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1
Prevalence of HBV and HCV infections in screened people in Rwanda during WHD 2017 campaign
By MAKUZA Jean Damascene, MD, MSc.
Rwanda Biomedical Center
Outline
2
✓ Viral hepatitis program structure in Rwanda
✓ Background
✓ Methodology
✓ Results for WHD 2017
✓ Conclusion
Viral Hepatitis Program Structure in Rwanda
3
RBC
IHDPC
HIV, AIDS, STIs &OBBI Division
HIV Prevention Unit
HIV C&T Unit
EpidemiologicalSurveillance and
Research UnitOBBI&STIs Unit
TB Division ...
BIOS
2011• Hepatitis unit created
within RBC
• National TWG created• Viral load testing
introduced in 1st facility
2012
2013• Guidelines for prevention and
treatment• ROFAH created• Screening introduced at 2 facilities• Treatment available at 4 referral
centers
• Guidelines updated• National Policy adopted• NOP developed • HCWs trainings• Media coverage WHD activities• Price negotiations with pharmaceutical
companies• Limited coverage of treatment by health
insurances• First patient’s treated with SOF/Ribavirin
2015
2016• Sensitizing high risk groups• Screening of ~117,000
PLHIV• ELISA used at 13 sites• 1st patients treated with
SOF/LDV • Standardized patient file
introduced
2017-2018• Campaigns: ~438k
people screened and ~427k vaccinated
• Screening: remaining ~26k PLHIV and high risk population like prisoners, FSW and MSM
• 1st patients treated with SOF/DCV
• 8505 patients treated (SOF/LDV &SOF/DCV)
Screening Site at Muhanga, Southern Province, June 2017 4
Milestones in Viral Hepatitis Program
VH response has been a result of strong partnerships
5
Civil Society
MoH RBC
Other Partners
Referral Hospitals
Private Sector
TWG
HBVAg Prevalence Estimates in different groups
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a. General population not well known
b. From Rwanda Blood Transfusion
Center 1.9-3.2% (2000-2012)
c. Pregnant women in sentinel sites 3.5%
(2011)
d. HCWs at CHUB 2.9% (2015)
e. HIV-positive : 4.3% (2017)
HCV Prevalence Estimates in different groups
General population
Not known
Rwanda Blood Transfusion Center
0.8-3.2%
(2000-2012)
Pregnant women in sentinel sites
2.6%
(2011)
PLWHIV
4.7%
(2017)
01 02 03 04
WHO estimates . Prevalence for hepatitis in Rwanda= 4%
Methodology
8
✓ Screening targeted individuals:
✓ aged >45 years in lower socio-economic groups
✓ FSWs
✓ Diabetics
✓ HCWS
✓ Sensitization done through multimedia announcements and local church leaders
✓ Healthcare workers introduced and trained in VH screening, diagnosis and patient
counseling
✓ Sample testing for HBV & HCV using Murex Elisa (Spe:100%, Se: 99.9%)
✓ Bivariate and multivariate logistic regressions used to assess factors associated
with HBSAg and HCVAb positivity
WHD 2016 at Car Free zone, Kigali, 2016
photo, new times, 16
WHD campaign at Muhanga , 2017
Free Hep B&C screening
WHD Campaign, 2017
World Hepatitis Day (WHD) Campaign, 2017 Results
✓ Started from June 2017
✓ Covered 30 districts
✓ Screened population for HBV & HCV : 126,215
✓ HCV antibody positive: 11,006(8.86%)
✓ PCR for HCVAb +: 48.2% HCV VL were detectable
✓ Positivity were increased with age at both HCV antigen
and HCV VL
✓ HBs antigen positive: 4,923
Proportion Screening Positive for HBsAg and HCVAb from Rwanda 2016-2017 Campaigns
12
3,9
4,54,2
3,1
8,9
6,5
4,7 4,6
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
9,0
10,0
General Population (N=124214) Prisoners (N=52082) PLHIV (N=135895) Female Sex Workers (N=3660)
%P
osi
tive
Population Group
% HBsAg+ % HCVAb+
HBV Antigen and HCV Antibody Positivity by Age Group(N=126215)
13
3.5
5.1 5.3
43.3
2.2 2.3
3.3
4.8
16.5
0
2
4
6
8
10
12
14
16
18
<25 25-34 35-44 45-54 >55
%Sc
ree
ned
Age group(yrs)
HBV %Positive HCV %Positive
HBV Antigen and HCV Antibody Positivity by District Screened
% HBV Ag Positive % Anti-HCV Positive
*Sample size=126215 of general population screened at 1-2 screening site per district in the 2017 campaign
Conclusion
✓ Results from the campaign serve as preliminary evidence
for variations in prevalence across different populations.
✓ Rwanda’s experience serves as important evidence for
other low and middle-income countries.
✓ campaign results will be used to plan national services for
future integration and decentralization of screening into
routine care at lower-level health centers.
Acknowledgment
✓ RBC staff especially HIV Division for their support
✓ Partners organizations which supported this activity
✓ Healthcare Workers who supported the collection of
samples and information needed
✓ Patients who participated in screening campaign
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ANY QUESTIONS?