{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T05:39:49Z","timestamp":1764999589012,"version":"3.46.0"},"reference-count":45,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T00:00:00Z","timestamp":1707264000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"name":"World Heath Organization Europe","award":["Funded data collection partially, no grant number"],"award-info":[{"award-number":["Funded data collection partially, no grant number"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,11]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study sought to determine the prevalence and associated factors of hepatitis B virus (HBV) infection ever in life and chronic HBV infection in Armenia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A population-based cross-sectional seroprevalence study combined with a phone survey of tested individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All administrative units of Armenia including 10 provinces and capital city Yerevan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study frame was the general adult population of Armenia aged \u226518 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The participants were tested for anti-HBV core antibodies (anti-HBc) and HBV surface antigen (HBsAg) using third-generation enzyme immunoassays. In case of HBsAg positivity, HBV DNA and hepatitis D virus (HDV) RNA PCR tests were performed. Risk factors of HBV infection ever in life (anti-HBc positivity) and chronic HBV infection (HBsAg positivity) were identified through fitting logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The seroprevalence study included 3838 individuals 18 years and older. Of them, 90.7% (3476 individuals) responded to the phone survey. The prevalence of anti-HBc positivity was 14.1% (95% CI 13.1% to 15.2%) and HBsAg positivity 0.8% (95% CI 0.5% to 1.1%). The viral load was over 10\u2009000\u2009IU\/mL for 7.9% of HBsAg-positive individuals. None of the participants was positive for HDV. Risk factors for HBsAg positivity included less than secondary education (aOR=6.44; 95%\u2009CI 2.2 to 19.1), current smoking (aOR=2.56; 95%\u2009CI 1.2 to 5.6), and chronic liver disease (aOR=8.44; 95%\u2009CI 3.0 to 23.7). In addition to these, risk factors for anti-HBc positivity included age (aOR=1.04; 95%\u2009CI 1.04 to 1.05), imprisonment ever in life (aOR=2.53; 95%\u2009CI 1.41 to 4.56), and poor knowledge on infectious diseases (aOR=1.32; 95%\u2009CI 1.05 to 1.67), while living in Yerevan (vs provinces) was protective (aOR=0.74; 95%\u2009CI 0.59 to 0.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provided robust estimates of HBV markers among general population of Armenia. Its findings delineated the need to revise HBV testing and treatment strategies considering higher risk population groups, and improve population knowledge on HBV prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080281","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T23:06:33Z","timestamp":1707347193000},"page":"e080281","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence of hepatitis B virus infection among general population of Armenia in 2021 and factors associated with it: a cross-sectional study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3039-1466","authenticated-orcid":false,"given":"Anahit","family":"Demirchyan","sequence":"first","affiliation":[{"name":"Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Dudareva","sequence":"additional","affiliation":[{"name":"Department for Infectious Disease Epidemiology, Robert Koch Institut, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serine","family":"Sahakyan","sequence":"additional","affiliation":[{"name":"Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lusine","family":"Aslanyan","sequence":"additional","affiliation":[{"name":"Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Muradyan","sequence":"additional","affiliation":[{"name":"Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lusine","family":"Musheghyan","sequence":"additional","affiliation":[{"name":"Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antons","family":"Mozalevskis","sequence":"additional","affiliation":[{"name":"Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narina","family":"Sargsyants","sequence":"additional","affiliation":[{"name":"National Institute of Health named after academician Suren Avdalbekyan, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gayane","family":"Ghukasyan","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office in Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varduhi","family":"Petrosyan","sequence":"additional","affiliation":[{"name":"Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,7]]},"reference":[{"key":"2025120521351711000_14.2.e080281.1","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/S2468-1253(22)00124-8","article-title":"Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"7","author":"Sheena","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025120521351711000_14.2.e080281.2","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/0016-5085(93)90261-A","article-title":"The discovery of the hepatitis viruses","volume":"104","author":"Purcell","year":"1993","journal-title":"Gastroenterology"},{"key":"2025120521351711000_14.2.e080281.3","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.02.007"},{"key":"2025120521351711000_14.2.e080281.4","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1080\/21645515.2020.1847951","article-title":"Prevalence and factors associated with hepatitis B virus infection among household members: a cross-sectional study in Beijing","volume":"17","author":"Zhao","year":"2021","journal-title":"Hum Vaccin Immunother"},{"key":"2025120521351711000_14.2.e080281.5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.23937\/2474-3658\/1510132","article-title":"Burden of hepatitis B infection among high risk populations in Western Kenya","volume":"6","author":"Mercy Jelagat","year":"2020","journal-title":"J Infect Dis Epidemiol"},{"key":"2025120521351711000_14.2.e080281.6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.5005\/jp-journals-10018-1269","article-title":"Hepatitis B virus infection among health care workers in Indonesia","volume":"8","author":"H Muljono","year":"2018","journal-title":"Euroasian J Hepatogastroenterol"},{"key":"2025120521351711000_14.2.e080281.7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.7150\/ijms.2.50","article-title":"Epidemiology and prevention of hepatitis B virus infection","volume":"2","author":"Hou","year":"2005","journal-title":"Int J Med Sci"},{"key":"2025120521351711000_14.2.e080281.8","doi-asserted-by":"crossref","first-page":"3793","DOI":"10.3748\/wjg.v28.i29.3793","article-title":"Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma","volume":"28","author":"Gnyawali","year":"2022","journal-title":"World J Gastroenterol"},{"key":"2025120521351711000_14.2.e080281.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-5575-6","article-title":"The impact of economic and social factors on the prevalence of hepatitis B in Turkey","volume":"18","author":"Tosun","year":"2018","journal-title":"BMC Public Health"},{"key":"2025120521351711000_14.2.e080281.10","doi-asserted-by":"crossref","first-page":"S343","DOI":"10.1093\/infdis\/jiaa668","article-title":"Hepatitis B vaccines","volume":"224","author":"Pattyn","year":"2021","journal-title":"J Infect Dis"},{"key":"2025120521351711000_14.2.e080281.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2011.12.116"},{"key":"2025120521351711000_14.2.e080281.12","unstructured":"Andreasyan D , Bazarchyan A . \"Health and Health Care\" Yearbook. Yerevan: National Institute of Health Named after Academician S. Avdalbekyan, 2022: 299."},{"key":"2025120521351711000_14.2.e080281.13","unstructured":"Demirchyan A , Mirzoyan L , Thompson ME . Synthesis of the existing data on Hepatitis B in Armenia. Yerevan: American University of Armenia, Center for Health Services Research, 2000. Available: https:\/\/aua.am\/chsr\/PDF\/2000\/HepatitB_FINAL.pdf"},{"key":"2025120521351711000_14.2.e080281.14","unstructured":"Ghazinyan H , Mkhitaryan A , Melik-Andreasyan G , et al . Updating HBV status in Armenia. optimal management of hepatitis B virus infection; 25\u201327 September Athens. Proceedings of EASL Special Conference; Greece, 2014:159"},{"key":"2025120521351711000_14.2.e080281.15","first-page":"20","article-title":"Epidemiological characteristics of viral hepatitis in Armenia (in Russian)","volume":"4","author":"Melik-Andreasyan","year":"2013","journal-title":"\u0412 \u041c\u0438\u0440\u0435 \u0412\u0438\u0440\u0443\u0441\u043d\u044b\u0445 \u0413\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u0432"},{"key":"2025120521351711000_14.2.e080281.16","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.ijid.2020.12.068","article-title":"Prevalence of HIV, HCV and HBV in Central Asia and the caucasus: a systematic