HIV PrEP programmes as a framework for diagnosing and treating HBV infection in adolescents and young adults in Kwazulu-Natal, South Africa

Authors list

Gloria Sukali Jacob Busang Jaco Dreyer Thandeka Khoza Marion Delphin Nonhlanhla Okesola Carina Herbst Elizabeth Waddilove Janine Upton Janet Seeley Collins Iwuji Motswedi Anderson Philippa Matthews Maryam Shahmanesh

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Abstract

Background: Guidelines for Hepatitis B treatment released by the World Health Organization in 2024 include the use of dual therapy, combining tenofovir with emtricitabine or lamivudine. These fixed-dose combinations are also used for Pre-Exposure Prophylaxis (PrEP) in people at risk of Human Immunodeficiency Virus (HIV). We hypothesize that pre-existing HIV PrEP programmes can support access to HBV testing and treatment.

Methods: At the Africa Health Research Institute (AHRI) in KwaZulu Natal, South Africa, we evaluated PrEP uptake and retention amongst adolescents and young adults aged 15-30 years. We reviewed HBV status, acceptance of PrEP and retention in follow-up between June 2021 - Sept 2024.

Results: 15,847 adolescents and young adults received an assessment in the community, of whom 3481/15847 (21.9%) were eligible for HIV prevention interventions. 3431/3481 (98.6%) accepted HBV screening, of whom 21/3431 (0.6%) tested positive for HBsAg. These 21 individuals had not previously been aware of their HBV status, but one was already on antiretroviral therapy for HIV infection. Amongst the remaining 20, 16/20 (80%) were considered eligible for PrEP, and 15 started PrEP. When investigating follow up and retention in care, among 14 individuals due for a refill 8/14 (57.1%) returned at least once.

Conclusion: Sexual reproductive health and PrEP programmes provide an opportunity for HBV testing and treatment. However, attrition from the care cascade at each step highlights the pressing need for interventions that address barriers to sustainable delivery of long-term care.