National progress towards hepatitis B and C micro-elimination in a high-risk haemodialysis population: The Brunei Darussalam experience

Objective: To evaluate trends in hepatitis B virus (HBV) and hepatitis C virus (HCV) prevalence and incidence among the national haemodialysis (HD) population from 2013 to 2025 and characterize the demographic, clinical, and outcome profiles of affected patients. Methods: This retrospective observational cohort study utilized data from the Brunei Dialysis and Transplant Registry and the national electronic health record system (BRU-HIMS). Results: 77 HBV and 50 HCV cases were identified amongst 3 080 period prevalent HD patients over the 13-year study period. A sustained decline in both infections was observed, with a more marked reduction in HCV. Overall period prevalence was 2.5% (95% CI 2.1-2.7) for HBV and 1.8% (95% CI 1.4-1.9) for HCV, while cumulative incidence rates were 2.6% (95% CI 1.9-3.2) and 1.1% (95% CI 0.6-1.5), respectively. Patients with incident HCV infection were younger than those with HBV and the general incident HD population. HBV infection was more common among individuals of Chinese ethnicity. Glomerulonephritis was more frequently identified as the primary cause of end-stage kidney disease among infected patients than in the non-infected cohort. Cirrhosis was present in 26% of HBV and 28% of HCV cases. Antiviral therapy uptake was 38% for HBV and 44% for HCV. Conclusions: HBV and HCV burden among HD patients in Brunei has declined substantially during the study period, supporting progress towards hepatitis elimination. This success appears underpinned by five strategic pillars: centralized registry surveillance, nephrology-led care, stringent infection control measures, nurse-led monitoring, and community support.