SEROPREVALENCE OF HBsAg, HCV AND HIV AND ASSOCIATED RISK FACTORS IN A CORRECTIONAL FACILITY IN SOUTHERN NIGERIA: A CROSS-SECTIONAL STUDY

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O.G. Egbi¹, D.S. Oyedepo², I.R. Edeki³, D.A. Aladeh⁴, T. Ujah⁵, J.D. Okpiri⁵, O.A Adejumo⁶, O.A. Osunbor⁷, V.O. Ndu⁵, R. Madubuko³, S.O. Oiwoh8¹, M. Mamven⁹

1. Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria.
2. Department of Internal Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria.
3. Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo, Nigeria.
4. Department of Internal Medicine, Diete Koki Memorial Hospital, Yenagoa, Bayelsa State, Nigeria.
5. Department of Internal Medicine, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
6. Department of Internal Medicine, University of Medical Sciences, Ondo State, Nigeria.
7. Department of Internal Medicine, Stella Obasanjo Hospital, Benin City, Edo State.
8. Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
9. Department of Internal Medicine, University of Abuja, Abuja.

Abstract

Background: Incarceration has been known to increase the transmission of some blood-borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Correctional centres are thought to be the reservoir of these infections, thereby constituting a risk to the larger society when the individuals are released.

Objectives: The study determined the sero-prevalence of HBV, HCV, and HIV and associated factors for infections among people living in a correctional centre (PLCC) in Southern Nigeria.

Methodology: This was a cross-sectional study involving PLCC. An objectively structured questionnaire was administered to obtain socio-demographic information and data about the history of recreational drug use, previous incarceration, and duration of incarceration. Blood samples were screened for hepatitis B virus, hepatitis C virus and HIV.

Results: A total of 302 PLCC participated in this study with a male: female ratio of 12:1. The sero-prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV infections were 6.6%, 2% and 3.6% respectively. The co-infection rate of HBV/ HCV was 0.3% and HIV/HBV co-infection also 0.3%. There was a significant association between gender, ethnicity, monthly income and HBV status. History of genital rashes/discharge was also significantly associated with HCV status while ‘HIV status’ was associated with sharing of personal belongings, history of genital rashes/discharge and cigarette smoking.

Conclusion: HBV, HCV and HIV infections are prevalent among PLCC. The infections were associated with some socio-demographic and clinical variables.

Keywords: HBV-hepatitis B virus, HCV- hepatitis C virus, HIV- human immunodeficiency virus, PLCC- people living in correctional centre

Introduction

Incarceration has been known to increase the transmission of some blood-borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). People living in correctional centres (PLCC) have a significantly higher prevalence of these infections than the non-incarcerated general population.^1,2 These infections are of great public health importance with associated burdens because of the risks of chronicity, infections progression, high morbidity and mortality. Hepatitis B and C affect the liver causing both acute and chronic diseases. Hepatitis B caused 820,000 deaths globally in 2019 mainly through chronic liver disease, liver cirrhosis and hepatocellular carcinoma.³ Globally, 296 million people have chronic hepatitis B virus infection, 81 million of whom are in Africa.³ There are over 4 million acute clinical cases of HBV every year.³ The overall estimated sero-prevalence of hepatitis B in sub-Saharan Africa (SSA) remains high at 6.1%.⁴ The pooled prevalence of HBV in Nigeria is 9.5%, with the highest prevalence (12.1%) seen in the North West and the lowest (5.9%) seen in the South East geo-political zone.⁵ Globally, 58 million people have chronic hepatitis C infection with 1.5 million new cases per year. ⁶

Approximately, 290,000 people died from the virus worldwide in 2019.⁶ The overall adult prevalence of hepatitis C in SSA is 3.94%.7 The pooled prevalence of hepatitis C in Nigeria is 2.2%.⁸ Hepatitis C infection progresses to chronicity and expensive to treat. An estimated 39 million people were living with HIV at the end of 2022, two-third of whom are in SSA.⁹ Six hundred and thirty thousand people died from HIV-related causes and 1.3 million people were infected with HIV in 2022.⁹ The estimated national HIV prevalence is 2.1% with the highest prevalence in the South South zone and lowest in the North West zone.¹⁰

Hepatitis B and C are transmitted through body fluids such as blood, semen, saliva and vaginal fluids infection. Hepatitis C shares a similar mode of transmission like HBV but with a low sexual transmission rate. HIV infection occurs via sexual intercourse, shared intravenous drug use and during child birth or breastfeeding. HBV, HCV and HIV share the same common route of infection and co-infection. A systematic review of studies in Africa found the overall seroprevalences of HBV infection, HCV infection and HBV/HCV coinfection in people living with HIV to be 10.7%, 5.4% and 0.7% respectively.¹¹ Correctional centres are thought to be the reservoir of these infections and people living there could spread the infection to the larger society when released. Intravenous drug abuse, tattooing, high-risk sexual behaviours, poor quality of healthcare services, overcrowding, sub-optimal sanitary and environmental condition, higher level of illiteracy and previous imprisonment are some of the identified risk factors.^2,12 Overcrowding is a peculiar problem in Nigeria correctional centres with 63% of PLCC awaiting trials and the percentage of overcrowding put at 81% in southern Nigeria.¹³