Neglected Hepatitis B –Place prevention before treatment

Lea Lea Cho, Nilar Shwe Yee, Aung Yu Naing, Kyaw Thu Hein

Background
Hepatitis B (HBV) among people who inject drugs (PWID) is a complex clinical and public health challenge that currently lacks multilateral commitment from different stakeholders. Globally 1.4 million of PWID are living with chronic HBV of whom the majority is unaware of their infection. Contrary to HCV and HIV treatment, HBV prevention is highly cost-effective but little is known about the epidemiology of HBV, seroprotection and vaccination coverage amongst PWID.
Methodology
Asian Harm Reduction Network (AHRN) runs comprehensive harm reduction programs in drug use endemic areas in Myanmar. PWIDs receive health education about hepatitis; if willing, they are referred for HBV and/or HIV screening. When HBV negative, they are vaccinated with accelerated vaccination schedule: day 0, 7 and 21 and double vaccine dosage for HIV positive clients. Starting from 2016, modest incentive (1.5$) was provided at the time of screening, first & third vaccination to cover travel expenses. Clients were traced if they did not appear for follow up vaccination by peer treatment-facilitators. Antibodies checked 2 months after the last vaccination.
Results
From January 2015 to June 2018, AHRN conducted 22,556 screenings, 2259 (10%) were HBV positive. 18,745 clients received first dose vaccination and 14,204 completed 3 (75.8% completion rate). 7,577 (53.3%) returned for HBV antibody testing (HBsAb) and 6,061 (80%) were HBsAb positive. Amongst HIV positive, 69% (1399/2037) revealed HBsAb and 31% (638/2037) were HBsAb negative. Amongst HIV negative, 84% (3247/3878) showed HBsAb positive and 16% (631/3878) showed HBsAb negative and the same rate for HIV unknown cases.

Conclusion
Outreach, transport incentives, accelerated vaccination schedule, follow-up are effective in increased HBV screening and vaccination. Increased uptake and completion of accelerated HBV vaccination schedule is associated with high seroprotection amongst PWID. However, HIV positive PWIDs are less likely to achieve seroprotection and other preventive measures should be in place.