Addressing the Silent Epidemic of Hepatitis B Virus: Awareness, Screening and Vaccination Efforts in Abuja, Nigeria

doi:10.21203/rs.3.rs-5079063/v1

Background: Hepatitis B virus (HBV) is a major global health threat, especially in Sub-Saharan Africa, where Nigeria has a prevalence exceeding 8%. Despite the availability of effective vaccines, inadequate coverage and lack of awareness have resulted in high rates of chronic infections and HBV-attributable liver disease. The study aimed to raise awareness of HBV across various communities and to enroll participants for HBV screening and vaccination.

Methods: A cross-sectional study was conducted in 16 districts of Abuja from April 2022 to March 2023. Participants aged 18 and over were screened for hepatitis B, and those testing negative were offered on-site vaccination. Blood samples were collected and tested using HBV immunochromatographic tests and real time polymerase chain reaction (RT-PCR) for HBV DNA quantification. Data were collected through interviews and analyzed using R software, with descriptive statistics calculated for continuous and categorical variables. Associations between socio-demographic factors and hepatitis B/vaccine status were assessed using the Chi-square test of independence.

Results: Out of 3,245 individuals screened, 141 (4.3%) tested positive for HBV. The highest prevalence was observed in the 20–39 age group (5.9%), with males showing a higher infection rate (5.4%) compared to females (3.7%) [p = 0.02]. The mean age of HBV-positive individuals was significantly lower (30.8 years) than those negative for HBV (36.2 years) [p = <0.001]. Among 2,506 participants who consented to vaccination, 2,488 received the first dose, 1,834 the second dose (73.2%), and 1,100 the third dose (43.9%). Vaccination uptake declined with each subsequent dose, but higher proportions of older participants completed the third dose. A similar pattern of HBV prevalence was observed across gender and age groups.

Conclusion: The study reveals a 4.3% prevalence of hepatitis B, with the highest infection rate among individuals aged 20–39 years, and males showing a higher prevalence than females. Although vaccination uptake was high for the first dose, adherence declined for subsequent doses. These findings highlight the need for targeted public health interventions, particularly among younger adults and males, to improve awareness and vaccination completion. Enhanced community engagement and sustained vaccination efforts are crucial for reducing HBV transmission and achieving better coverage.

Hepatitis B Virus

Rapid Diagnostic Testing

Polymerase Chain Reaction (PCR)

Screening

Vaccination

Awareness

Hepatitis B virus (HBV) is a hepatotropic virus that can cause life-threatening liver damage, representing a significant global health concern. It is estimated that 248 million people live with chronic HBV infection worldwide [1]. The prevalence of HBV surface antigen (HBsAg) is 8.83% in Africa and 5.26% in the Western Pacific, with a global seroprevalence of 3.61% [1]. Nigeria, in Sub-Saharan Africa, is hyper-endemic for HBV infection, with a prevalence rate exceeding 8% [2]. A meta-analysis of 46 Nigerian studies places the average prevalence at 13.6% [3]. HBV is a leading cause of liver disease morbidity and mortality globally, accounting for over 360 million cases of chronic hepatitis and 620,000 deaths annually [3].

In Sub-Saharan Africa, HBV is responsible for 44% of cirrhosis cases and 47% of hepatocellular carcinoma [4, 5]. Despite the availability of a highly effective and affordable recombinant DNA vaccine since 1982, and its introduction in Nigeria in 1995, vaccination programs have suffered from inadequate government funding and widespread community misconceptions [6]. As a result, vaccination coverage remains low, with UNICEF and the World Health Organization (WHO) estimating that only 41% of Nigerians were vaccinated against HBV in 2013 [7]. The virus can lead to chronic infections, significantly increasing the risk of childhood hepatic failure, cirrhosis and liver cancer [3]. Approximately nine in ten Nigerians with chronic HBV are unaware of their infection status, and are thus absent from the global public health statistics due to a lack of resources, awareness, and political will to address Nigeria’s HBV plight [3]. Consequently, Nigeria has one of the highest rates of HBV-attributable cancer in West Africa, with an age-standardized incidence estimate of 2.6 to < 5.1 cases per 100,000 persons [8].

