Grant: Travel Awards - Institute Community Support

Aims: We aimed to quantify the HBV burden in the Rwandan population and compare the HBV care cascade before and after integrating and decentralizing HBV care services. Methods: We used data from the District Health Information System 2 and included individuals > 2 years old. The HBV care cascade was analyzed across five stages: (1) lifetime prevalence, (2) diagnosis, (3) engagement with care, (4) treatment initiation, and (5) treatment continuation. Care cascades were compared between pre-decentralization and post-decentralization periods when most individuals were followed up at the health center. Stratified analyses and multivariable logistic regression were used to identify factors associated with progression through the cascade. Results: Between January 2016 and June 2023, among the 4,604,468 persons included, 55,820 were diagnosed with HBV infections. Of those, 21,182 were engaged in care, 5,966 were eligible for HBV treatment, 4,746 initiated treatment, and 4,621 continued treatment one year after initiation. Individuals screened post-decentralization (July 2019 - June 2023) were more likely to be engaged with care, eligible for HBV treatment, and initiate therapy than those screened pre-decentralization (January 2016 - June 2019). Stratified analyses revealed among individuals screened pre-decentralization, those receiving care from provincial and referral hospitals had a higher engagement with care, eligibility for treatment, and treatment initiation compared to those receiving care at health centers, the lowest level of the health system in Rwanda. Conclusion: Individuals screened for HBV post-decentralization had improved engagement along the care cascade compared to those screened pre-decentralization, having higher rates of enrollment in care, eligibility for treatment, and treatment initiation. These findings highlight the importance of integrating HBV care into existing services and decentralizing HBV services.