Browsing by Author "Andersson MI"

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    A new approach to prevent, diagnose, and treat hepatitis B in Africa.
    (2023) Spearman CW; Andersson MI; Bright B; Davwar PM; Desalegn H; Guingane AN; Johannessen A; Kabagambe K; Lemoine M; Matthews PC; Ndow G; Riches N; Shimakawa Y; Sombié R; Stockdale AJ; Taljaard JJ; Vinikoor MJ; Wandeler G; Okeke E; Sonderup M; School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA.; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; LiveWell Initiative, Yesuf Abiodun Street, Victoria Island, Lagos, Nigeria.; Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK.; Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia.; Department of Internal Medicine, Jos Univeristy Teaching Hospital, Jos, Nigeria.; Radcliffe Department of Medicine, University of Oxford, Oxford, UK.; Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa.; Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, Paris, France.; The National Organisation for People Living With Hepatitis B, Kampala, Uganda.; Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway.; School of Medicine, University of Zambia, Lusaka, Zambia.; Division of Infection and Immunity, University College London, Gower Street, London, WC1E 6BT UK.; Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Service d'hépato-Gastroentérologie, CHU Yalgado OUÉDRAOGO, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK.; Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.; Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.; Department of Infectious Diseases, University College London Hospital, Euston Road, London, NW1 2BU UK.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.; Women in Hepatitis Africa, Womens Wellness Center for Hepatitis, Isale Ajoke, Iwaya-Makoko, Lagos State, Nigeria.; Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso.; Department of Clinical Infection, Microbiology and Immunity, University of Liverpool, Liverpool, UK.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    There are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB.
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    Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa.
    (2017-Nov-01) Coffie PA; Egger M; Vinikoor MJ; Zannou M; Diero L; Patassi A; Kuniholm MH; Seydi M; Bado G; Ocama P; Andersson MI; Messou E; Minga A; Easterbrook P; Anastos K; Dabis F; Wandeler G; Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, South Africa.; Service de Médecine Interne, CNHU Hubert Maga, Cotonou, Benin.; Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.; Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.; Service des Maladies Infectieuses et de Pneumologie, CHU Sylvanus Olympio, Lomé, Togo.; INSERM U1219, Bordeaux Population Health, Bordeaux, France.; Department of Infectious Diseases, Fann University Hospital, Dakar, Senegal.; ISPED, Université de Bordeaux, Bordeaux, France.; Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.; Hôpital de Jour, Service des Maladies Infectieuses et Tropicales, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Department of Medicine, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.; Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland.; Department of Infectious Diseases, Fann University Hospital, Dakar, Senegal. gilles.wandeler@ispm.unibe.ch.; Infectious Diseases Institute, Kampala, Uganda.; Department of Medicine at University of Alabama, Birmingham, AL, USA.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. gilles.wandeler@ispm.unibe.ch.; Centre de Prise en charge de Recherche et de Formation. CePReF-Aconda-VS, Abidjan, Côte d'Ivoire.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. gilles.wandeler@ispm.unibe.ch.; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, USA.; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.; Division of Medical Virology, Department of Pathology, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.; Centre Médical de Suivi de Donneurs de Sang/ CNTS/PRIMO-CI, Abidjan, Côte d'Ivoire.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. METHODS: A medical chart review was conducted in large urban HIV treatment centers in Côte d'Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. RESULTS: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37 years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4-14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p < 0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p = 0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02-4.79) had a confirmed HCV infection. CONCLUSIONS: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.