Monitoring hepatitis B and C infections among HIV patients: a proposed model for a cascade of care in viral hepatitis in the Dominican Republic [poster]

Abstract

Background: Although the hepatitis B vaccine began widely used in high-income countries in the 1980s, almost 20 years later it was still rarely used in low- and middle-income countries. The main reasons behind these gaps included limited money for immunization, a lack of the infrastructure needed to carry out effective immunization programs, and a lack of political interest in immunization [1]. It is estimated a HBV prevalence of 2 to 4% in the Caribbean, and for HCV it is around 1.2% in the Latin-American region [2]. In the DR prevalence of both HIV and/or HBV/HCV are higher among GMT persons [3].

Materials and methods: Patients enrolled in care in a community-based clinic in Santo Domingo were evaluated for clinical indicators of HBV/HCV/Syphilis and HIV infections. A proposed model of cascade of care was proposed with the indicators found (Figures 1, 2)

Results: A total of 2435 cases of HIV (+) patients were evaluated. Serological tests demonstrating HBsAg detection was 91% (n = 2238), and co-infection HIV/HBV was 63% (n = 29), and Tenofovir-based ARV regimens among HBsAg (+) was 49% (n = 14) The mean age in the HIV/HBV/HCV cohort was 44 years old, 71.8% were male, and of those 12% was MSM. HCV/HIV co-infection was 41%(n = 19), and the frequency of HIV/HBV/HCV was only 4.3%. In all cases there were no HBV or HCV viral loads available, and none of them with treatment for HCV infection. Among those with HBV infection and HIV 48% was on ARV Tenofovir-based treatment.

Conclusions: This study reveals that it is needed more investment on early detection and intensive screening for both HBV and HCV in the context of non-HIV positive patients. The proposed cascade of care to monitor interventions requires a scale-up in case reporting and early treatment in each scenario.