review","volume":"104","author":"Davlidova","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2025120521351711000_14.2.e080281.17","unstructured":"Roche Diagnostics . Elecsys\u00ae Anti-HBc II. Immunoassay for the qualitative determination of total antibodies against hepatitis B core antigen (HBcAg). n.d. Available: https:\/\/diagnostics.roche.com\/global\/en\/products\/params\/elecsys-anti-hbc-ii.html]"},{"key":"2025120521351711000_14.2.e080281.18","unstructured":"Roche Diagnostics . Elecsys\u00ae HBsAg II. Immunoassay for the qualitative determination of hepatitis B surface antigen (HBsAg). n.d. Available: https:\/\/diagnostics.roche.com\/global\/en\/products\/params\/elecsys-hbsag-ii.html]"},{"key":"2025120521351711000_14.2.e080281.19","doi-asserted-by":"crossref","unstructured":"Hosmer DW , Lemeshow S . Applied logistic regression, 2nd ed. New York: A Wiley-Interscience Publication, 2000: 92\u2013116. doi:10.1002\/0471722146","DOI":"10.1002\/0471722146"},{"key":"2025120521351711000_14.2.e080281.20","unstructured":"Khetsuriani N , Gamkrelidze A , Shadaker S , et al . Hepatitis B prevalence and the impact of vaccination in Georgia: results from a nationwide serosurvey International liver congress TM 2022 [London]. 2022. Available: https:\/\/www.postersessiononline.eu\/173580348_eu\/congresos\/ILC2022\/aula\/-THU_283_ILC2022.pdf"},{"key":"2025120521351711000_14.2.e080281.21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S2468-1253(18)30056-6","article-title":"Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study","volume":"3","author":"Razavi-Shearer","year":"2018","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025120521351711000_14.2.e080281.22","unstructured":"Coalition for Global Hepatitis Elimination . Data dashboard Armenia. Available: https:\/\/www.globalhep.org\/country-progress\/armenia [Accessed 27 Jul 2023]."},{"key":"2025120521351711000_14.2.e080281.23","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.1016\/j.vaccine.2015.05.092","article-title":"Substantial decline in hepatitis B virus infections following vaccine introduction in Tajikistan","volume":"33","author":"Khetsuriani","year":"2015","journal-title":"Vaccine"},{"key":"2025120521351711000_14.2.e080281.24","unstructured":"Robert Koch Institute . Report: technical assessment of viral hepatitis response in Armenia. Berlin Robert Koch Institute; 2023. 16\u20139."},{"key":"2025120521351711000_14.2.e080281.25","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2174\/1874357901812010033","article-title":"Determining the actual prevalence of hepatitis B in Khyber Pakhtunkhwa-Pakistan: a meta-analysis","volume":"12","author":"Khan","year":"2018","journal-title":"Open Virol J"},{"key":"2025120521351711000_14.2.e080281.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-019-4428-y","article-title":"Hepatitis B infection in the general population of China: a systematic review and meta-analysis","volume":"19","author":"Wang","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2025120521351711000_14.2.e080281.27","doi-asserted-by":"crossref","first-page":"32","DOI":"10.12688\/wellcomeopenres.17601.3","article-title":"Sexual dimorphism in chronic hepatitis B virus (HBV) infection: evidence to inform elimination efforts","volume":"7","author":"Brown","year":"2022","journal-title":"Wellcome Open Res"},{"key":"2025120521351711000_14.2.e080281.28","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2018.02302","article-title":"Sex-dependent outcome of hepatitis B and C viruses infections: synergy of sex hormones and immune responses?","volume":"9","author":"Ruggieri","year":"2018","journal-title":"Front Immunol"},{"key":"2025120521351711000_14.2.e080281.29","unstructured":"More countries reaching hepatitis B control targets brings the WHO European region closer to eliminating viral hepatitis as a public health threat [press release]. Available: https:\/\/www.who.int\/europe\/news\/item\/24-04-2023-more-countries-reaching-hepatitis-b-control-targets-brings-the-who-european-region-closer-to-eliminating-viral-hepatitis-as-a-public-health-threat2023 [Accessed 25 Apr 2023]."