The lack of affordable diagnostics, such as specialized immunoassays and nucleic acid tests, along with high out-of-pocket costs for vulnerable populations, poses significant barriers to eliminating HBV in Nigeria, making it a critical public health threat. Although clinical and epidemiological research on HBV infection in Nigeria is advancing, it has yet to attract the necessary funding and investment [9]. In regions with high endemicity, where at least 8% of the population are chronic HBV carriers, the virus is primarily contracted at birth or in early childhood, often through perinatal transmission from mother to child. Approximately 90% of individuals infected during the perinatal period, 30% of those infected in early childhood, and 6% of those infected after the age of five develop chronic HBV infection. Among adults, transmission typically occurs through contact with infected blood and bodily fluids, such as semen, vaginal fluids, and saliva. Common routes of spread include unscreened blood transfusions, sexual activities, the use of contaminated or inadequately sterilized instruments, and sharing sharp objects during traditional or cultural practices, such as local circumcisions. Horizontal transmission, such as long-term household contact without sexual involvement, is also prevalent in highly endemic regions [4].

HBV is also recognized as an occupational health hazard for healthcare practitioners [4]. Despite growing awareness of hepatitis, understanding of HBV remains limited in Nigeria, especially concerning vaccination coverage among adults. Combating HBV requires comprehensive knowledge of its causes, prevention, and a commitment to implementing these strategies through both individual and collective responsibility in preventing, diagnosing, and treating infections [10]. Although an effective HBV vaccine is available, studies have shown low vaccine uptake, particularly in rural communities, due to insufficient awareness and sensitization efforts [6].

The risk of contracting HBV in Nigeria is substantial, not only due to low vaccination rates but also because as much as 75% of the population is expected to be exposed to the virus at some point [11]. Various studies have reported differing national and risk group-specific estimates. Previous reports suggest an HBV prevalence of 10–15% in the general Nigerian population [12]. High prevalence rates have also been documented among specific groups, such as surgeons (25.7%), voluntary blood donors (23.4%), and infants (16.3%) [13–15]. In 2013, a study conducted in Kano, Nigeria, found that 12.3% of 440 HIV-positive patients were co-infected with HBV [16]. Although pregnant women are generally considered a low-risk group for HBV infection, rates as high as 11% have been reported in Nigeria [17]. Hepatitis B remains the most common cause of chronic liver disease in Nigeria. In the southern region, up to 58.1% of patients with chronic liver disease tested positive for HBsAg [18].

According to Nigeria's National Guidelines for the Prevention, Care, and Treatment of Viral Hepatitis B & C, there is a global goal to eliminate viral hepatitis by 2030, as endorsed by the United Nations member states during the 59th World Health Assembly in 2016 [19]. This target has spurred vaccination campaigns by various organizations aiming to eradicate HBV. Given the severe consequences of HBV infection, understanding its epidemiology is crucial, especially in low-income settings. Experts in viral hepatitis stress the importance of prioritizing vaccination efforts. The hepatitis B vaccine is highly immunogenic, offering 90–100% protection when the full vaccination schedule is completed in infants, children, and adults [20].

In line with this global aspiration, the Remedium Plus Foundation, a non-profit, non-governmental organization affiliated with the Society of St. Vincent De Paul at St. Benedict Catholic Church in Lokogoma, Abuja, Nigeria, initiated a campaign in underserved rural communities in Abuja. This campaign aimed to screen for HBV, determine its prevalence, and provide immunoassay and nucleic acid testing for individuals who tested positive.

Study Area

A cross-sectional study was conducted in sixteen randomly selected districts of Abuja: Lokogoma, Dogongada, Kabusa, Sherriti, Ndako, Utako, Gwagwalada, Kubwa, Waru, Gwarinpa, Apo Mechanic, Asokoro, Wuse, Garki, and Dagba - Area 1. The study spanned from April 2022 to March 2023. Abuja, the capital city of Nigeria, is located in the central part of the country within the Federal Capital Territory (FCT). It became the capital in 1991 and has since experienced rapid population growth, with the metro area population estimated to exceed 4 million by 2024 [21]. The city's landscape is characterized by savanna vegetation and is underlain by crystalline rocks, including granites and gneisses.

