Hepatitis B stigma by association with HIV in Zambia

Transcription

1 Hepatitis B stigma by association with HIV in Zambia Michael Vinikoor 1,2, Annie Kanunga 1, Jodie Dionne-Odom 2, Janet Turan 2, and Edford Sinkala 1,3 1 TROPGAN, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; 2 University of Alabama at Birmingham, Birmingham, USA; 3 University Teaching Hospital, Lusaka, Zambia Conference on Liver Disease in Africa, Nairobi, Kenya th September 2018 mjv3@uab.edu; (whatsapp)

2 Financial disclosures I have no disclosures to report

3 Background: goals of Hep B response in Africa To reduce incidence To increase knowledge of HBV status To provide treatment in order to lower the risk of cirrhosis and cancer Link and engage people living with HBV in chronic medical care Provide antiviral therapy Very similar to goals of the HIV response

4 Background: substantial overlap between HBV and HIV in Zambia

5 Index testing for HBV WHO Hepatitis Testing Guidelines for HBV Focused testing in most affected populations Recommended public health approach in HBV as you can (a) identify asymptomatic chronic carriers and (b) prevent new cases through vaccination We performed a mixed-methods evaluation of HBV disclosure and contact testing within the HBV cohort at University Teaching Hospital in Lusaka, Zambia 79 patients with chronic HBV monoinfection (age 18+ years, HIV-negative, HBsAg-pos.) undertook a survey and 32 participated in 1 of 5 focus group discussions.

6 Stigma Scale for Chronic Illness adapted for HBV Comments: This scale was chosen as it is general, brief, and includes both internalized and experienced stigma items Simple Likert scoring was used (range 0-4 points/item) and all items weighted equally Minimum score was 0; maximum was 32 Molina Y et al. Int J Behav Med. 2013

7 % 776 contacts were enumerated (sexual partners, first degree blood relatives, and house mates) 8 of 67 (11.9%) contacts were HBsAg-pos

8 While low awareness was a barrier to HBV disclosure and index testing, stigma emerged another significant challenge for patients 88.6% (of n=79) had disclosed their HBV status to at least 1 partner (9 had never disclosed) Median stigma score was 9 (IQR, 4-13) A 1-unit increase in stigma score was associated with 13% lower odds of disclosure to at least one contact. Multivariable analysis could not be done due to small sample.

9 ARVs (which are dispensed for HBV) look distinctive in Zambia and are strongly linked with HIV When you tell them that HBV is more dangerous than HIV, they don t understand. And when they see those drugs for HIV they think you are HIVpositive. Like last time, my brother, went there to take some drugs at the hospital there for (HBV) and he was in the same line with HIV patients. (Female, age 33) Antiretroviral drugs Other common pills in Zambia

10 Initiation of antivirals for HBV can trigger experienced stigma that is related to HIV And once you re put on these drugs, it means you ll be taking these drugs for life like it was for HIV. That means something to say, okay in this respect and in the regions where we are coming from, here once you are on the ARVs you are regarded as if you have HIV, and people will distance themselves from you in the name of stigma. (Male, age 27)

11 Lack of awareness of HBV transmission patterns in Africa also leads to stigma Why is it [HBV] stigmatized, its more associated to STIs, it s more like a sexually transmitted disease. So when you talk of hepatitis you know it s just like HIV, ehh its very much stigmatized because even the messages we usually see say avoid sex, use condom. (Male, age 52) However, there s this situation of having the whole family tested [for HBV] which I ve never heard about in any HIV. (Male, age 21)

12 Patients on antivirals for HBV were accused of being HIV-positive Immediately you ll bring in the explanation of no it [HBV] is related to HIV if you want to take that line I can assure you, you are going to achieve something, but if you are going to go to say no hepatitis can also be related to HIV then I can assure you, and even when you are giving drugs the person becomes uh and then he is distracted, confusion starts, because now he s going to say maybe they are just hiding this HIV. (Female, age 32)

13 Discussion Index testing is feasible and potentially cost-saving. One of early reports on Hepatitis B stigma in Africa highlights the potential impact of the HIV epidemic and scale-up of ART for HIV on HBV. Main limitation was reliance on self-report for the testing cascade. More work should be done around HBV health messaging: how do we avoid HBV stigma becoming a major barrier to testing and engagement in care while still integrating HBV activities within the HIV health system (for efficiency)?