Challenges of Hepatitis B Treatment in Rural Sub-Saharan Africa: Treatment Initiation and Outcomes from a Public Hospital-Based Clinic in Kono, Sierra Leone.

Despite a high prevalence, there are few successful models for de-centralizing diagnosis and treatment of chronic hepatitis B virus (HBV) infection among rural communities in sub-Saharan Africa. We report baseline characteristics and one-year retention outcomes for patients enrolled in a HBV clinic integrated within chronic disease services in a rural district hospital in Sierra Leone. We conducted a retrospective cohort study of patients with HBV infection enrolled between April 30 th 2019 and April 30 th 2021. Patients were eligible for one-year follow-up if enrolled before February 28, 2020. Treatment eligibility at baseline was defined as cirrhosis (diagnosed by clinical criteria of decompensated cirrhosis, ultrasonographic findings, or aspartate-aminotransferase-to-platelet ratio > 2) or co-infection with HIV or HCV. Retention in care was defined as a documented follow-up visit at least one year after enrollment. We enrolled 623 individuals in care, median age of 30 years (IQR 23-40). Of 617 patients with available data, 97 (15.7%) had cirrhosis. Treatment was indicated among 113 (18.3%) patients, and initiated among 74 (65.5%). Of 39 patients eligible for one-year follow-up on treatment at baseline, 20 (51.3%) were retained at one year, among whom 12 (60.0%) had documented viral suppression. Among the 232 patients not initiated on treatment eligible for one-year follow-up 75 (32.3%) were retained at one year. Although further interventions are required to improve outcomes, our findings demonstrated feasibility of retention and treatment of patients with HBV infection in a rural district in Sub-Saharan Africa, when integrated with other chronic disease services.