Tackling viral Hepatitis B & C more critical in light of COVID-19

Coronavirus disease 2019 (COVID-19), the illness caused by SARS-COV-2 virus continues to spread rapidly throughout the world. In most of the Sub-Saharan countries like Uganda, health care service providers are testing, tracing, isolating, and managing patients with COVID-19.

Measures to reduce or contain the community spread of SARS-COV-2 have relatively been effective and implemented in most districts in Uganda with Entebbe and Kampala as the epicenter of preparation and response.

Uganda reported her first confirmed case of COVID-19 on March 22, 2020. As of July 16, 2020, there were 1,051 confirmed cases in the country, with no fatalities and 1,014 cumulative recoveries including both Ugandans and foreigners (www.health.go.ug/covid/). The COVID-19 diagnostics in Uganda are mainly managed by the Uganda Virus Research Institute (UVRI) with CPHL/UNHLS overseeing the already decentralized COVID-19 response laboratories at the border points of entry Tanzania (Mutukula-Kyotera/Rakai), Kenya (Malaba-Busia), and South Sudan (Elegu-Nimule).

Currently, Uganda is carrying out targeted testing, contact tracing, and sporadic community testing, with advocacy to transition to a widespread community testing strategy. The lock-down restrictions, curfew, hand washing, social distancing, and the wearing of face masks as stringent measures were put in place to slow the chain of transmission within the general population.

These measures have gone the extra mile in ensuring that health care systems in areas with new outbreaks are not overwhelmed. Conversely, these measures have had an adverse impact on general healthcare service delivery. Scenarios such as outpatient care drying up, surgeons postponing surgical procedures, researchers delaying or suspending hundreds of clinical trials, oncologists switching cancer patients to oral treatments, and closure of other infectious diseases clinics like hepatitis B clinics, have become commonplace countrywide.

July is designated as a world hepatitis month to drive the mandate of awareness, and advocacy in finding the missing millions who remain unaware of their viral hepatitis status, and for the positively diagnosed to have access to linkage to care.

As COVID-19 continues to ravage the world, the global viral hepatitis community has grown increasingly concerned about the potential impact of COVID-19 on the 400 million people estimated to be living with viral hepatitis B and C globally.

Data on seroprevalence of viral hepatitis remains sparse, particularly for the hepatitis C virus (HCV) in Sub-Saharan Africa. In Uganda, viral hepatitis B remains one of the deadly silent killers with an estimated 52% lifetime exposure risk of the general population, and 9 out of 10 people still unaware of their viral hepatitis status within the country.

The seroprevalence of Hepatitis B virus (HBV) according to a 2010 survey stood at 10% and in the Uganda Population-based HIV Impact Assessment (UPHIA) done in 2016 placed the prevalence at 4.1%. Relatedly, the prevalence of HCV is estimated at 1-2% of the general population.

COVID-19 has led to Hepatitis related health service delivery disruptions across Uganda due to a variety of factors, including but not restricted to; avoidance of health care facilities because of fear of infection, inability to access Hepatitis clinics due to restrictions on movement and travel, and inability to afford transport or items such as face-masks, sanitizers and handwashing facilities for facility visits due to income loss and delay in distribution. In addition, critical hepatitis services such as free hepatitis B screening/testing, logistics, and hepatitis supplies or testing kits, hepatitis B vaccines, vaccination cards, consumables, referral of samples using the HUB transport system for further evaluation for enrolment on care including the viral load testing, free hepatitis B antiviral medications, and adherence counselling strategies have been curtailed due to lock-down, curfews, social distancing requirements and diversion of resources to COVID-19 response and control. In fact, HBV clinics that test, counsel, and treat depend heavily on foot traffic which has dropped exponentially. With people not coming to get tested, the clinics are struggling to keep their doors open amidst the COVID-19 pandemic.

Unfortunately, to-date there are slow unclear mechanisms put in place by the Ministry of Health Uganda (MOH) to scale up the continuity of the viral hepatitis program. In jeopardy is the drive to eliminate the two deadly silent killers by 2030; Hepatitis B (HBV) and hepatitis C (HCV). Integration of viral hepatitis B, hepatitis C, and HIV/AIDS remain unclear at this point in time.

There is increased vulnerability of people living positively with chronic hepatitis B and C, with a potential for increased numbers, it is critical that actions are taken to minimize the effects of COVID-19 on HBV/HCV related mortality. Unless there is a scale-up in screening, diagnosis, and linkage to care, viral hepatitis B and C will continue to spread and kill millions in our communities. Patients with suspected COVID-19 should be at the same time tested for HBV, HCV, and HIV, and optimizing testing networks so that all hepatitis positive patients have access to viral load testing and linkage to care

The writer is the clinical director at Lugei Foundation and a research associate at Clarke International University (CIU).