Hepatitis B prevalence and treatment needs among Tibetan refugees residing in India

Untreated chronic hepatitis B can lead to liver failure and/or liver cancer. These complications can be avoided through prevention with vaccination or treatment of disease. To inform health policy for the Tibetan community in India, we conducted study of hepatitis B prevalence and treatment needs. We conducted a cross-sectional study over 3 months of 2013. Households were randomly selected for participation via a satellite map; one boarding school and one residential monastery were also included. Participants were asked questions and a whole blood sample was collected for HBsAg assay. Participants with a positive HBsAg result were tested for hepatitis B e antigen, ALT, and AST. Participants with a negative HBsAg result were tested for anti-hepatitis B core antibodies. We recruited 2,769 participants; of which 247 (8.9%) were positive for HBsAg. Participants more likely to have a positive HBsAg result were those born in Tibet (12.4%) and aged 30-59 years old. Of those with a positive HBsAg result, 60.7% were positive for hepatitis B e antigen 7% of whom fit into a likely treatment-needed category; the others fit into management categories requiring repeat ALT testing with or without liver fibrosis assessment. Among participants negative for HBsAg, 52.9% from household sampling had anti-HBc antibodies. We identified a high endemicity of chronic hepatitis B in a Tibetan community in India. Resource appropriate approaches are needed for managing chronic hepatitis B in settings such as this one.