hepat. 2025 Jan;32(1):e14051. doi: 10.1111/jvh.14051.
Zanzibar, a low-resource semiautonomous region of Tanzania, has an estimated prevalence of hepatitis B virus (HBV) infections of 3.6%. To assess the feasibility of care and treatment, a 5-year hepatitis B demonstration project was implemented in Zanzibar during January 2017-December 2021, following the 2015 WHO HBV care and treatment guidelines. Participants included adults (aged ≥ 18 years) who tested positive for HBV surface antigen and tested negative for HIV and hepatitis C antibody. Participants were examined for clinical signs of liver disease and testing was conducted at baseline to assess treatment eligibility and every 6-12 months thereafter. Tenofovir disoproxil fumarate (TDF) was provided at no cost to treatment-eligible participants. Clinical and laboratory data were analysed to assess improvement in proximal disease outcomes. Among 596 participants enrolled, the median age was 32 years (IQR 26-39) and 365 (61%) were male. Of those enrolled, 268 (45%) returned for ≥ 1 follow-up visit, with a median of 511 days of follow-up. Overall, 58 patients initiated treatment: 15 met treatment criteria based on liver cirrhosis alone; 13 by APRI > 1.5; among those with HBV DNA results, six met criteria based on HBV DNA levels and ALT activity; 24 met ≥ 2 criteria. Significant decreases in ALT activities, APRI scores and HBV DNA levels were observed among those treated. This hepatitis B care and treatment programme was demonstrated to be feasible in a low-resource setting. Despite challenges, testing and linkage to care is critical to decrease the global burden of hepatitis B.
桑给巴尔是坦桑尼亚一个资源匮乏的半自治区，估计乙肝病毒（HBV）感染率为3.6%。为评估护理和治疗的可行性，2017年1月至2021年12月期间，在桑给巴尔实施了一项为期5年的乙肝示范项目，该项目遵循2015年世界卫生组织乙肝护理和治疗指南。参与者包括乙肝表面抗原检测呈阳性、艾滋病毒和丙肝抗体检测呈阴性的成年人（年龄≥18岁）。对参与者进行肝病临床体征检查，并在基线时进行检测以评估治疗资格，此后每6 - 12个月检测一次。符合治疗条件的参与者可免费获得替诺福韦酯（TDF）。分析临床和实验室数据以评估近端疾病结局的改善情况。在登记的596名参与者中，中位年龄为32岁（四分位间距26 - 39岁），365名（61%）为男性。登记的参与者中，268名（45%）返回进行了≥1次随访，中位随访时间为511天。总体而言，58名患者开始治疗：15名仅根据肝硬化符合治疗标准；13名根据APRI>1.5符合标准；在有乙肝病毒DNA结果的患者中，6名根据乙肝病毒DNA水平和谷丙转氨酶活性符合标准；24名符合≥2项标准。在接受治疗的患者中，观察到谷丙转氨酶活性、APRI评分和乙肝病毒DNA水平显著下降。该乙肝护理和治疗项目在资源匮乏的环境中被证明是可行的。尽管存在挑战，但检测和与护理的联系对于减轻全球乙肝负担至关重要。
