By Michael Gwarisa
More than 91 million Africans live with Hepatitis B or C, which are the deadliest strains of the virus, according to a World Health Organization (WHO) scorecard that was launched in 2021.
The Viral Hepatitis Scorecard 2021 which looked at data from the African region but focused on Hepatitis B and C, both of which cause liver cirrhosis and cancer showed that in 19 countries, more than 8 percent of the population is infected with Hepatitis B, while in 18 countries, more than 1 percent of the population lives with Hepatitis C.
In 2020, the African region accounted for 26 percent of the global burden for Hepatitis B and C and 125,000 associated deaths. Around 70 percent of Hepatitis B infections worldwide occur in Africa. It can take decades after infection from the virus before an individual starts manifesting symptoms.
Thus, what is particularly worrying for the future is that the region accounts for 70 percent of the global Hepatitis B cases found among children younger than 5 years, with 4.5 million African children infected.
Currently, 33 countries have a Hepatitis B prevalence of more than 1 percent among children younger than 5 years, which is a small improvement from 40 countries in 2019.
Speaking during a panel session on Viral Hepatitis, Dr Olufunmilayo Lesi – WHO Viral Hepatitis Lead said the rise in drugs use especially those who inject drugs was pushing the prevalence of Hepatitis high.
“You might be asking why we are talking about Hepatitis at an HIV conference. There is a point of overlap of Hepatitis C, HIV and Drug use. The prevalence of Hepatitis C is high. 50 to 70 percent of some people who inject drugs so it becomes a very important co-morbidity and global health has recognised that and in the last funding cycle, Hepatitis C and B were also addressed in the Global Funding Cycle,” said Dr Lesi.
She added that elimination of Hepatitis is possible, however, there was a Dr Olufunmilayo Lesi – lack of awareness of the disease and only a few knew of their hepatitis status.
“In our Global Health Sector strategy, we also have a target of reaching 90 percent of people to ensure they are aware of the diseases.
So HIV’s first 95 percent is similar to Hepatitis C and B’s first 90 percent. Do you know where we are? We are only at 20 percent so there is huge testing gap and we need innovative way to close that gap.”
She said Hepatitis self-testing was the way to go and has the potential to scale up and support HVB.
“For viral Hepatitis, we have a strategy we have the tools, we have a target we have the guidelines. Why are we not making progress? However, we can eliminate viral hepatitis. Egypt has shown us that Hepatitis C elimination is possible.”
In 2021, WHO established the 2021–2030 Framework for an Integrated Multisectoral Response to Tuberculosis, HIV, Sexually Transmitted Infections and Hepatitis in the African region.
The aim is to support milestones that include the introduction of the Hepatitis B birth dose vaccine in 35 Member States, diagnosis of at least 30 percent of those with chronic hepatitis infections, and the achievement of 30% of people with Hepatitis B and C on treatment.
Hepatitis remains an important public health threat in Africa. Progress in prevention, diagnosing and treatment was impeded between 2019 and 2021 due to the insufficient implementation of hepatitis interventions in countries.
Vanessa Msolomba, Project Manager at the Wits Reproductive Health and HIV Institutee (Wits RHI) at said self-testing for Hepatitis has proven to be a reliable tool in in South Africa.
“As of 2018, according to a study that was done, there was about 45 prevalence among people who inject drugs but the study that we have conducted this year, we have recruited about 1279 participants and of those, 960 have been positive on the Hepatitis C Self-Testing which is about 70 percent.
“So self-testing increases Hepatitis C coverage and also creates awareness because the majority of participants that we have seen, about 3 percent say they have never tested for Hepatitis C before,” said Vanessa.
Meanwhile, WHO has devised new recommendations for Hepatitis testing and screening. WHO Technical Officer Lead for viral hepatitis prevention, testing and populations Global HIV, Hepatitis and Sexually Transmitted Infections Programmes said WHO now recommended focused testing.
“In all epidemic settings, offer HBsAg or HCV Ab testing to adults and adolescents: From populations most affected by HBV or HCV infection (ie. populations with high seroprevalence or history of risk exposure and/or behaviour).
“With a clinical suspicion of chronic viral hepatitis (ie. symptoms, signs, laboratory markers) including children. HBV: Sexual partners, children and other family members, and close household contacts of those with HBV infection; Health-care workers: in all settings, and offer HBV vaccination not vaccinated previously.”
In settings with ≥2% or ≥5% (intermediate/high) HBsAg or HCV Ab prevalence, offer all adults and adolescents routine access to testing, with linkage to care and prevention services. Consider where specific identified birth cohorts of older persons at higher risk of HCV infection.
All pregnant women should be tested for HIV, syphilis and hepatitis B surface antigen (HBsAg) at least once and as early as possible in the pregnancy (HIV standing recommendation since 2007; syphilis: strong recommendation, moderate-quality evidence; HBsAg: strong recommendation, low quality evidence
