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According to a survey conducted in 2016, 90% of Ugandans do not know their hepatitis B status
Damian Halloran and Kenneth Kabagambe
A silent killer is wreaking havoc around the world, killing more than 1.3 million people a year.
This killer is viral hepatitis. It is "silent" because most people do not realize that they have the disease before it has ever caused them serious damage.
The World Health Organization has declared that hepatitis has reached epidemic proportions. It is essential to establish an effective strategy to overcome it. This strategy should begin with routine screening for hepatitis in endemic areas. To get treatment if necessary and to stop the spread of the disease, we need to identify the "millions of missing people" with the virus that causes it.
There are several types of hepatitis, all of which cause inflammation of the liver. Hepatitis B and hepatitis C, two viruses, cause the most damage. In 2015, both strains were responsible for about 90% of all hepatitis deaths. Hepatitis B is transmitted through bodily fluids, mainly during intercourse or from mother to child. Hepatitis C is usually transmitted through the blood, especially through dangerous injections. There are effective treatments for hepatitis B and hepatitis C. But only 9% of sufferers and 20% of these are aware of their infection.
Some countries, such as Uganda and Egypt, have launched effective initiatives to strengthen the prevention, detection and treatment of hepatitis. These efforts can be a model for other nations.
According to a survey conducted in 2016, 90% of Ugandans do not know their hepatitis B status. At Mulago Hospital, the country's largest hospital, about 80% of liver cancers are related to the disease .
Over the last 15 years, the Ugandan government has implemented several initiatives to eliminate hepatitis, including vaccination and mbad screening. Since 2012, infants received the first dose of the hepatitis B vaccine shortly after birth.
From 2015 to 2018, the Ugandan Ministry of Health went further by conducting a mbad screening and vaccination program for adults and adolescents. More than 23 million people were screened for hepatitis B. Of those tested negative, 17.6 million were vaccinated. HIV-positive people have been offered treatment. In addition, Parliament has committed 10 billion Ugandan shillings – about $ 2.7 million – a year to fight against hepatitis.
Civil society organizations have increased government efforts. The National Organization for People Living with Hepatitis B in Uganda, for example, advocates improving medical services for patients and raises awareness of the importance of early diagnosis, prevention and treatment.
The organization also strives to dispel the negative stigma badociated with hepatitis. Many Ugandans mistakenly believe that the disease is spreading like the Ebola virus and ostracizing people with hepatitis. Unless discrimination stops, people will remain reluctant to get tested.
Innovative technologies reinforce Uganda's efforts. Researchers across the country recently completed a successful clinical trial of Abbott's new, highly sensitive diagnostic test for hepatitis B, which can detect infection in 15 minutes. Such quick diagnoses can allow patients to connect to treatment almost immediately. Since the device is also portable, it can be easily deployed in remote locations with limited healthcare infrastructure.
Egypt is also progressing against hepatitis. About 6% of the population had hepatitis C in 2015.
In October 2018, the Egyptian authorities launched a public awareness campaign in partnership with community leaders and the private sector, with the aim of eliminating the disease. Famous singers, actors and comedians participated in the event to educate the public about risk factors, common forms of transmission and how to sign up for free tests .
Seven thousand health workers have been trained to administer tests. An online system tracked all data and provided usable badyzes for disease surveillance.
In the space of seven months, about 60 million Egyptians were examined in 2,500 test centers located in mosques, schools, mobile vans and other gathering places. To date, more than four million people have been treated. Egypt is on track to reduce its hepatitis C infection rate to less than 1%. President Abdel Fattah el-Sisi has donated one million doses of hepatitis C treatment, made in Egypt, to other African countries fighting the disease.
The efforts of Uganda and Egypt show that there are effective models for hepatitis control. Other heavily affected countries may follow similar strategies to defeat this silent killer.
Kenneth Kabagambe is founding executive director of the Uganda-based National Organization for People with Hepatitis B and coordinator of the African Hepatitis Summit project.
Damian Halloran is Vice President, Emerging Markets for Infectious Diseases, Rapid Diagnosis, Abbott.
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