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

Area of Science:

• Hepatology
• Public Health
• Epidemiology

Background:

• Limited data exist on the hepatitis B virus (HBV) care cascade in sub-Saharan Africa.
• This study assesses the HBV care cascade in Rwanda, a region with significant HBV burden.

Purpose of the Study:

• To evaluate the stages of the hepatitis B virus (HBV) care cascade in Rwanda.
• To identify factors influencing patient progression through the HBV care cascade.

Main Methods:

• Analysis of District Health Information System 2 data from January 2016 to June 2023, covering 4.6 million individuals screened for HBV.
• The HBV care cascade was defined across six stages: prevalence, diagnosis, care enrollment, treatment eligibility, initiation, and continuation.
• Hierarchical logistic regression was employed to determine factors affecting progression through the care cascade.

Main Results:

• Out of 4,604,468 screened individuals, 138,512 tested positive for HBV.
• Only 37.0% of diagnosed individuals were enrolled in care, and 30.3% of those were eligible for treatment.
• While 76.1% of eligible individuals initiated treatment, 98.9% were retained one year later. Older individuals (35-54 years) and those closer to health facilities showed better engagement.

Conclusions:

• Engagement across the HBV care cascade in Rwanda is suboptimal, with significant drop-offs at diagnosis and care enrollment.
• Younger individuals and those residing farther from healthcare facilities face greater barriers to HBV care.
• Targeted interventions to enhance awareness and improve healthcare accessibility are vital for strengthening HBV prevention and management programs.