Study Population

The study targeted residents of selected districts in Abuja, including those who were working or schooling outside the district but were present during the screening and vaccination period. Eligible participants were individuals aged 18 years and older who provided written informed consent. Exclusions were made for individuals under the age of 18 and those who did not provide written informed consent.

Community Engagement

Effective community engagement played a vital role in the study. Information was disseminated through various channels, including religious organizations, social media platforms, and estate communication networks. To raise awareness about hepatitis, health talks were conducted, providing the community with essential knowledge and encouraging active participation.

Data Collection Method

Trained field workers conducted face-to-face interviews, ensuring accurate and thorough data collection. Participants were screened for hepatitis B during these interviews, and those who tested negative were immediately offered on-site vaccination. For participants who tested positive for HBV, a detailed life history was documented, with a focus on identifying potential risk factors.

Screening with Rapid Diagnostic Tests (RDT)

Rapid Diagnostic Test (RDT) was used to screen participants for HBV infection, during the first stage of the screening process. Briefly, the study participants had their thumbs swabbed with 70% ethanol to ensure aseptic conditions. A lab technician then swiftly pricked each participant’s finger using a sterile lancet, and the blood sample was promptly applied to RDT, which was pre-labeled with a unique numerical identifier for tracking. The results were interpreted following the manufacturer’s instructions. All used needles were safely discarded in a sharp’s container, while the RDT kits and other consumables were disposed of in a designated waste bag to maintain proper biohazard protocols. These tests meet the World Health Organization’s “ASSURED” criteria: Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end-users [22].

Specimen Collection and Analysis for Confirmatory Testing of HBV Positive Cases

A 3 ml blood sample was collected from each participant using standard venipuncture phlebotomy. The blood was carefully transferred into sterile, plain sample containers, with each tube appropriately labeled with the participant's identification number. The serum was separated by first allowing the blood to clot at room temperature, followed by centrifugation at 2500 rpm for 10 minutes. After separation, the serum was transferred into serum aliquot containers and stored at -20°C until laboratory analysis. All stored samples were analyzed in batches within seven days of collection. During these procedures, all form of work area contamination, spills and aerosols were minimized.

Laboratory analytical methods

HBV Immunochromatographic Test

The HBV immunochromatographic test employs two assay techniques to detect HBV markers in serum samples. The direct antigen-antibody-antigen "Sandwich" method is used to identify HBsAg, HBsAb, HBcAg, and HBeAg. This technique involves immunochromatographic strips containing gold nanoparticles pre-coated with monoclonal antibodies specific to these antigens. These tests work on the principle of antigen-antibody reactions, which, in the presence of a chromogen, produce a visible reaction after 15 minutes. The results are interpreted according to the kit manufacturer's instructions. For detecting HBcAb, an indirect antigen-antibody-antibody assay method was used.

HBV RT-PCR (Real-Time Polymerase Chain Reaction)

The HBV RT-PCR method involves the use of fluorescent probes to detect and quantify HBV DNA. During PCR, if the target HBV DNA is present, the probe will specifically bind between the forward and reverse primers. The 5'-3' exonuclease activity of Taq polymerase cleaves the probe, leading to an increase in fluorescence from the reporter, which is proportional to the amount of accumulated product. The normalized reporter signal (Rn) is calculated by dividing the reporter signal by the passive reference signal. The delta Rn (DRn), representing the difference between the normalized reporter signal and the pre-PCR reporter signal, increases as the target DNA is amplified. A relative fluorescent emission threshold is set, based on the baseline of the first 15 cycles, and the threshold cycle (Ct) is determined, which reflects the starting quantity of HBV DNA. DNA was extracted from 100 µl of serum using the SMI test EX-R and D (Sumitomo Metal Industries, Tokyo, Japan) according to the manufacturer’s instructions. Next, DNA was purified and suspended in 20 ml of distilled water. A 10-µl aliquot of this solution was used for RT-PCR, performed with a PCR core reagent kit (RoboGene ®, Analytika Jena, Germany) and an ABI 7700 sequence detector system (Perkin Elmer, Foster City, Calif.). The amplification reaction mixture includes DNA solution, TaqMan buffer, nucleotides, primers, TaqMan probe, AmpliTaq Gold DNA polymerase, and Amp Erase uracil N-glycosylase (UNG). The thermal cycling conditions involved an initial UNG activation at 50°C for 2 minutes, followed by Taq Gold activation and UNG inactivation at 95°C for 10 minutes, and 53 cycles of amplification at 95°C for 20 seconds and 60°C for 1 minute. Quantification of HBV DNA was conducted as a blind test, with real-time data acquisition and analysis.

