EVOLVE-HBV: A retrospective cross-sectional study to quantify and characterise HBV infection, exposure, immunity and susceptibility in a rural population in KwaZulu-Natal, South Africa

‘EVOLVE-HBV’: A retrospective cross-sectional study to quantify and characterise HBV infection, exposure, immunity and susceptibility in a rural population in KwaZulu-Natal, South Africa | medRxiv Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search ‘EVOLVE-HBV’: A retrospective cross-sectional study to quantify and characterise HBV infection, exposure, immunity and susceptibility in a rural population in KwaZulu-Natal, South Africa View ORCID Profile Motswedi Anderson , Lusanda Mazibuko , Gloria Sukali , Tongai G Maponga , View ORCID Profile Marion Delphin , Elizabeth Waddilove , Janine Upton , VG Naidoo , Stephen Olivier , Gregory Ording-Jespersen , Dickman Gareta , Emily Martyn , Resign Gunda , Kobus Herbst , Willem A Hanekom , Nokukhanya Msomi , Lulama Mthethwa , Malcolm Ellapen , Theresa Smit , View ORCID Profile Thumbi Ndung’u , Emily B Wong , Mark J Siedner , Thandeka Khoza , Kathy Baisley , Collins Iwuji , View ORCID Profile Philippa C Matthews doi: https://doi.org/10.64898/2026.03.17.26347919 Motswedi Anderson 1 Africa Health Research Institute , KwaZulu Natal, South Africa 2 Botswana Harvard Health Partnership Institute , Gaborone, Botswana 3 The Francis Crick Institute , 1 Midland Road, London NW1 1AT London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Motswedi Anderson Lusanda Mazibuko 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Gloria Sukali 1 Africa Health Research Institute , KwaZulu Natal, South Africa 4 Division of Infection and Immunity, University College London , London, WC1E 6BT, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tongai G Maponga 5 Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences , Tygerberg, Cape Town, South Africa 6 National Health Laboratory Service, Tygerberg Business Unit , Tygerberg, Cape Town, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Marion Delphin 3 The Francis Crick Institute , 1 Midland Road, London NW1 1AT London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Marion Delphin Elizabeth Waddilove 3 The Francis Crick Institute , 1 Midland Road, London NW1 1AT London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Janine Upton 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site VG Naidoo 7 Department of Gastroenterology and Hepatology, Inkosi Albert Luthuli Central Hospital , Durban, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Stephen Olivier 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Gregory Ording-Jespersen 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Dickman Gareta 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Emily Martyn 3 The Francis Crick Institute , 1 Midland Road, London NW1 1AT London, UK 4 Division of Infection and Immunity, University College London , London, WC1E 6BT, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Resign Gunda 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kobus Herbst 1 Africa Health Research Institute , KwaZulu Natal, South Africa 8 DSTI-SAMRC South African Population Research Infrastructure Network (SAPRIN) , Durban, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Willem A Hanekom 1 Africa Health Research Institute , KwaZulu Natal, South Africa 4 Division of Infection and Immunity, University College London , London, WC1E 6BT, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Nokukhanya Msomi 9 Discipline of Virology, School of Medicine, University of KwaZulu–Natal , South Africa 10 National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital , Durban, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lulama Mthethwa 9 Discipline of Virology, School of Medicine, University of KwaZulu–Natal , South Africa 10 National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital , Durban, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Malcolm Ellapen 10 National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital , Durban, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Theresa Smit 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Thumbi Ndung’u 1 Africa Health Research Institute , KwaZulu Natal, South Africa 4 Division of Infection and Immunity, University College London , London, WC1E 6BT, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Thumbi Ndung’u Emily B Wong 1 Africa Health Research Institute , KwaZulu Natal, South Africa 11 Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mark J Siedner 1 Africa Health Research Institute , KwaZulu Natal, South Africa 12 Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA, USA , Find this author on Google Scholar Find this author on PubMed Search for this author on this site Thandeka Khoza 1 Africa Health Research Institute , KwaZulu Natal, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kathy Baisley 1 Africa Health Research Institute , KwaZulu Natal, South Africa 13 London School of Hygiene and Tropical Medicine , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Collins Iwuji 1 Africa Health Research Institute , KwaZulu Natal, South Africa 14 Department of Global Health & Infection, Brighton and Sussex Medical School, University of Sussex , Brighton, BN1 9PX, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Philippa C Matthews 3 The Francis Crick Institute , 1 Midland Road, London NW1 1AT London, UK 4 Division of Infection and Immunity, University College London , London, WC1E 6BT, UK 15 Department of Infectious Diseases, University College London Hospital , Euston Road, London NW1 2BU, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Philippa C Matthews For correspondence: philippa.matthews{at}crick.ac.uk Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Introduction International goals aim to eliminate Hepatitis B Virus (HBV) as a public health threat by 2030, but data representing African populations remain limited. We therefore investigated the population prevalence of HBV and treatment eligibility in a rural South African setting. Methods We tested archived plasma samples from 2200 participants in a population-based study in KwaZuku Natal for HBV surface antigen (HBsAg), HBV core antibody (anti-HBc), and HBV surface antibody (anti-HBs). For samples testing HBsAg-positive, we quantified alanine transferase (ALT) and HBV DNA viral load. We evaluated demographic and clinical correlates of HBV biomarkers, explored the geographical distribution of HBsAg, and assessed HBV treatment eligibility. Results Weighted HBV infection prevalence was 10.4% (95% CI: 9.0%-12.1%). Evidence of HBV exposure and clearance was found in 34.9% (95% CI: 32.4 - 37.5). Overall prevalence of vaccine-mediated HBV immunity was 8.9% (95% CI: 7.5%-10.4%) but for the sub-group born between 2000-2005 (after the HBV vaccine was implemented) this increased to 20.2% (95% CI 15.8-25.4). Infection prevalence was highest in the South of the region. Over 60% of individuals testing HBsAg-positive met treatment eligibility criteria. Conclusion Prevalence of HBV infection and exposure in this setting is high, while vaccine-mediated immunity is low. These data highlight a pressing need for scale-up of interventions to support progress towards global elimination targets. Funding The Francis Crick Institute (ref. CC2223), the Africa Oxford Initiative (Research Development Award) and Wellcome Strategic Core Award (227167/A/23/z). Ethics University of KZN (UKZN) ref. 00004495/2022; University College London ref. 23221/001. Competing Interest Statement PCM has previously received funding from GSK to support a Doctoral Fellow in her group, and for the NIHR viral hepatitis Health Informatics Collaborative programme in the UK, outside the scope of this project. PCM has received funding from J&J for delivery of educational material, and receives book royalties from Oxford University Press. CI and TN has previously received grant funding from Gilead Sciences, paid to their institution, for investigator sponsored-research. CI received travel support from the International Vaccine Institute to attend a workshop. EM received support to attend meetings from Francis Crick Institute. TN received consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead Sciences. TN serves on the HIV Cure Advisory Board, Gilead Sciences Inc, Scientific Advisory Panel and MATRIX. KH serves on the H3Africa Data and Biospecimen Access Committee (DBAC). Funding Statement The EVOLVE-HBV project at the Africa Health Research Institute was supported by core funding from the Francis Crick Institute (ref. CC2223) and the Africa Oxford Initiative (Research Development Award to TGM and PCM). MA, EW, MD, EM and PCM are funded by the Francis Crick Institute which receives its core funding from Cancer Research UK (CC2223), the UK Medical Research Council (CC2223), and the Wellcome Trust (CC2223). PCM also receives funding from University College London NIHR Biomedical Research Centre (BRC). CI receives funding from the Wellcome Trust (228025/Z/23/Z) and NIHR (NIHR204828). EBW receives funding from AHRI core award from Wellcome Strategic Core Award (227167/A/23/z). KH received funding from the Wellcome Trust and South African Population Research Infrastructure Network (SAPRIN) for the surveillance. The Vukuzazi study was funded by the Wellcome Strategic Core Award (227167/A/23/z). The funders had no role in the study design, analysis, presentation of data or decision to publish. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: EVOLVE-HBV was approved by the Biomedical Research Ethics Committee (ref. 00004495/2022) of University of KZN (UKZN) and University College London (UCL) ethics committee in the United Kingdom (UK) (ref. 23221/001). The study was also approved by the AHRI Community Advisory Board, and the Vukuzazi Scientific Steering Committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . Back to top Previous Next Posted March 19, 2026. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. 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