The prevalence of and factors associated with hepatitis B and hepatitis C among men who have sex with men in Kigali, Rwanda

Rwanda has scaled up its viral hepatitis B (HBV) and C (HCV) prevention and treatment programs over the last decade. However, data to guide HBV and HCV programming for men who have sex with men (MSM) and transgender women (TGW) are limited. This analysis characterizes the epidemiology of HBV and HCV among MSM and TGW in Kigali, Rwanda. We leveraged stored plasma samples of 729 MSM/TGW recruited in Kigali using respondent-driven sampling (RDS) conducted between March and August 2018. Rapid diagnostic tests were used to screen for HBV surface antigen (HBsAg) and HCV antibodies (HCVAb). Viral load (VL) testing for HBV and HCV was performed for all positive samples. Approximate Bayesian logistic regression models using penalized likelihood estimation via data augmentation were used to assess factors associated with HBsAg and HCVAb positivity; adjusted odds ratios (aOR) and 95% profile-likelihood limits (PLL) from these models are reported. The mean age was 25 years (IQR: 22–31; range:18–68); 14.4% ( n = 106) of participants were TGW. Prevalence of HBsAg was 3.4% (25/729; RDS adjusted: 2.7%,95%CI: 1.2% – 4.2%). Most, 92.0%(23/25) had detectable HBV DNA, the median HBV DNA was 3.0 (IQR:1.9–3.7) log 10 IU/ml. Age (aOR:1.04; 95%PLL:1.00-1.09), having sexual partners who ever injected drugs (aOR:3.13; 95%PLL:1.51–6.53), and reporting STI symptoms in the year preceding study entry (aOR:2.11; 95% PLL:1.03–4.34) were associated with HBsAg positivity. HCVAb was detected in 1.6% (12/729; RDS adjusted: 1.7% (95%CI: 0.7% − 2.7%), including 33.3% (4/12) with detectable HCV RNA. Age was the only factor significantly associated with HCVAb positivity (aOR:1.06; 95%PLL:1.01–1.12). Ongoing screening for viral hepatitis among MSM and TGW in Rwanda is needed and can strengthen viral hepatitis prevention, diagnosis, treatment, and hepatocellular carcinoma (HCC) screening programs. The prevalence of HBV and HCV was highest among MSM/TGW aged 35 and older(HBsAg 7.6%; HCVAb 3.8%), a group in which we previously found higher prevalence of HIV and other STIs. Interventions tailored to the needs of older MSM/TGW are needed. Finally, the high burden of HBV among individuals whose partners inject drugs suggests that the networks of MSM/TGW who inject drugs overlap with the networks of those who do not inject drugs. For optimal public health impact, MSM/TGW programming should consider addressing both injection drug use and sex-related acquisition and transmission risks.