Chronic viral hepatitis B: evaluation of the care of patients monitored at the SMIT in Tivaouane, Sénégal.

Objectives: Chronic hepatitis B is a liver-tropic disease caused by hepatitis B virus (HBV) with hepatitis B surface antigen persisting beyond 6 months. According to a 2024 report by the Pasteur Institute, the prevalence of chronic HBV infection in Senegal is alarming, ranking among the highest in the world, between 10 and 17%. Senegal currently does not have a standardized algorithm for the management of chronic hepatitis B. Since 2017, the European Association for the Study of the Liver (EASL) has proposed a new classification of chronic hepatitis B and a surveillance scheme. The objective was to evaluate the management of patients with viral hepatitis B in rural areas according to the EASL criteria. Methods: Retrospective and prospective, descriptive study with analytical aim from March 15, 2022 to December 7, 2024, at the SMIT Mame Abdou Aziz Sy Dabakh hospital in Tivaouane. Included were patients with chronic hepatitis B who had benefited from an initial management assessment according to the criteria of the EASL. Data were captured using Kobocollect software, encoded, and analyzed using R software, V.4.4.0. Ethical considerations were respected. Results: We collected 72 patients. The median age was 34 years (28-41), with a female predominance (56.9%). Housewives (34.7%) and teachers (16.7%) were the most represented. The notion of familial liver cancer (16.67%) was reported with 41.67% in the first degree as well as in the second degree. The discovery of HBV carriage was made during an assessment initiated by the practitioner (63.9%), prenatal assessment (19%), and during a blood donation (9.7%). Nine patients (12.51%) were symptomatic. The hepatitis B e-antigen dosage was negative in 69 patients (95.53%). The median alanine aminotransferase levels were 23.10 IU/l (16-32.25) and viral load 379.5 IU/ml (37-1562). Two hepatitis D virus/HBV co-infections were observed. Fibrosis (F0-F1) was found in 82.5% of cases, F2-F3 in 14.3%, and cirrhosis in 3.2%. Tenofovir disoproxil fumarate treatment was initiated in 10 patients (13.9%), according to the 2017 EASL guidelines. Ineligible patients (86.1%) were placed on surveillance, the rate and frequency of which depended on the initial phase. Among the patients lost to follow-up, 42 were under surveillance (67.64%) and four were under treatment (40%). Lack of treatment and high cost of care were the main reasons for exclusion from follow-up. In multivariate analysis, no factor was significantly associated with loss to follow-up. Conclusions: Our study highlights the challenges of managing chronic viral hepatitis B in rural areas. The high cost of monitoring and the lack of treatment for the majority of patients contribute to loss of follow-up.