title: Prevalence of HIV and hepatitis B virus co-infection in sub-Saharan Africa and the potential impact and program feasibility of hepatitis B surface antigen screening in resource-limited settings.
abstract: BACKGROUND
  Screening people living with HIV for hepatitis B virus (HBV) co-infection is recommended in resource-rich settings to optimize HIV antiretroviral therapy (ART) and mitigate HBV-related liver disease. This review examines the need, feasibility, and impact of screening for HBV in resource-limited settings (RLS).
  
  
  METHODS
  We searched 6 databases to identify peer-reviewed publications between 2007 and 2013 addressing (1) HIV/HBV co-infection frequency in sub-Saharan Africa (SSA); (2) performance of hepatitis B surface antigen (HBsAg) rapid strip assays (RSAs) in RLS; (3) impact of HBV co-infection on morbidity, mortality, or liver disease progression; and/or (4) impact of HBV-suppressive antiretroviral medications as part of ART on at least one of 5 outcomes (mortality, morbidity, HIV transmission, retention in HIV care, or quality of life). We rated the quality of individual articles and summarized the body of evidence and expected impact of each intervention per outcome addressed.
  
  
  RESULTS
  Of 3940 identified studies, 85 were included in the review: 55 addressed HIV/HBV co-infection frequency; 6 described HBsAg RSA performance; and 24 addressed the impact of HIV/HBV co-infection and ART. HIV/HBV frequency in sub-Saharan Africa varied from 0% to >28.4%. RSA performance in RLS showed good, although variable, sensitivity and specificity. Quality of studies ranged from strong to weak. Overall quality of evidence for the impact of HIV/HBV co-infection and ART on morbidity and mortality was fair and good to fair, respectively.
  
  
  CONCLUSIONS
  Combined, the body of evidence reviewed suggests that HBsAg screening among people living with HIV could have substantial impact on preventing morbidity and mortality among HIV/HBV co-infected individuals in RLS.
authors.affiliation: *United States Department of State, Office of the US Global AIDS Coordinator and Health Diplomacy, Washington, DC; †Division of Viral Hepatitis, National Center for HIV/AIDS, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA; ‡Office of HIV and AIDS, Bureau for Global Health, United States Agency for International Development, Washington, DC; §US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; and ‖The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD.
authors.forename: Lara
authors.initials: L
authors.lastname: Stabinski
authors.forename: Siobhan
authors.initials: S
authors.lastname: OʼConnor
authors.forename: Matthew
authors.initials: M
authors.lastname: Barnhart
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Kahn
authors.forename: Tiffany E
authors.initials: TE
authors.lastname: Hamm
mesh_terms: D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D060085:Coinfection; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000150:complications* / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D062489:Health Impact Assessment; D006295:Health Resources; D006509:Hepatitis B / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D008403:Mass Screening; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D011934:Reagent Strips
chemical_list: D044966:Anti-Retroviral Agents; D006514:Hepatitis B Surface Antigens; D011934:Reagent Strips