STRIKE-HBV: establishing an HBV screening programme in Kilifi, Kenya-challenges, successes and lessons learnt

Abstract

Objectives: Chronic hepatitis B infection affects 65 million people in the WHO African Region, but only 4.2% of these are diagnosed and 0.2% on treatment. Here, we present a short report describing establishment of a hepatitis B virus (HBV) programme in Kenya. We share experiences, successes and challenges to support development of future programmes.

Methods: From March 2023, we began the 'STRIKE-HBV' Study to identify people living with HBV (PLWHB) in Kilifi, Kenya. We employed local staff and provided education and training. Individuals were identified through three routes: (1) we offered free-of-charge HBV testing for all non-pregnant adults attending Kilifi Country Hospital (KCH) outpatient department; (2) we invited PLWHB to reattend for review; and (3) we invited close contacts of PLWHB for screening and vaccination if HBV was negative. All those seropositive for HBV were offered a comprehensive liver health assessment.

Results: We have established a framework for HBV screening, assessment and linkage to care in Kilifi. Between March 2023 and March 2024, we collected data for 80 PLWHB, comprising (1) screening of 1862 people of whom 30 were seropositive, (2) enrolment of 38 people known to be living with HBV and (3) testing of 97 close contacts of PLWHB, of whom 12 were positive. Among a limited subset with elastography data, we identified 9 of 59 as having significant fibrosis, and a further 6 people had laboratory aspartate transaminase (AST) to platelet ratio index (APRI) scores in keeping with fibrosis. We encountered challenges including procurement delays for hepatitis B surface antigen testing kits and HBV vaccinations, and issues accessing liver elastography.

Conclusions: HBV screening was well received by the Kilifi population, has identified people at risk of liver disease progression and is improving linkage to care and vaccination at KCH. Future HBV programmes in WHO Africa can build on this experience as we work to develop accessible, affordable and acceptable care pathways.

Keywords: HEPATITIS B; Implementation Science; PUBLIC HEALTH; VIROLOGY.

Figure 1

Flow of the STRIKE-HBV Study—a cross-sectional study recruiting outpatients attending Kilifi County Hospital (KCH), Kenya to undertake hepatitis B surface antigen (HBsAg) testing, liver health assessment, referral to clinical care, tracing and vaccination of close contacts. Inclusion criteria are shown along with investigations undertaken on those testing HBsAg positive, referral and vaccination pathways. ALT, alanine aminotransferase; AST, aspartate aminotransferase; bHCG, beta-human chorionic gonadotropin; GGT, gamma-glutamyl transpeptidase; Hb, haemoglobin; HBeAg, hepatitis B ‘e’ antigen; HBV, hepatitis B virus; INR, international normalised ratio; kPa, kilopascals; OPD, outpatient department.