Johannessen, AsgeirAsgeirJohannessenStockdale, Alexander JAlexander JStockdaleHenrion, Marc Y RMarc Y RHenrionOkeke, EdithEdithOkekeSeydi, MoussaMoussaSeydiWandeler, GillesGillesWandelerSonderup, MarkMarkSonderupSpearman, C WendyC WendySpearmanVinikoor, MichaelMichaelVinikoorSinkala, EdfordEdfordSinkalaDesalegn, HailemichaelHailemichaelDesalegnFall, FatouFatouFallRiches, NicholasNicholasRichesDavwar, PantongPantongDavwarDuguru, MaryMaryDuguruMaponga, TongaiTongaiMapongaTaljaard, JantjieJantjieTaljaardMatthews, Philippa CPhilippa CMatthewsAndersson, MoniqueMoniqueAnderssonMboup, SouleymanSouleymanMboupSombie, RogerRogerSombieShimakawa, YusukeYusukeShimakawaLemoine, MaudMaudLemoine2024-10-142024-10-142023-01-03https://boris-portal.unibe.ch/handle/20.500.12422/116837In sub-Saharan Africa, simple biomarkers of liver fibrosis are needed to scale-up hepatitis B treatment. We conducted an individual participant data meta-analysis of 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries to assess the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index and two other fibrosis biomarkers using a Bayesian bivariate model. Transient elastography was used as a reference test with liver stiffness measurement thresholds at 7.9 and 12.2kPa indicating significant fibrosis and cirrhosis, respectively. At the World Health Organization-recommended cirrhosis threshold (>2.0), aspartate aminotransferase-to-platelet ratio index had sensitivity (95% credible interval) of only 16.5% (12.5-20.5). We identified an optimised aspartate aminotransferase-to-platelet ratio index rule-in threshold (>0.65) for liver stiffness measurement >12.2kPa with sensitivity and specificity of 56.2% (50.5-62.2) and 90.0% (89.0-91.0), and an optimised rule-out threshold (<0.36) with sensitivity and specificity of 80.6% (76.1-85.1) and 64.3% (62.8-65.8). Here we show that the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index threshold is inappropriately high in sub-Saharan Africa; improved rule-in and rule-out thresholds can optimise treatment recommendations in this setting.en600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesarticle10.48350/1767933659680510.1038/s41467-022-35729-w