O3021: Screening Rates and the Prevalence of Hepatitis B Among People Living with HIV in Eswatini: An Opportunity for Birth Dose Hepatitis B Vaccination

Background: Chronic hepatitis B (CHB) is a significant cause of morbidity and mortality globally and remains underrecognized with only 9% of people aware of their CHB status. People living with human immunodeficiency virus (HIV) (PLWH) have higher rates of coinfection with hepatitis B virus (HBV) and worse outcomes. HBV birth dose vaccination (BDV) has demonstrated great success in prevention of vertical transmission in countries where it has been implemented. Currently, only 14/54 countries in Africa have introduced routine HBV BDV and it has not been implemented in Eswatini.

Methods: This was a retrospective review of electronic medical records of all PLWH enrolled into HIV care at an HIV clinic in Eswatini from 2004-2021 to examine HBV screening with hepatitis b surface antigen (HBsAg) and prevalence rates. Differences in screening and prevalence rates were assessed using chi-square and Fisher’s exact tests.

Results: A total of 4,644 PLWH were enrolled between 2004-2021, 62.5% female, 27.2% age 0-4, 14.6% age 5-9, 8.9% age 10-14, 4.2% age 15-19, and 45.2% age ≥20 years. HBV screening rate for patients newly enrolled in HIV care was 47%, with lowest screening rates in age groups 0-4 and 15-19 years (p= < 0.001). Screening rates peaked in 2012 at 81%, with rates lowest between 2016-2021 at 39% (p=0.001, Table 1). There was no significant difference in screening or HBV infection rates by gender. Overall, coinfection prevalence among those screened was 5.8%, highest in those 20 years and older at 7.6%. Significant coinfection in age 0-4 was seen at 4.6% (p=0.01), all born after 2000. In parallel, coinfection rates were higher in those born prior to 1996 at 7.5% in comparison to 3.9% in those born after 1996 (p=0.001). Overall, there was no specific trend in coinfection rates based on year of enrollment into HIV care (Figure 1).

Conclusion: HBV screening rates among PLWH in Eswatini have been inconsistent over the years and remain significantly below the World Health Organization (WHO) 2030 target of 90% of all people knowing their CHB status. Efforts to increase HBV screening rates among PLWH is critical given the higher morbidity and mortality associated with coinfection and to inform prevention of transmission, disease monitoring and treatment. Overall rates of coinfection in PLWH in Eswatini are lower in those born after implementation of routine 3 dose HBV vaccination series in 1996. Despite this, prevalence of coinfection among children ages 0-4 years remains high, concerning for ongoing vertical transmission. Screening PLWH could facilitate targeted HBV BDV for this high-risk population to further decrease transmission. Future directions include analysis of screening and prevalence among other HIV centers in Tanzania, Uganda, Lesotho, and Malawi where HBV BDV has not been implemented and comparing to Botswana where HBV BDV was implemented in 2000.