Clinical assessment and Continuum of Care of chronic hepatitis B patients in a Subsaharan African setting

Abstract

Abstract Background: Chronic Hepatitis B (CHB) infection is a major public health problem in the world. Cameroon has a high prevalence, estimated at about 11.2%. In Cameroon the management of CHB remains very challenging. The study aims at assessing the clinical assessment and the steps of the Continuum of Care (CoC) of chronic hepatitis B patients. Methods: A hospital based retrospective cohort study reviewing files of CHB patients who attended care from January 2014- December 2017 in the Douala General Hospital, a tertiary hospital in Cameroon. The CoC was assessed As follows step 1- enrolment in care, step 2-basic work up done, step 3- antiviral treatment uptake, step 4- viral load suppression. Descriptive statistics was used to represent proportions, the Kaplan Meier curve estimated retention in care and multivariate analysis identified independent association with treatment uptake. Results: The mean age at diagnosis was 33.7 (±12.0) years, males were predominant with 59.4%. The characteristics of the CoC were as follows: were enrolled in care 1033 patients, 492 (47.6%) completed the basic work up, were initiated on treatment 121 (11.7%); and viral load suppression was achieved in 53 (5.1%). Sociodemographic characteristics such as male gender (aOR: 2.1, CI: 1.2- 3.5), older age > 34 years (aOR 0.03, CI: 0.003-0.33), having a medical insurance (aOR: 5.7, CI: 3.0-10.9) were independently associated with treatment uptake. Conclusion: The study clearly showed a decreasing proportions of patients at various steps of the CoC, with treatment uptake mostly influenced by some sociodemographic factors. The real need to develop strategies to improve the CoC of CHB in Cameroon is therefore very apparent.