Title: Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-
sectional study
Version: 0 Date: 14 Jan 2021
Reviewer's report:
Thanks for the opportunity to review this manuscript. The paper provided useful insights
by characterizing clinical stages of CHB patients in Eritrea and the discussed implications
for patient management. The manuscript included comprehensive background, well-defined
objectives and clear methodologies. Results were well presented and thoroughly discussed in
light of international guidelines. I have a couple of minor comments/suggestions for authors to
consider:
• Background:
o Please provide background information on how decision on CHB treatment is currently
made by physicians in Eritrea? Is there a standardized national treatment guidelines for CHB
management in place, or the country adopts AASLD guidelines, or practice varies by facilities/
physicians?
• Methods:
o Line 130-137: Please clarify how patients were recruited. Were ALL patients tested + for both
HBsAg and anti-HBc during the study period included or a sample was selected? If the latter,
please specify sampling methodology.
o Laboratory methods: Provide information on when lab tests (particularly HBeAg, anti-HBe,
viral load and ALT) were conducted? Were all of these tests  performed as part of the standard
management protocol at the study sites or there were tests performed for this study’s purpose?
If the first, which results were used when patients have multiple tests over time?
• Results and Discussion
o Table 1: In addition to mean, median, min/max values for ALT and HBV viral load, it’s useful
to provide % by category groups (normal range/elevated ALT; viral load (<2000 IU/ml, 2000
and 20,000 IU/ml, >20,000 IU/ml)
o Table 2: Is there a specific reason for not including age groups in Demographics while it was
included in other analysis?
o Line 226: typo (relevantduring)
o I think it’s interesting to emphasize and discuss:
# 5 out of 293 patients (equivalent to 1.7%) of the study participants were eligible for antiviral
treatment at the time of study. Given that the participating clinics received patient referrals from
other provinces, would you expect eligibility rate to be lower, higher or similar at other health
facilities in Eritrea?
# 5 out of 15 patients with elevated ALT were eligible for treatment (Figure 4) regardless
of HBeAg and viral load results. Besides, the likelihood that patients with ALT may require
antiviral treatment in patients with positive HBeAg (4 out of 11) is higher than that among
patients with negative HBeAg  (1 out of 4).
# Discussion of the results in the local context of would be beneficial (line 261-271). Were lab
tests  (particularly HBeAg, viral load) widely available in Eritrea? In settings where those tests
are not available, if any, what’s the implications of the study results?
Title: Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-
sectional study
Version: 0 Date: 14 Jan 2021
Reviewer's report:
Thanks for the opportunity to review this manuscript. The paper provided useful insights
by characterizing clinical stages of CHB patients in Eritrea and the discussed implications
for patient management. The manuscript included comprehensive background, well-defined
objectives and clear methodologies. Results were well presented and thoroughly discussed in
light of international guidelines. I have a couple of minor comments/suggestions for authors to
consider:
• Background:
o Please provide background information on how decision on CHB treatment is currently
made by physicians in Eritrea? Is there a standardized national treatment guidelines for CHB
management in place, or the country adopts AASLD guidelines, or practice varies by facilities/
physicians?
• Methods:
o Line 130-137: Please clarify how patients were recruited. Were ALL patients tested + for both
HBsAg and anti-HBc during the study period included or a sample was selected? If the latter,
please specify sampling methodology.
o Laboratory methods: Provide information on when lab tests (particularly HBeAg, anti-HBe,
viral load and ALT) were conducted? Were all of these tests  performed as part of the standard
management protocol at the study sites or there were tests performed for this study’s purpose?
If the first, which results were used when patients have multiple tests over time?
• Results and Discussion
o Table 1: In addition to mean, median, min/max values for ALT and HBV viral load, it’s useful
to provide % by category groups (normal range/elevated ALT; viral load (<2000 IU/ml, 2000
and 20,000 IU/ml, >20,000 IU/ml)
o Table 2: Is there a specific reason for not including age groups in Demographics while it was
included in other analysis?
o Line 226: typo (relevantduring)
o I think it’s interesting to emphasize and discuss:
# 5 out of 293 patients (equivalent to 1.7%) of the study participants were eligible for antiviral
treatment at the time of study. Given that the participating clinics received patient referrals from
other provinces, would you expect eligibility rate to be lower, higher or similar at other health
facilities in Eritrea?
# 5 out of 15 patients with elevated ALT were eligible for treatment (Figure 4) regardless
of HBeAg and viral load results. Besides, the likelihood that patients with ALT may require
antiviral treatment in patients with positive HBeAg (4 out of 11) is higher than that among
patients with negative HBeAg  (1 out of 4).
# Discussion of the results in the local context of would be beneficial (line 261-271). Were lab
tests  (particularly HBeAg, viral load) widely available in Eritrea? In settings where those tests
are not available, if any, what’s the implications of the study results?
Please review this paper.
user
Title: Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-
sectional study
Version: 0 Date: 14 Jan 2021
Reviewer's report:
Thanks for the opportunity to review this manuscript. The paper provided useful insights
by characterizing clinical stages of CHB patients in Eritrea and the discussed implications
for patient management. The manuscript included comprehensive background, well-defined
objectives and clear methodologies. Results were well presented and thoroughly discussed in
light of international guidelines. I have a couple of minor comments/suggestions for authors to
consider:
• Background:
o Please provide background information on how decision on CHB treatment is currently
made by physicians in Eritrea? Is there a standardized national treatment guidelines for CHB
management in place, or the country adopts AASLD guidelines, or practice varies by facilities/
physicians?
• Methods:
o Line 130-137: Please clarify how patients were recruited. Were ALL patients tested + for both
HBsAg and anti-HBc during the study period included or a sample was selected? If the latter,
please specify sampling methodology.
o Laboratory methods: Provide information on when lab tests (particularly HBeAg, anti-HBe,
viral load and ALT) were conducted? Were all of these tests  performed as part of the standard
management protocol at the study sites or there were tests performed for this study’s purpose?
If the first, which results were used when patients have multiple tests over time?
• Results and Discussion
o Table 1: In addition to mean, median, min/max values for ALT and HBV viral load, it’s useful
to provide % by category groups (normal range/elevated ALT; viral load (<2000 IU/ml, 2000
and 20,000 IU/ml, >20,000 IU/ml)
o Table 2: Is there a specific reason for not including age groups in Demographics while it was
included in other analysis?
o Line 226: typo (relevantduring)
o I think it’s interesting to emphasize and discuss:
# 5 out of 293 patients (equivalent to 1.7%) of the study participants were eligible for antiviral
treatment at the time of study. Given that the participating clinics received patient referrals from
other provinces, would you expect eligibility rate to be lower, higher or similar at other health
facilities in Eritrea?
# 5 out of 15 patients with elevated ALT were eligible for treatment (Figure 4) regardless
of HBeAg and viral load results. Besides, the likelihood that patients with ALT may require
antiviral treatment in patients with positive HBeAg (4 out of 11) is higher than that among
patients with negative HBeAg  (1 out of 4).
# Discussion of the results in the local context of would be beneficial (line 261-271). Were lab
tests  (particularly HBeAg, viral load) widely available in Eritrea? In settings where those tests
are not available, if any, what’s the implications of the study results?
assistant