By utilizing RDTs for initial screening and follow-up confirmatory tests for positive cases, we ensured a robust and reliable approach to identifying HBV infection among the study participants. This method allowed for timely identification and appropriate referral for further medical care and intervention [23].

Data Analysis

The data were analyzed using R statistical software version 4.4.1. The study included a total of 3,245 respondents, with data collected on variables such as age, sex, hepatitis B status, and the number of vaccine doses administered. Age, a continuous variable, was categorized based on existing knowledge of the disease and evidence from prior research. Descriptive statistics were computed, including mean and standard deviation, as well as median and interquartile range for continuous variables. For categorical variables, frequency and percentage distributions were calculated. To assess associations between socio-demographic factors and hepatitis B status or vaccine status, the Chi-square test of independence was employed.

Out of 3,245 individuals screened, 2,025 (62.4%) were females, 1,941 (59.8%) were aged 29-39 years (Table 1). The mean age of respondents was significantly lower among those who tested positive for hepatitis B (30.8 years) compared to those who tested negative (36.2 years) [p = <0.001]. Of those screened, 141 (4.3%) tested positive for HBV. The highest prevalence of hepatitis B was observed in the 20 - 39 years age group (5.9%), followed by the 0 - 19 years age group. The least prevalence was found in the 60+ years age group. Additionally, the prevalence of hepatitis B was significantly higher among male respondents (5.4%) compared to female respondents (3.7%) [p = 0.02].

Table 1. Socio-demographic characteristics by hepatitis B status of respondents

Variable	N	Overall, N = 3,245 Frequency (%)	Negative, N = 3,104 Frequency (%)	Positive, N = 141 Frequency (%)	p-value
Age (years)	3,154				<0.001
Mean (SD)		35.9 (12.4)	36.2 (12.5)	30.8 (8.8)
(Missing)		91	90	1
Age category	3,154				<0.001
0-19		157 (100.0%)	151 (96.2%)	6 (3.8%)
20-39		1,941 (100.0%)	1,827 (94.1%)	114 (5.9%)
40-59		870 (100.0%)	851 (97.8%)	19 (2.2%)
60+		186 (100.0%)	185 (99.5%)	1 (0.5%)
(Missing)		91	90	1
Gender	3,243				0.020
Female		2,025 (100.0%)	1,950 (96.3%)	75 (3.7%)
Male		1,218 (100.0%)	1,152 (94.6%)	66 (5.4%)
(Missing)		2	2	0

For the vaccination program, 2506 participants provided written informed consent although only 2,488 (99.3%) participants received the first dose. For the second dose, 1,834 (73.2%) were vaccinated. Finally, for the third dose, 1,100 (43.9%) participants received the vaccine, while 1,406 did not (Table 2).

