Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020
Authors: Bedassa Bira Bejiga , Ebo Gemechu Gudeta , Ayalew Jemal , Tura Jaleta Bulti , Wariso Feyiso Bati , Lulseged Sileshi , Tollera Getachew , Kifle Tsigereda , Abdella Saro 
Published: May 2022

Background

Hepatitis B and C virus infections are endemic diseases in sub-Saharan Africa, the region with the highest prevalence of these infections in the world. Female sex workers are exposed to sexually transmitted infections, including hepatitis B and C, because of their high-risk sexual behavior and limited access to health services. There is no data on national prevalence estimate on hepatitis B and C virus infections among female sex workers in Ethiopia, a critical gap in information this study aimed to fill.

Methods

This was a cross-sectional, biobehavioral, national study conducted from December 2019 - April 2020 among 6085 commercial female sex workers aged ≥15 years and residing in sixteen (n=16) regional capital cities and selected towns of Ethiopia. Blood samples were collected for hepatitis B and C virus serological testing from the participants. The data were collected using an open data kits (ODK) software and imported into STATA version16 for analysis. Descriptive statistics (frequencies and proportions) were used to summarize data on the study variables. Bivariate and multivariate logistic regression analyses were conducted to determine the strength of association between independent variables (risk factors) and the outcome (hepatitis B and C virus infection). Adjusted Odd ratio (AOR) was used to determine independent associations, 95% confidence interval to assess precision of the estimates, and a P value ≤ 0.05 was considered statistically significant.

Results

The prevalence of hepatitis B and C infections among the 6085 female sex workers was 2.6% [(95% CI (2.2,2.8)] and 0.5% [(95% CI (0.4,0.7)], respectively. Female sex workers who had 61-90 and ≥91 paying clients in the past six months [(AOR=1.66; 95% CI, (0.99, 2.79); P=0.054] and [(AOR=1.66 95% CI, (1.11, 2.49); P=0.013], respectively, age at first sex selling of 20-24 and >25 years [(AOR=1.67; 95% CI, (1.14, 2.44); P=0.009)] and [(AOR=1.56; 95% CI (1.004, 2.43); P=0.048)], respectively, known HIV positive status [(AOR=1.64; 95% CI (1.03, 2.62); P=0.036] were significantly associated with the prevalence of hepatitis B virus infection. Similarly, hepatitis C was significantly associated with, age at first sex ≤15 years and age 16-20 years [(AOR=0.21; 95%CI (0.07,0.61); P=0.005)] and [(AOR=0.18; 95% CI (0.061, 0.53); P=0.002)], respectively, known HIV positive status [(AOR=2.85; 95%CI (1.10,7.37); P=0.031)] and testing positive for syphilis [(AOR=4.38; 95% CI (1.73,11.11); P=0.002)], respectively.

Conclusion

This analysis reveals an intermediate prevalence of hepatitis B and a low prevalence of hepatitis C infection among female sex workers in Ethiopia. It also suggests that population groups with like female sex workers are highly vulnerable to hepatitis B, hepatitis C, and other sexually transmitted infections. There is a need for strengthening treatment and prevention interventions, including immunization services.