| Titre : | Delayed access to different diagnostic tests and its impact on accurate diagnosis of HBV-related liver diseases in Burkina Faso |
| Auteurs : | Nicole Kamikazi ; Ecole des hautes études en santé publique (EHESP) (Rennes, FRA) |
| Type de document : | Mémoire |
| Année de publication : | 2025 |
| Description : | 48p. |
| Langues: | Anglais |
| Classement : | MPH/ (Mémoires MPH à partir de 2024) |
| Mots-clés : | Hépatite virale B ; Test dépistage ; Diagnostic ; Fibrose ; Thérapeutique ; Burkina Faso |
| Résumé : |
Background: Hepatitis B virus (HBV) diagnostic tests are essential for evaluating the risk of progression to fibrosis and the decision for treatment eligibility. Access, particularly to HBV DNA and FibroScan, is often limited and delayed in resource-limited settings. While there are efforts to implement less expensive markers, their accuracy varies across different settings, and there is a lack of evidence on the impact of the delayed access on their accuracy.
Objectives: This study aims to (1) describe delays in completing prescribed HBV diagnostic tests, (2) evaluate how these delays impact the diagnostic accuracy of alternative fibrosis markers, namely APRI and FIB-4, and (3) assess the agreement level and accuracy of the different antiviral treatment eligibility criteria. Methods: In this retrospective cohort study, medical records of all consecutive persons living with HBV (n=630) followed at Bogodogo University Hospital Centre from 2014 to 2022 were extracted. Individuals were prescribed five tests: HBV DNA, FibroScan, HBeAg, transaminases, and platelet count, and test dates and results were recorded upon receipt of test outcomes. Individuals less than 18 years old and those with HIV or HCV coinfections were excluded from this analysis. In the diagnostic accuracy analysis, FibroScan was used as the reference test for fibrosis staging, while the 2017 European Association for the Study of the Liver (EASL) was used as the reference standard for treatment eligibility decision. Results: A substantial proportion of individuals were able to complete the essential tests required for treatment eligibility: 95.1% for ALT, 87.5% for HBV DNA, and 85.9% for FibroScan. Within 3 months of the first visit at Bogodogo, 57.6% completed HBV DNA testing, while 63.0% had a FibroScan. A testing delay of 1-month to 1-year was associated with increased odds of fibrosis diagnostic misclassification compared to a 3 days interval: OR: 2.28 (95% CI: 1.06- 5.10) using APRI and OR: 3.09 (95% CI: 1.20- 8.69) using FIB-4. In the presence of delays, agreement with EASL 2017 was lower for the 2024 WHO treatment guidelines (Cohen’s kappa=0.36) compared to alternative treatment eligibility criteria that are based on accessible tests, namely TREAT B (0.66) and HEPSANET (0.67). Conclusion: These findings highlight the negative impact of diagnostic delays on the accuracy of non-invasive fibrosis markers, and reinforces the prioritization of FibroScan for fibrosis staging. In settings where HBV DNA testing is unavailable, treatment decisions can rely on guidelines developed for resource-limited settings, TREAT B and HEPSANET. |
| Diplôme : | Master MPH of public health |
| Plan de classement simplifié : | Master of Public Health - master international de Santé Publique (MPH) |
| En ligne : | https://documentation.ehesp.fr/memoires/2025/mph/nicole_kamikazi.pdf |
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