Table 2. Summary of Hepatitis B Vaccine Status by Age and Location

Variable	1st Dose			2nd Dose			3rd Dose
Variable	Not received, N = 18 (%)	Received N = 2,488 (%)	p-value	Not received N = 672 (%)	Received N = 1,834 (%)	p-value	Not received N = 1,406 (%)	Received N = 1,100 (%)	p-value
Age			0.8			<0.001			<0.001
Mean (SD)	34.9 (11.4)	36.0 (15.8)		34.8 (22.9)	36.4 (12.2)		34.8 (18.2)	37.6 (11.8)
Age category			>0.9			0.005			<0.001
0-19	0 (0.0%)	108 (100.0%)		29 (26.9%)	79 (73.1%)		72 (66.7%)	36 (33.3%)
20-39	11 (0.7%)	1,559 (99.3%)		456 (29.0%)	1,114 (71.0%)		918 (58.5%)	652 (41.5%)
40-59	5 (0.7%)	678 (99.3%)		151 (22.1%)	532 (77.9%)		340 (49.8%)	343 (50.2%)
60+	1 (0.7%)	137 (99.3%)		31 (22.5%)	107 (77.5%)		70 (50.7%)	68 (49.3%)
Location						<0.001			<0.001
Area 1 - Dagba	0 (0.0%)	75 (100.0%)		15 (20.0%)	60 (80.0%)		41 (54.7%)	34 (45.3%)
Asokoro	0 (0.0%)	132 (100.0%)		17 (12.9%)	115 (87.1%)		20 (15.2%)	112 (84.8%)
Dnako	0 (0.0%)	265 (100.0%)		30 (11.3%)	235 (88.7%)		104 (39.2%)	161 (60.8%)
Dogongada	2 (0.6%)	333 (99.4%)		88 (26.3%)	247 (73.7%)		226 (67.5%)	109 (32.5%)
Garki	0 (0.0%)	135 (100.0%)		26 (19.3%)	109 (80.7%)		67 (49.6%)	68 (50.4%)
Gwagwalada	0 (0.0%)	148 (100.0%)		37 (25.0%)	111 (75.0%)		69 (46.6%)	79 (53.4%)
Kabusa	6 (2.5%)	236 (97.5%)		93 (38.4%)	149 (61.6%)		165 (68.2%)	77 (31.8%)
Kubira	0 (0.0%)	160 (100.0%)		30 (18.8%)	130 (81.3%)		89 (55.6%)	71 (44.4%)
Lokogoma	5 (1.2%)	421 (98.8%)		108 (25.4%)	318 (74.6%)		261 (61.3%)	165 (38.7%)
MACC	1 (1.0%)	95 (99.0%)		18 (18.8%)	78 (81.3%)		49 (51.0%)	47 (49.0%)
OLQP	2 (1.4%)	143 (98.6%)		52 (35.9%)	93 (64.1%)		91 (62.8%)	54 (37.2%)
Sherriti	1 (0.7%)	148 (99.3%)		111 (74.5%)	38 (25.5%)		138 (92.6%)	11 (7.4%)
Waru	1 (0.5%)	197 (99.5%)		47 (23.7%)	151 (76.3%)		86 (43.4%)	112 (56.6%)

The highest proportion of male respondents were seen among the 35 - 39 years age category while the highest proportion of female respondents were seen among the 25 - 29 years age category (Figure 1). There were nearly two times more females (62.4%) than males (37.6%).

Figure 1. Age and sex distribution of all respondents, Abuja, 2023. This figure illustrates the demographic breakdown of participants by age and gender. The majority of respondents fall within the 20–39 years age group, with females representing a larger proportion of the study population. As age increases, the number of participants in both gender categories declines, highlighting a concentration of younger individuals in the study. This distribution reflects the study's focus on an active, predominantly younger demographic, with potential implications for interpreting the results related to hepatitis B prevalence.

A similar trend in hepatitis B positivity is observed in both males and females, as shown in Figure 2. The highest prevalence occurs in the 20–39 age group and gradually decreases with age. However, a notable finding is seen in older age groups, where only males had positive cases beyond 50 years of age when compared with females.

Figure 2. Distribution of age by gender for Hepatitis B positive respondents in Abuja, 2023. This figure shows the breakdown of individuals who tested positive for hepatitis B by age and gender. The highest prevalence is observed in the 20–39 years age group for both males and females, after which the prevalence declines. However, a notable trend is observed beyond the age of 50, where only males tested positive for hepatitis B.