},{"key":"2025120521351711000_14.2.e080281.30","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1002\/hep.32231","article-title":"Incidence and prediction of HBsAg seroclearance in a prospective multi-ethnic HBeAg-negative chronic hepatitis B cohort","volume":"75","author":"Terrault","year":"2022","journal-title":"Hepatology"},{"key":"2025120521351711000_14.2.e080281.31","first-page":"S135","article-title":"Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration","volume":"117 Suppl 1","author":"Galea","year":"2002","journal-title":"Public Health Rep"},{"key":"2025120521351711000_14.2.e080281.32","doi-asserted-by":"crossref","DOI":"10.1101\/cshperspect.a021410","article-title":"Hepatitis B virus epidemiology","volume":"5","author":"MacLachlan","year":"2015","journal-title":"Cold Spring Harb Perspect Med"},{"key":"2025120521351711000_14.2.e080281.33","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1002\/(SICI)1096-9071(199603)48:3<262::AID-JMV8>3.0.CO;2-6","article-title":"Risk factors for hepatitis B virus infection among heterosexuals attending a sexually transmitted diseases clinic in Italy: role of genital ulcerative diseases","volume":"48","author":"Corona","year":"1996","journal-title":"J Med Virol"},{"key":"2025120521351711000_14.2.e080281.34","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2020.00231","article-title":"Socioeconomic status and access to healthcare: interrelated drivers for healthy aging","volume":"8","author":"McMaughan","year":"2020","journal-title":"Front Public Health"},{"key":"2025120521351711000_14.2.e080281.35","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00103-021-03473-z","article-title":"Hepatitis B virus infection and vaccine-induced immunity: the role of sociodemographic determinants: results of the study \u201cGerman Health Interview and Examination Survey for Adults\u201d (DEGS1, 2008-2011)","volume":"65","author":"Brodzinski","year":"2022","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"2025120521351711000_14.2.e080281.36","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines9060625","article-title":"Knowledge, vaccination status, and reasons for avoiding vaccinations against hepatitis B in developing countries: a systematic review","volume":"9","author":"Machmud","year":"2021","journal-title":"Vaccines (Basel)"},{"key":"2025120521351711000_14.2.e080281.37","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4269\/ajtmh.2009.81.240","article-title":"Population-based multicentric survey of hepatitis B infection and risk factor differences among three regions in Brazil","volume":"81","author":"Pereira","year":"2009","journal-title":"Am J Trop Med Hyg"},{"key":"2025120521351711000_14.2.e080281.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.03.021"},{"key":"2025120521351711000_14.2.e080281.39","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.1.65"},{"key":"2025120521351711000_14.2.e080281.40","doi-asserted-by":"publisher","DOI":"10.1086\/502978"},{"key":"2025120521351711000_14.2.e080281.41","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3748\/wjg.15.423","article-title":"DNA-guided hepatitis B treatment, viral load is essential, but not sufficient","volume":"15","author":"B\u00e1rcena Marug\u00e1n","year":"2009","journal-title":"World J Gastroenterol"},{"key":"2025120521351711000_14.2.e080281.42","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1365-2893.2009.01168.x","article-title":"Hepatitis B viral load and risk for liver cirrhosis and hepatocellular carcinoma in The Gambia, West Africa","volume":"17","author":"Mendy","year":"2010","journal-title":"J Viral Hepat"},{"key":"2025120521351711000_14.2.e080281.43","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1111\/apt.15725","article-title":"Moderate levels of serum hepatitis B virus DNA are associated with the highest risk of hepatocellular carcinoma in chronic hepatitis B patients","volume":"51","author":"Kim","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120521351711000_14.2.e080281.44","unstructured":"World Health Organization . Global hepatitis report. Geneva: Licence: CC BY-NC-SA 3.0 IGO; 2017. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/255016\/9789241565455-eng.pdf?sequence=1&isAllowed=y"},{"key":"2025120521351711000_14.2.e080281.45","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","article-title":"Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study","volume":"8","author":"Razavi-Shearer","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-080281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T05:35:27Z","timestamp":1764999327000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-080281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,7]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bmjopen-2023-080281"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-080281","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}