PMID- 32315297 OWN - NLM STAT- MEDLINE DCOM- 20200714 LR - 20220716 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 17 IP - 4 DP - 2020 Apr TI - Hepatitis B virus seroepidemiology data for Africa: Modelling intervention strategies based on a systematic review and meta-analysis. PG - e1003068 LID - 10.1371/journal.pmed.1003068 [doi] LID - e1003068 AB - BACKGROUND: International Sustainable Development Goals (SDGs) for elimination of hepatitis B virus (HBV) infection set ambitious targets for 2030. In African populations, infant immunisation has been fundamental to reducing incident infections in children, but overall population prevalence of chronic hepatitis B (CHB) infection remains high. In high-prevalence populations, adult catch-up vaccination has sometimes been deployed, but an alternative Test and Treat (T&T) approach could be used as an intervention to interrupt transmission. Universal T&T has not been previously evaluated as a population intervention for HBV infection, despite high-profile data supporting its success with human immunodeficiency virus (HIV). METHODS AND FINDINGS: We set out to investigate the relationship between prevalence of HBV infection and exposure in Africa, undertaking a systematic literature review in November 2019. We identified published seroepidemiology data representing the period 1995-2019 from PubMed and Web of Science, including studies of adults that reported prevalence of both hepatitis B surface antigen (HBsAg; prevalence of HBV infection) and antibody to hepatitis B core antigen (anti-HBc; prevalence of HBV exposure). We identified 96 studies representing 39 African countries, with a median cohort size of 370 participants and a median participant age of 34 years. Using weighted linear regression analysis, we found a strong relationship between the prevalence of infection (HBsAg) and exposure (anti-HBc) (R2 = 0.45, p < 0.001). Region-specific differences were present, with estimated CHB prevalence in Northern Africa typically 30% to 40% lower (p = 0.007) than in Southern Africa for statistically similar exposure rates, demonstrating the need for intervention strategies to be tailored to individual settings. We applied a previously published mathematical model to investigate the effect of interventions in a high-prevalence setting. The most marked and sustained impact was projected with a T&T strategy, with a predicted reduction of 33% prevalence by 20 years (95% CI 30%-37%) and 62% at 50 years (95% CI 57%-68%), followed by routine neonatal vaccination and prevention of mother to child transmission (PMTCT; at 100% coverage). In contrast, the impact of catch-up vaccination in adults had a negligible and transient effect on population prevalence. The study is constrained by gaps in the published data, such that we could not model the impact of antiviral therapy based on stratification by specific clinical criteria and our model framework does not include explicit age-specific or risk-group assumptions regarding force of transmission. CONCLUSIONS: The unique data set collected in this study highlights how regional epidemiology data for HBV can provide insights into patterns of transmission, and it provides an evidence base for future quantitative research into the most effective local interventions. In combination with robust neonatal immunisation programmes, ongoing PMTCT efforts, and the vaccination of high-risk groups, diagnosing and treating HBV infection is likely to be of most impact in driving advances towards elimination targets at a population level. FAU - McNaughton, Anna L AU - McNaughton AL AUID- ORCID: 0000-0002-7436-8727 AD - Nuffield Department of Medicine, University of Oxford, Medawar Building for Pathogen Research, Oxford, United Kingdom. FAU - Lourenco, Jose AU - Lourenco J AD - Department of Zoology, University of Oxford, Medawar Building for Pathogen Research, Oxford, United Kingdom. FAU - Bester, Phillip Armand AU - Bester PA AUID- ORCID: 0000-0002-5795-5313 AD - Division of Virology, University of the Free State and National Health Laboratory Service, Bloemfontein, South Africa. FAU - Mokaya, Jolynne AU - Mokaya J AUID- ORCID: 0000-0001-8398-0689 AD - Nuffield Department of Medicine, University of Oxford, Medawar Building for Pathogen Research, Oxford, United Kingdom. FAU - Lumley, Sheila F AU - Lumley SF AUID- ORCID: 0000-0001-6825-9324 AD - Nuffield Department of Medicine, University of Oxford, Medawar Building for Pathogen Research, Oxford, United Kingdom. AD - Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom. FAU - Obolski, Uri AU - Obolski U AUID- ORCID: 0000-0001-7594-9745 AD - School of Public Health, Tel Aviv University, Tel Aviv, Israel. AD - Porter School of the Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel. FAU - Forde, Donall AU - Forde D AUID- ORCID: 0000-0003-2452-9868 AD - Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Headington, Oxford, United Kingdom. FAU - Maponga, Tongai G AU - Maponga TG AUID- ORCID: 0000-0002-6876-3712 AD - Division of Medical Virology, University of Stellenbosch, Faculty of Medicine and Health Sciences, Cape Town, South Africa. FAU - Katumba, Kenneth R AU - Katumba KR AD - Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda. FAU - Goedhals, Dominique AU - Goedhals D AD - Division of Virology, University of the Free State and National Health Laboratory Service, Bloemfontein, South Africa. FAU - Gupta, Sunetra AU - Gupta S AD - Department of Zoology, University of Oxford, Medawar Building for Pathogen Research, Oxford, United Kingdom. FAU - Seeley, Janet AU - Seeley J AUID- ORCID: 0000-0002-0583-5272 AD - Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda. AD - Faculty of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. FAU - Newton, Robert AU - Newton R AD - Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda. AD - Department of Health Sciences, University of York, York, United Kingdom. FAU - Ocama, Ponsiano AU - Ocama P AD - Makerere University College of Health Sciences, Kampala, Uganda. FAU - Matthews, Philippa C AU - Matthews PC AUID- ORCID: 0000-0002-4036-4269 AD - Nuffield Department of Medicine, University of Oxford, Medawar Building for Pathogen Research, Oxford, United Kingdom. AD - Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - 110110/WT_/Wellcome Trust/United Kingdom GR - MC_UU_00027/2/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20200421 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 RN - 0 (Hepatitis B Antibodies) RN - 0 (Hepatitis B Vaccines) SB - IM CIN - PLoS Med. 2020 Apr 21;17(4):e1003109. PMID: 32315316 MH - Africa/epidemiology MH - HIV Infections/blood/epidemiology/prevention & control MH - Hepatitis B/*blood/*epidemiology/prevention & control MH - Hepatitis B Antibodies/*blood MH - Hepatitis B Vaccines/*administration & dosage MH - *Hepatitis B virus MH - Humans MH - Seroepidemiologic Studies MH - Vaccination/methods PMC - PMC7173646 COIS- The authors have declared that no competing interests exist. EDAT- 2020/04/22 06:00 MHDA- 2020/07/15 06:00 PMCR- 2020/04/21 CRDT- 2020/04/22 06:00 PHST- 2019/08/22 00:00 [received] PHST- 2020/03/13 00:00 [accepted] PHST- 2020/04/22 06:00 [entrez] PHST- 2020/04/22 06:00 [pubmed] PHST- 2020/07/15 06:00 [medline] PHST- 2020/04/21 00:00 [pmc-release] AID - PMEDICINE-D-19-03078 [pii] AID - 10.1371/journal.pmed.1003068 [doi] PST - epublish SO - PLoS Med. 2020 Apr 21;17(4):e1003068. doi: 10.1371/journal.pmed.1003068. eCollection 2020 Apr.