Hepatitis B vaccination coverage across locations shows that almost all respondents received the first dose of the vaccine. However, there was a noticeable decline in the proportion of individuals receiving the second and third doses. The most significant reduction occurred in the Sherriti location, where many participants did not follow through with the subsequent doses. In contrast, Asokoro maintained nearly 100% vaccination coverage across all three doses, reflecting a higher level of adherence to the vaccination schedule in that area (Figure 3).

Figure 3. Distribution of vaccine status by location of residents in Abuja, 2023. This chart displays the coverage rates for each dose of the hepatitis B vaccine across different locations. While almost all respondents received the first dose, there was a noticeable decline in coverage for the second and third doses. The Sherriti location experienced the greatest reduction in vaccination rates, whereas Asokoro achieved near-complete vaccination coverage for all three doses. This variation highlights differences in vaccine uptake and adherence across the study areas.

Vaccine status by dose shows that nearly the entire population received the first dose of the hepatitis B vaccine (Figure 4). However, there was a progressive decrease in the proportion of individuals receiving the second and third doses. Notably, a higher proportion of older individuals completed all three doses, indicating better adherence to the vaccination schedule among this age group. This trend underscores the need for targeted efforts to improve completion rates for the second and third doses, particularly among younger populations.

Figure 4. Distribution of Vaccination Status by Dose received among various age groups in Abuja, 2023.

This study reveals important sociodemographic differences that require attention and offers crucial insights into the epidemiology of HBV in the study area. This conversation revolves on the screening for HBV and determines the prevalence of HBV infection in some underserved suburbs. It also offers insights from the research and recommendations for future intervention paths.

The Health Fair program organized by the Remedium Plus Foundation successfully screened 3,245 individuals, far exceeding its initial target of 1,000 people and recorded a prevalence of 4.3%. In comparison, a similar study conducted in Lagos State, Nigeria, screened 4,862 individuals and reported a prevalence rate of 2.1%, with 100 positive cases [24]. Other studies in Nigeria have reported varying prevalence rates of HBV. For instance, in the North-East region, an 8.2% prevalence was observed among pregnant women, while a lower prevalence of 2.5% was reported among blood donors in South-West Nigeria [25, 26]. Although another study in north west Nigeria reported a much higher prevalence of 15.1% among pregnant women [27].

These regional differences highlight the impact of specific risk factors and population characteristics on HBV transmission. Our study area included localities close to internally displaced persons (IDP) camps, which are known to have high-risk populations, including sex workers. These camps often have higher rates of HBV due to increased exposure to risk factors such as unprotected sex and limited access to healthcare services. This proximity likely contributed to the increased prevalence rate observed in our study compared to Lagos, where the population distribution and risk factors may differ [24]. The findings underscore the need for targeted interventions and vaccination programs in high-risk areas, including those near IDP camps, to effectively control the spread of HBV.

A similar study conducted in Senegal found a significantly higher HBV prevalence of 13.6% among healthcare workers [22]. This elevated prevalence may be attributed to the increased risk healthcare workers face due to their occupational exposure to infections, placing them in a higher-risk category compared to the general population. Frequent contact with blood and bodily fluids, as well as needle stick injuries, are potential contributors to the heightened vulnerability of healthcare workers to HBV infection.

The age group 20–39 had the highest participation rate, followed by the 40–59 age group in the present study. The Lagos study had a median age of 33 years, with most positive cases being between 21 and 30 years old [24]. Our results are similar to those of another study among pregnant women in North west Nigeria where the highest HBV seropositivity was observed in the age group 21-25 years [27]. This higher participation in the younger age group could be attributed to several factors, including increased exposure to risk behaviors such as multiple sexual partners, a history of blood transfusions, surgeries, or hospitalizations, and traditional practices like tattoos, piercings, scarification, and circumcision [28]. Additionally, this age group is more likely to be active on social media and other platforms where information about hepatitis B is disseminated. Other risk factors, such as drug use, unprotected sex, alcohol abuse, and injuries from sharp objects, are also more prevalent among individuals in this age range [29].

