Clinical Assessment and Continuum of Care of Chronic Hepatitis B Patients in a Low-Income Setting in Africa

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. This study aimed to assess the clinical characteristics and the steps of the Continuum of Care (CoC) of chronic hepatitis B patients. Methods: We conducted a hospital-based retrospective cohort study. We reviewed files of CHB patients who were diagnosed and followed up from January 2014 to December 2017 at 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 initiation, step 4—viral load suppression. Descriptive statistics were used to summarize proportions, the Kaplan-Meier curve was used to estimate retention in care and multivariate analysis was used to test for association with treatment initiation. Results: We consulted a total of 1120 records of patients with CHB. We retained 1033 patients in the study, giving a proportion of 92%. The mean age at diagnosis was 33.7 (±12.0) years. There was a male predominance with the proportion of 59.4% (sex ratio of 1.48). Among the 1033 patients enrolled in care, 492 (47.6%) completed the basic work up, 121 (11.7%) were initiated on antiviral treatment, and viral load suppression was achieved in 53 (5.1%). According to multivariate analysis, male gender (AOR = 2.1; 95%CI [1.2 - 3.5]; p = 0.007), older age > 34 years (AOR = 0.03; 95%CI [0.003 - 0.033]; p = 0.004), and having a health insurance (AOR = 5.7; 95%CI [3.0 - 10.9]; p < 0.001) were the factors independently associated with treatment initiation. Conclusion: The study clearly showed a decreasing proportion of patients at various steps of the CoC, with treatment initiation mostly influenced by some sociodemographic factors. The real need to develop strategies to improve the CoC of CHB in Cameroon is therefore very necessary.