Hepatitis B Virus Care Cascade in Rwanda: A Population-based Study From 2016-2023.

Abstract

In sub-Saharan Africa, data on the hepatitis B virus (HBV) care cascade are limited. We assessed Rwanda's HBV care cascade. We analyzed data from the District Health Information System 2, capturing 4.6 million individuals (≥2 years) screened for HBV from January 2016 to June 2023. The HBV care cascade included 6 stages: (1) chronic HBV prevalence, (2) diagnosis, (3) care enrollment, (4) treatment eligibility, (5) treatment initiation, and (6) treatment continuation. HBV infection was defined as a reactive hepatitis B surface antigen test. Hierarchical logistic regression identified factors influencing progression through the cascade. Among 4 604 468 screened individuals, 138 512 were hepatitis B surface antigen-positive. District Health Information System 2 data included 57 520 cases, of which 52 827 (91.8%) had HBV monoinfection. Of those diagnosed, 21 247 (37.0%) were enrolled in care and 6429 (30.3%) were eligible for treatment. Among eligible individuals, 4893 (76.1%) initiated treatment, with 4839 (98.9%) retained on treatment 1-year after initiation. Individuals aged 35-54 years were more likely to engage in care (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 1.12-1.27), initiate treatment (aOR: 1.45; 95% CI: 1.14-1.86), and remain on treatment (aOR: 2.88; 95% CI: 1.09-7.63) compared to those <35 years. Individuals living 30-60 minutes from health facilities were less likely to engage in care or continue treatment compared to those living at a shorter distance. Engagement in the HBV care cascade is low, particularly among younger individuals and those living farther from health facilities. Efforts to improve awareness and accessibility are essential to strengthen HBV prevention and care.