According to a 2016 survey, 90% of Ugandans do not know their hepatitis B status
By Damian Halloran and Kenneth Kabagambe
A silent killer is wreaking havoc across the globe, claiming more than 1.3 million lives every year.
That killer is viral hepatitis. It is "silent" because most people do not realize they have the disease until after it has already caused serious harm.
The World Health Organization says hepatitis has reached epidemic proportions. It is critical to establish an effective strategy for defeating it. That strategy should start with systematic testing for hepatitis in endemic regions. To get treatment where needed, and to halt the spread of the disease, we must identify the "missing millions" who have the virus that causes it.
There are several types of hepatitis, all of which lead to inflammation of the liver. Hepatitis B and hepatitis C, which are both viral, cause the most damage. In 2015, the two strains were responsible for about 90% of hepatitis deaths. Hepatitis B is transmitted by bodily fluids, largely through sexual intercourse, or from mother to child. Hepatitis C is usually transmitted by blood, especially through unsafe injection practices. Effective treatments for hepatitis B and hepatitis C exist. But only 9% of people with the former and 20% of those with the latter are aware of their infection.
Some countries, like Uganda and Egypt, have launched successful initiatives to boost prevention, screening, and treatment of hepatitis. These efforts can provide a blueprint for other nations.
According to a 2016 survey, 90% of Ugandans do not know their hepatitis B status. At Mulago Hospital, the largest hospital in the country, about 80% of liver cancers are linked to the disease.
Over the last decade and a half, the Ugandan government has implemented several initiatives aimed at eliminating hepatitis, including vaccination and mass screening. Since 2012, infants have been given the first dose of the hepatitis B vaccine shortly after birth.
From 2015 to 2018, Uganda's Ministry of Health went further, by conducting a mass screening and vaccination program for adults and adolescents. Over 23 million people were tested for hepatitis B. Of those who tested negative, 17.6 million were vaccinated. People who tested positive were offered treatment. Additionally, Parliament committed 10 billion Ugandan shillings -- approximately $2.7m -- annually to fight hepatitis.
Civil society organizations have augmented the efforts of the government. The National Organization for People Living with Hepatitis B in Uganda, for example, advocates for improved medical services for patients and builds awareness about the importance of early diagnosis, prevention, and treatment.
The organization also works to dispel the negative stigma associated with hepatitis. Many Ugandans incorrectly believe the disease spreads like Ebola, so they ostracize people with hepatitis. Unless discrimination ends, people will remain reluctant to get tested.
Innovative technologies are bolstering Uganda's efforts. Researchers in the country recently completed a successful clinical trial for a new, highly sensitive hepatitis B diagnostic test, developed by Abbott, which can detect infection in 15 minutes. Such quick diagnoses can enable patients to connect with treatment almost immediately. The device is also portable, so it can be easily deployed in remote locations with limited healthcare infrastructure.
Egypt is making progress against hepatitis, too. About 6% of the population had hepatitis C in 2015.
In October 2018, Egyptian authorities launched a public awareness campaign in partnership with community and private-sector leaders, with the goal of eliminating the disease. Famous singers, actors, and comedians participated, educating the public on risk factors, common forms of transmission, and how they could register for free testing.
Seven thousand health workers were trained to administer tests. An online system tracked all data and provided actionable analytics for disease surveillance.
Over seven months, about 60 million Egyptians were screened at 2,500 test centres in mosques, schools, mobile vans, and other gathering places. To date, more than four million people have been treated. Egypt is on track to drive its hepatitis C infection rate to less than 1%. President Abdel Fattah el-Sisi has offered one million doses of hepatitis C treatment, manufactured in Egypt, to other African nations fighting the disease.
The efforts of Uganda and Egypt show that there are effective models for combatting hepatitis. Other high-burden countries can follow similar strategies in order to defeat this silent killer.
Kenneth Kabagambe is Founding Executive Director of the Uganda-based National Organization for People Living with Hepatitis B and Coordinator for the African Hepatitis Summit project.
Damian Halloran is Vice President, Infectious Disease Emerging Markets, Rapid Diagnostics, Abbott.