Hepatitis B (HBV) is taken seriously in Rwanda due to its severe consequences. HBV is transmitted when blood or another body fluid from an HBV-infected person enters the body of an uninfected individual.
This transmission can occur through the sharing of needles, syringes, or other drug-injection equipment, or from mother to baby during childbirth.
According to Rwanda Biomedical Centre (RBC) statistics, between 2022 and 2023, a total of 475,625 people were screened for HBV, 7,639 of them (1.6 per cent) tested positive for Hepatitis B surface antigen (HBsAg), 1,711 (0.36 per cent) had detectable viral load and 1,123 were eligible and initiated on HBV treatment.
In terms of HBV management, almost five million people have been screened since screening services began in 2015. Up to 138,512 have tested positive for HBsAg, and 8,258 have been put on HBV treatment to date.
The analysis of Hepatitis B by province showed that the Western Province screened the highest number of people (124,686), while the Northern Province screened less (55,987). The highest proportion of positivity was observed in the Eastern Province (1.95 per cent) and the Southern Province (1.87 per cent) respectively.
In regards to districts, Gatsibo in Eastern Province, and Gisagara in Southern Province, had the highest HBs Antigen positivity rates, between 2.79 per cent and 3.79 per cent.
Almost all the districts with high positivity rates are located near the borders, suggesting potential cross-border transmission.
What is being done to control Hepatitis B?
Sensitisation and screening
According to RBC's 2022-2023 report on HIV, STI, and viral hepatitis programmes, public awareness of diseases is key for their control and elimination. In 2022-2023, the population was continuously informed about viral hepatitis and STIs through radio and TV broadcasts and live chats to answer questions from the public.
This, according to RBC, resulted in increased demand for health services and behaviour change, as well as demand for screening, as shown in the following figure; a total of 475,625 people were screened for HBV.
Rwanda's national HBV guidelines suggest that all pregnant women should be routinely screened for HBsAg at first contact and delivery, and followed up to determine whether they are infected and can benefit from treatment, but also to prevent the transmission from mother to child.
Vaccination
Vaccination is also a key solution for the prevention of Hepatitis B. Infant immunization against HBV has been in place since 2002 in Rwanda, and the national coverage reached 99 per cent in 2020 (Rwanda DHS, 2019-2020). Subsequently, more than 7,000,000 individuals benefited from the service.
From July 2022 to June 2023, a total of 351,181 children were vaccinated against HBV as part of the pentavalent vaccine, 312 children born to HBV-infected mothers received the HBV vaccine within 24 hours of birth and 18,531 adults were vaccinated against HBV.
Triple elimination of mother-to-child transmission of HIV, syphilis, and hepatitis
As a public health priority, Rwanda has pledged to implement the triple elimination of mother-to-child transmission of HIV, syphilis, and Hepatitis B. The triple e-MTCT programme is aimed at promoting a cohesive strategy for improving mothers' and their children's outcomes.
Rwanda has long been implementing a double elimination of HIV and syphilis, and in the current fiscal year, 365,759 pregnant women were screened for HIV with a positivity rate of 0.4 per cent. 289,648 pregnant women were screened for syphilis, and 2,772 (0.96 percent) were confirmed positive.
In the context of universal health coverage and the integration of communicable disease prevention and control services, Rwanda is in the process of moving from double elimination to triple elimination, where, in addition to HIV and syphilis screening, HBV screening is mandatory for all pregnant women as a full package at their first visit.
The triple elimination plan aims to guarantee the quality, availability, and accessibility of reproductive, maternal, and child health (MCH) services. To date, more than a third of Rwanda's health facilities have begun comprehensive screening of pregnant women for HIV, syphilis, and HBV.
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Specific guidelines for triple elimination are under development, as is a functional surveillance system to comprehensively identify and track women living with, or at risk of, these three infections, as well as infant outcomes.
Training on hepatitis management
In addition to trained healthcare providers who can manage hepatitis B, 2,612 more healthcare providers were trained on viral hepatitis and STIs in 2022-2023 to continuously strengthen STIs and hepatitis B management.
These included 46 hospital directors, 30 directors of health at the district level, 92 nurses in different hospitals, 92 medical doctors, 92 data managers in different hospitals, 1,130 heads of health centres, and 1,130 data managers at health centres.