According to gender distribution, there were more female respondents than male respondents in the present study. The Lagos study had predominantly male HBV positive cases [24]. Our results are in contrast to the observation among blood donors where more males tested positive for HBV [26]. This could be because women are inherently more likely than men to engage in health-seeking behaviors due to their innate maternal instinct, most pregnant women are checked for HBV as a requirement for antenatal registration, which makes it easier for them to show up for follow-up or future screening when opportunity arises.

Another study in Egypt shares a similar finding, the frequency of HBV in men and women found that men were more likely to contract the virus (3.75%) than women (2.2%) [30]. The observed gender gap could potentially be explained by variations in risk behaviors, including high rates of unprotected sexual activity and occupational exposures in men. Males continued to test positive for HBV after the age of 50, according to the findings, which may be related to persistent risky behavior or delayed onset of symptoms compared to females.

Nigeria, a West African country, has a lower HBV vaccination rate compared to many other Sub-Saharan African nations [31]. During the study, all individuals present on the designated screening days were enrolled, regardless of sex, socio-demographic characteristics, or risk factors. Those who tested negative were immediately administered the first dose of the HBV vaccine, while those testing positive were counseled and linked to care. However, only about 30 out of 141 positive cases were successfully linked to care due to financial constraints. A lack of funding posed a significant barrier, limiting the reach of vaccinations and reducing the scope of outreach efforts, which may have affected the identification of additional cases. This disparity underscores the importance of targeted education and screening programs, particularly in regions with varying HBV prevalence rates, to improve the detection and management of infections [32].

The need to intensify efforts towards achieving widespread immunization coverage, especially among the adult population, is critical. In this study, a key outcome of the campaign was the vaccination of 80.2% of participants with the first dose. Nearly all participants who tested negative for HBV in the study area received their first dose of the hepatitis B vaccine. However, the percentage of individuals receiving the second and third doses gradually decreased, with 59.1% receiving the second dose and only 35.4% completing the third dose.

In contrast, another study reported low user acceptance of the HBV vaccine, particularly among men who have sex with men, where only 17.9% received the first dose, 12.2% the second, and 5.9% the full series [33]. People who inject drugs and transgender women/sex workers demonstrated higher levels of acceptance for the first dose (66.7% and 53.3%, respectively), but completion rates significantly dropped for subsequent doses (24.4% and 26.7% for the second dose, and 6.7% and 0% for the third) [33].

Interestingly, older adults in this study were more likely to complete the third dose the HBV vaccine, possibly due to increased health awareness as they age. Our results are at variance with a similar study done in the United States where vaccination adherence rates for the third dose were lowest among the youngest adults, aged 18–39 years [34]. Analysis of vaccination status by location revealed that most eligible participants in all areas received their first dose. However, in wealthier neighborhoods like Asokoro, nearly 100% maintained vaccination across all three doses, while suburbs like Sherriti experienced the greatest decline, likely due to socioeconomic factors influencing healthcare access. This is consistent with findings of the American study where vaccination adherence rates were observed to be lowest among those living in a neighborhood with a median household income [34].

This disparity underscores the importance of enhanced follow-up and ensuring the completion of the immunization schedule for full protection against HBV. To prevent new infections, Nigeria urgently needs to intensify efforts, including continuous education and awareness campaigns focused on young adults and high-risk groups, to curb HBV transmission.

Limitations

The study's limitations included low vaccination coverage and follow-up due to financial constraints, which restricted access to care for positive cases. Only 30 out of 147 positive cases were successfully referred for additional management, indicating that paucity of funds was a significant obstacle to getting HBV-positive people into care. This research emphasizes how important it is to provide free or heavily subsidized healthcare services for managing HBV, especially for vulnerable groups living in low-income environments.

The absence of a structured questionnaire for data collection may have impacted data quality, and gender disparities, along with a higher prevalence in certain age groups, were noted. Excluding individuals under 18 years limited insights into younger populations, and potential selection bias may have affected the accuracy of the analysis. Additionally, the study’s limited geographic scope may restrict the generalizability of its findings. These challenges highlight barriers to achieving the global goal of eradicating hepatitis B by 2030, emphasizing gaps in immunization programs and awareness efforts.

