Prevalence of Hepatitis B Virus Co-Infection Among HIV-Seropositive Persons Attending Antiretroviral Clinics in the Eastern Region of Ghana

Abstract

Background: Hepatitis B virus and HIV infections are endemic in sub-Saharan Africa where 22.9 million individuals are estimated to be infected with HIV and nearly 50 million people are chronic HBV carriers. Due to similar routes of transmission, co-infections with the two viruses are common. Hepatitis B being severely infectious and found in HIV-positive patients, could pose more serious health problems. In Ghana, the prevalence of HBV infection is estimated at 15% of the adult population and the estimated HIV prevalence among antenatal clients in 2010 ranged from 0.4% in Krachi and Adibo, two rural sites to 7.4% in Agomanya, an urban site in Ghana. The guidelines for antiretroviral therapy (ART) in Ghana were reviewed in September 2011 to include for the first time the management of hepatitis B virus (HBV) co-infection with HIV. Clearly, the guidelines reveal a deficit of information to guide policy but understanding the extent of these dual epidemics is critical to the optimization of treatment. We determined the prevalence and risk factors of HBV co-infection in Persons Living with HIV (PLHIV) and assessed the knowledge of ART staff regarding the co-infection in the Eastern region. Method: A cross sectional study was conducted in five ART clinics to obtain data from a probability proportionate to size random sample of PLHIV in the Eastern region from March to June 2012 and a self-administered questionnaire to assess knowledge of health care workers was done. Descriptive and logistic regression models were used for analysis. Results: Of 320 PLHIV recruited for study, 28 were positive for HBsAg giving an overall prevalence of 8.8% and site specific prevalence ranged from 13.6% in Asesewa to 0% in Atua. More females 19 (67.9%) were found to be HBsAg positive and participants ages ranged from 4 to 76 years with a mean age of 40.82 (± 12.7) years. There were statistically significant relationships between HBV infection and increasing age (p=0.004), partner with history of HBV infection (p=0.010) and history of HBV infection in the past (p=0.020). ART staff obtained 84.2% (SD± 20.53; 95% CI: 89-98.1) and 53.1% (SD± 35.06; 95% CI: 13.0-88.9)) in the “general knowledge” and “management practice” indexes respectively. Conclusion: Prevalence of HBV-HIV co-infection was within worldwide estimates of 5-10%. Individuals with HBV positive partners or with history of HBsAg testing were more likely to have HBV infection. Knowledge of ART staff with regards to management practices of HBV- HIV co-infection and HBV vaccination coverage among PLHIV were found to be low. Trainings should be done on a regular basis to address needs gaps and the inclusion of PLHIV in HBV vaccination programmes should also be considered.