Hepatitis B virus contact disclosure and testing in Lusaka, Zambia: a mixed-methods study

Sarah Franklin, Amina Mouliom, Edford Sinkala, Annie Kanunga, Anna Helova, Jodie Dionne-Odom, Janet M Turan, Michael Vinikoor, Sarah Franklin, Amina Mouliom, Edford Sinkala, Annie Kanunga, Anna Helova, Jodie Dionne-Odom, Janet M Turan, Michael Vinikoor

Abstract

Objectives: The aim of this study was to estimate the frequency of disclosure to and testing of contacts of patients with hepatitis B virus (HBV) in Zambia.

Design: We used a convergent parallel mixed-method research design including a quantitative survey and focus group discussions with patients with HBV.

Setting: A university hospital in Lusaka, Zambia.

Participants: 79 hepatitis B surface antigen (HBsAg)-positive, HIV-negative, adults (18+ years) receiving HBV care completed a quantitative survey and 32 also participated in a focus group discussion.

Outcomes and analysis: Contacts of patients with HBV were enumerated and patient-reported disclosure, contact testing and contact HBV test results were used to develop a testing cascade. Using multivariable logistic regression, we identified factors associated with disclosure of HBV status. In focus groups, we explored how index patient knowledge and awareness of their condition shaped perspectives on contact disclosure and testing. Focus groups coding and analysis followed a thematic analysis approach.

Results: Among 79 patients with HBV (median age 35 years; 26.6% women), the majority reported disclosure to ≥1 contact. According to the index patients' knowledge, of 776 contacts enumerated, 326 (42.1%) were disclosed to, 77 (9.9%) were tested, 67 (8.6%) received results and 8 (11.9%) were HBsAg-positive. Increased stigma score was associated with reduced disclosure. In focus groups, HBV awareness, knowledge and stigma emerged as barriers to disclosure and referral of contacts for testing. Association of HBV with HIV-related stigma was also reported as a strong barrier to contact disclosure and testing and to taking antivirals for HBV monoinfection.

Conclusions: HBV contact disclosure and testing were feasible and yielded new diagnoses in Zambia. A better understanding of barriers to seeking HBV testing and treatment is needed to scale-up this important intervention in Africa.

Trials registration number: NCT03158818.

Keywords: contact testing and disclosure; hepatitis B virus; stigma; sub-saharan africa.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Hepatitis B testing cascade among contacts to hepatitis B surface antigen (HBsAg)-positive Zambian adults.
Figure 2
Figure 2
Disclosure of chronic hepatitis B status to contacts according to relationship with the index case.

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