This study highlights critical sociodemographic differences and offers valuable insights into the epidemiology of HBV in underserved suburbs in Abuja. A total of 3,245 individuals were screened, revealing an overall HBV prevalence of 4.3%, with males showing a higher rate than females. Proximity to high-risk populations, such as those in IDP camps, and socio-economic factors likely contributed to the higher prevalence observed in this study compared to similar studies in other areas, like Lagos. Despite successful vaccination efforts, financial constraints hindered care for many positive cases, emphasizing the need for improved follow-up, education, and affordable healthcare access to reduce HBV transmission in Nigeria.

To reduce HBV transmission, continuous education and awareness campaigns should target young adults and high-risk groups, while gender-sensitive interventions can address specific risk behaviors in males and females. Strengthening follow-up procedures to ensure the completion of the full vaccination regimen is essential for effective HBV prevention. Expanding screening and immunization programs across the FCT and Nigeria, with financial support and accessible healthcare services, will ensure broader protection and improved health outcomes for all residents. Addressing these gaps is vital to meet global hepatitis eradication goals by 2030.

FCT – Federal Capital Territory
HBV - Hepatitis B virus
IDP – Internally Displaced Persons
PCR – Polymerase Chain Reaction
PHC - Primary Health Care
RDT – Rapid Diagnostic Test
RT-PCR – Real-Time Polymerase Chain Reaction
SSVP - Society of St. Vincent De Paul
UNG - uracil N-glycosylase
WHO - World Health Organization

Ethics approval and consent to participate

Ethical approval for the study was granted by the Nigeria Health Research Ethics Committee, under the Ministry of Health (approval no: FHREC/2022/01/13/17-03-22). Informed, written consent was obtained from all participants prior to their inclusion in the study. The objectives of the study were clearly explained, and the results of the rapid diagnostic tests (RDT) were shared with each participant. Detailed information about the potential health implications of HBV infection and preventive measures was provided. Participants who tested positive for HBV were referred to Natlane Ltd. and the GOFMC team for further advice and follow-up care, as necessary.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analyzed in this investigation are accessible from the corresponding author upon reasonable request. All data collected during this study are contained in this published publication [and its additional information files].

Competing interests

The authors declare that they have no competing interests.

Funding

The authors declare that no funding was received for this project.

Authors' contributions

O.M.A. conceptualized the idea, obtained ethical approval, contributed to the methodology and wrote the original draft. M.K.A. contributed to the draft and reviewed the manuscript for critical intellectual content. N.K. contributed to the original draft. J.E. coordinated the project, contributed to awareness and screening including data collection. K.N. contributed to awareness, screening, data collection, and data analysis. O.A. contributed to awareness, screening and the original draft. A.D. contributed to the methodology. K.E. analyzed the data and prepared the figures. I.N.A. contributed to the methodology. All authors reviewed and approved the final manuscript.

Acknowledgements

The authors acknowledge the provision of vaccines by the National Primary Health Care Development Agency and extend their gratitude to the Primary Health Care (PHC) centers for maintaining the cold chain of the vaccines. Special thanks go to the PHC nurses for their role in administering the vaccines to the study participants. The authors are also deeply appreciative of the professional members of the Society of St. Vincent De Paul (SSVP) for their invaluable contributions to the success of this study.

Additionally, they express their gratitude to CMARGS Pharmacy, Lokogoma, Abuja, for their support, as well as to Natlane Ltd., GO-FMC, and SSVP for the counseling services provided. The authors also extend their appreciation to the BIOFEM GROUP for supplying the RDT kits and awareness materials, and to GIG Innovations Ltd for offering logistics support.

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No competing interests reported.

Supplementarydatafiles.xlsx

Addressing the Silent Epidemic of Hepatitis B Virus: Awareness, Screening and Vaccination Efforts in Abuja, Nigeria

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Abstract

Figures

Background

Methods

HBV Immunochromatographic Test

HBV RT-PCR (Real-Time Polymerase Chain Reaction)

Results

Discussion

Conclusions

Abbreviations

Declarations

References

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Supplementary Files

Status:

Version 1