Improving continuum of care in Dominican Republic for HIV-infected patients co-infected with hepatitis B and C

Abstract

The estimated prevalence of hepatitis B and C among people living with HIV/AIDS is 5–20% and 6% respectively in Latin America, representing 2 to 4 million people. Liver diseases has become in the ART era the major cause of morbidity and mortality among PLWHIV. The effective management of HIV people co-infected with hepatitis B and C is a public heath priority requiring testing service, linkage to care and access to treatment. The objective of this study was to evaluate indicators involved with optimal cascade of care for HBV and HCV co-infected PLWHIV in Dominican Republic. Patients enrolled in care in two communitybased clinics in Santo Domingo and Santiago, DR were evaluated for clinical indicators of HBV, HCV and HIV infections. Socio-demographic determinants and serological/chemical data were collected from clinical files, and statistical analyses were used to assess their distribution in different key populations like MSM, Trans, and drug users. A total of 2787 HIV-infected patients were evaluated. Co-infection with HBV was found in 28 patients, and 100% were followed up, 85.7% (n=24) of them were retained in care and ARV containing tenofovir were prescribed to 71.4% (n=20). HCV co-infection was identified in 8 patients, and 87.5% (n=7) were followed, while 75%% (n=6) were retained to care without receiving treatment for HCV. This study identified significant differences between the continuum of care of HBV and HCV co-infections. Access to HCV treatment in co-infected populations is crucial for care and in turn to decrease new infections. However, seems to be a subregistry on hepatitis status compared with the current epidemiological data from the region. A more systematic screening for viral hepatitis among PLWHIV will be essential for early management and treatment. Increased detection, linkage to care and long-term follow up with access to medication and HBV vaccination are public health priority to improve patient outcome and curb these epidemics.