High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo

Introduction: Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two diseases in this vulnerable local population. Methods: A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three one-stop centers, set up at the Panzi, Mulamba and Bulenga hospitals. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Viral load quantification for HBV and HIV were performed using the GeneXpert. Results: For HBV, overall prevalence was 8.9% (95% CI [7.2–10.8%]), 32.1% [29.3–35.0%], and 14.5% [12.3–16.8%] for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The mean age was 40.57±14.99 years in the HBsAg-positive group (p=0.025). Risk factors for HBV infection were age (≥35 years) (AOR=1.83 [1.02-3.32]; p=0.041), having no schooling (AOR=4.14 [1.35-12.62]; p=0.012) or only primary school-level (AOR=4.88 [1.61-14.75]; p=0.005), and multiple aggressors (AOR=1.76 [1.09-2.84], p=0.019). The prevalence of HIV was 4.3% [3.1–5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (>2,000 copies/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (>1,000 copies/mL).  Conclusion: This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. These results highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement PBB received partial financial support from the World Bank for her PhD thesis through the Panzi Foundation (grant number IDA H 980-ZR). NO: the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study obtained approval from the ethics committee of the Catholic University of Bukavu (UCB/CIE/NC/008/2016) reviewed in 2019 by the national health ethics committee (CNES001/DPSK/124PP/2019) and from the ethics and scientific committees of the University de Bangui (22/UB/FACSS/CSVPR/19). Written informed consent was signed by the participant in the interest of knowing her serological status to consider early treatment in case of a positive result, as well as for her participation in the study. The preliminary results for HBV and HIV screening were given to participants immediately after screening and 3 weeks later for definitive result. HIV- and HBV-positive cases were referred to the Panzi Hospital for medical care. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data were encoded and stored in an electronic database. Follow-up sheets were securely stored at the ICART/Panzi Foundation Research Center and accessible only to the principal investigator of the study, Dr Parvine Basimane Bisimwa. These data include epidemiological, clinical and therapeutic data. As these data are anonymized for the protection of participants according to the health ethics guidelines of our region, we cannot make them available to third parties. Nevertheless, all these data are available from Parvine Bisimane Bisimwa at: parvinebisimwa@gmail.com