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Prevalence of chronic hepatitis B virus infection and infrastructure for its diagnosis in Madagascar: implication for the WHO’s elimination strategy
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Edité par CCSD ; BioMed Central -
International audience. Background: WHO developed a global strategy to eliminate hepatitis B by 2030 and set target to treat 80% ofpeople with chronic hepatitis B virus (HBV) infection eligible for antiviral treatment. As a first step to achieve thisgoal, it is essential to conduct a situation analysis that is fundamental to designing national hepatitis plans. Wetherefore estimated the prevalence of chronic HBV infection, and described the existing infrastructure for HBVdiagnosis in Madagascar.Methods: We conducted a stratified multi-stage serosurvey of hepatitis B surface antigen (HBsAg) in adults aged≥18 years using 28 sentinel surveillance sites located throughout the country. We obtained the list of facilitiesperforming HBV testing from the Ministry of Health, and contacted the person responsible at each facility.Results: A total of 1778 adults were recruited from the 28 study areas. The overall weighted seroprevalence ofHBsAg was 6.9% (95% CI: 5.6–8.6). Populations with a low socio-economic status and those living in rural areashad a significantly higher seroprevalence of HBsAg. The ratio of facilities equipped to perform HBsAg tests per100,000 inhabitants was 1.02 in the capital city of Antananarivo and 0.21 outside the capital. There were nofacilities with the capacity to perform HBV DNA testing or transient elastography to measure liver fibrosis.There are only five hepatologists in Madagascar.Conclusion: Madagascar has a high-intermediate level of endemicity for HBV infection with a severely limitedcapacity for its diagnosis and treatment. Higher HBsAg prevalence in rural or underprivileged populationsunderlines the importance of a public health approach to decentralize the management of chronic HBV carriersin Madagascar by using simple and low-cost diagnostic tools
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