Impact of COVID-19 on hepatitis B screening in Sierra Leone: insights from a community pharmacy model of care.

Objectives: To assess the impact of COVID-19-related interruptions and seasonal patterns on hepatitis B virus (HBV) screening in a hyperendemic setting in Sierra Leone. Methods: We conducted a retrospective study of HBV testing in a community pharmacy in Freetown, Sierra Leone, from October 01, 2019, through September 30, 2022. We compared participant characteristics using Pearson's chi-square test. We evaluated trends in HBV screening and diagnosis using one-way analysis of variance with Tukey's or Dunnett's post-test. Results: Of 920 individuals screened, 161 had detectable HBV surface antigen (seroprevalence 17.5% [95% CI 14.9-20.4]). There was a 100% decrease in HBV screening during January-June of 2020; however, screening increased by 27% and 23% in the first and second years after COVID-19, respectively. Mean quarterly tests showed a significant upward trend: 55 ± 6 tests during January-March (baseline), 74 ± 16 tests during April-June, 101 ± 3 tests during July-September, and 107 ± 17 tests during October-December (one-way analysis of variance test for trend, F = 7.7, P = 0.0254) but not the mean quarterly number of people diagnosed with HBV (F = 0.34, P = 0.7992). Conclusion: Community-based HBV screening dramatically improved following temporary disruptions related to COVID-19. Seasonal variation in HBV screening, but not HBV diagnosis, may have implications for HBV elimination efforts in Sierra Leone and other West African countries.