Uptake of hepatitis B diagnostic services among hepatitis B patients; The case of Yumbe Regional Referral Hospital, Uganda.

Abstract

Background: Despite hepatitis B virus infection being a vaccine preventable liver disease, 257 million people are estimated to be chronically infected globally making it one of the commonest infections, causing more than 820,000 deaths annually worldwide. Uganda is one of the SSA that continues to be highly endemic with a prevalence of 4.3%, associated with poor clinical management of those infected and non-robust health care system. Objectives: Assess uptake of HBV diagnostic services among HBV patients at YRRH as well as factors affecting their uptake. Methods: Data was collected using both quantitative and qualitative approaches. Chi square and modified Poisson regression analyses were undertaken to determine association of factors. FGD and four KI interviews were conducted to explore the facilitators and barriers affecting the provision of hepatitis B services and data was analyzed using inductive thematic analysis. Results. Only 1.01% (2/199) patients up-took all 4 recommended tests and 26.6% (53/199) had taken at least one test. CBC was mostly consumed 38.2% (76/199) while USS was the least at 7% (14/199), 7.5% (15/199) patients were screened for HIV with 33.3% (5/15) being HIV/HBV coinfected. 61.3% (122/199) patients did not take any main recommended test and 31.2% (62/199) had a main test taken. Only 7.5% (15/199) had both main tests. Uptake of main tests was associated with timing of tests (χ2 = 94.9, P< 0.000), HIV/HBV coinfection (χ2 = 20.46, P<0.000), duration in care, (χ2=68.9, P<0.000), average distance to hospital (χ2 = 15.5, P<0.017), and time lag between diagnosis and treatment initiation (χ2 = 45.5, P<0.000). Timing of tests was the only factor statistically associated with uptake of main recommended tests (PR = 0.44, 95% CI 0.210 – 0.92). Facilitators for provision of HBV services included availability of commodities, effective teamwork and HCWs’ knowledge of the treatment guidelines, collaboration with IPs, good hospital infrastructure and community demand while the barriers were insufficient human resource, commodity stock outs, language barrier and non-functionality of equipment. Conclusion. There was poor uptake of recommended tests by HBV patients at YRRH. HCWs should endeavor to provide all recommended tests before HBV treatment initiation for appropriate clinical management of the patients.