Hepatitis B virus prevalence, knowledge, attitudes, and preventive practices among men who have sex with men attending the most at-risk Population Initiative Clinic at Mulago Hospital, Uganda: a cross-sectional study.

Abstract

Background It is estimated that 30% of the world is infected with Hepatitis B Virus (HBV) and about 350 million of these are chronic infections causing approximately 1 million deaths per annum. Men who have Sex with Men (MSM) are known to have a very high risk of HBV infection due to their lifestyle choices, risky sexual behaviors and other unique factors. Despite the known risk, there is limited evidence regarding the HBV burden among this population to drive action. Therefore, this study sought to estimate the prevalence of HBV infection among this population and assess their knowledge, attitudes and practices concerning HBV infection and prevention.

Specific objectives The major objective of this study was to estimate the prevalence of HBV infection among MSM attending the Most At Risk Population Initiative (MARPI) clinic in Uganda and to assess their knowledge, attitudes and practices towards HBV infection and prevention. In addition to determining the association between the predictors and levels of knowledge, attitudes and practices towards HBV infection and prevention among MSM attending the MARPI clinic.

Methods A cross-sectional study was conducted and quantitative data was collected from MSM attending the MARPI clinic at Mulago National Referral Hospital. Upon consent, the individuals were subjected to a questionnaire to assess their demographic information, knowledge, attitude, and practices towards HBV infection and prevention and after that tested for HBV infection. The quantitative data generated was analyzed descriptively and inferentially using STATA 14.0 to demonstrate the HBV prevalence, knowledge, attitudes and practices.

Results Out of the 385 participants that were included in the study the mean age was 25.4 and 77.4% identified as homosexuals. The prevalence of HBV among MSMs was 3.1% and all of the MSM diagnosed with HBV stated that they indulged in condomless-anal sex. The prevalence of HBV was significantly higher among those who were HIV positive at 8.9% as compared to 2.5% among the HIV negatives at P=0.05. Among injectable drug users, the HBV prevalence was at 17.7% as compared to 2.5% among those who don’t use injectable drugs (P<0.001). The study found that 60.5%, 56.9% and 54.8% of the MSM visiting MARPI clinic had good knowledge, good attitudes and safe practices respectively. Majority of the MSMs (87.5%) acknowledged that they were at high HBV risk and would consider visiting the health facility for testing however, 81.6% had never been tested, only 10.9% had been vaccinated against HBV and 62.3% had no idea where one can get vaccinated from. Higher Education levels, and being a homosexual were factors associated with poor knowledge, poor attitudes and practices.

Conclusion and recommendations The findings demonstrated the burden of HBV among the MSM as well as their average knowledge, attitudes and practices towards HBV infection and prevention. There is a need for intensifying awareness creation activities to promote prevention of HBV through condom use, vaccination and routine HBV screening.