Hepatitis B treatment response and factors associated with HBV treatment success: A population-based study in Rwanda

Background: Timely treatment of chronic hepatitis B virus (HBV) infection reduces complications such as cirrhosis and hepatocellular carcinoma and improves overall survival. In Sub-Saharan Africa, data on HBV treatment success are limited, especially among people living with HBV mono-infection. We assessed the success of HBV treatment and associated factors among people diagnosed with HBV mono-infection and HIV co-infection. Methods: We used data from the District Health Information System 2 in Rwanda, covering 4.6 million screened individuals (January 2016–June 2023). Patients receiving HBV therapy for ≥12 months were included. Treatment success was defined as undetectable HBV DNA or normal ALT at 12 months. We used multilevel logistic regression to assess risk factors, accounting for clustering by hospital. Results: Among 4733 treated individuals (median age: 39 y, 58.4% male), 4518 (95.5%) achieved treatment success, increasing over time (90.3% for <2 y vs. 95.8% for ≥2 y of follow-up). Treatment success was mostly assessed by ALT normalization (87.5%). HBV mono-infected and HBV/HIV co-infected individuals had similar overall treatment success rates [3730 (95.5%) vs. 788 (95.2%)]. However, among those treated for <2 years, success was lower in HBV/HIV individuals [7 (43.8%) vs. 283 (92.7%)]. In multivariable analysis, HCV co-infection (aOR: 0.33; 95% CI: 0.12, 0.85), follow-up at provincial/referral hospitals (aOR: 0.26; 95% CI: 0.08, 0.86), and cirrhosis (aOR: 0.36; 95% CI: 0.20, 0.63) were associated with a lower likelihood of HBV treatment success. Conclusions: HBV treatment success in Rwanda was high but lower in those with HBV/HCV co-infection or cirrhosis, underscoring the need for early detection and monitoring.