Curing hepatitis through civil society engagement, prevention

By introducing safe medical practices the spread of not just hepatitis, but also other diseases can be controlled

According to the World Health Organization (WHO), “Viral hepatitis B and C (HBV) (HCV) affect 325 million people worldwide causing 1.34 million deaths a year. It is the second major killer infectious disease after tuberculosis, and 9 times more people are infected with hepatitis than HIV. Hepatitis is preventable, treatable, and in the case of hepatitis C, curable. However, over 80 per cent of people living with hepatitis are lacking in access to prevention, testing and treatment services.”

Pakistan has the second highest prevalence of HCV in the world. Hepatitis B and C together make 12 million infected people. Transmission is primarily associated with poor infection control practices in the healthcare settings along with reduced community exposures. According to the official data, close to 20 million people are unaware that they are living with the disease.

To eliminate viral hepatitis as a major public health threat, Pakistan has developed the National Hepatitis Strategic Framework (NHSF) 2017-21. Aligned with WHO’s Global Health Sector Strategy, the NHSF was developed with input from National and Provincial Health Departments and through the technical assistance of experts.

The NHSF is geared towards achieving WHO hepatitis elimination target of 90 per cent by 2030.

The key interventions of NHSF are focused on reducing the use of therapeutic injections, improve blood safety, and ensure proper sterilisation of invasive medical devices. Pakistan has the highest number of therapeutic injections per person per year. Experts have been stressing to conduct a wide mass-screening programme to ascertain the burden of the disease so that a comprehensive strategy is developed to handle the disease.

In majority of the cases, injections have been considered the primary cause of the spread of hepatitis. According to a study conducted by WHO, 16 billion injections are given worldwide, out of which more than 40 per cent injections are unnecessary. The infections carried by needles are invisible to the naked eye, and the poor recipients usually have no clue of the risks of disease transmission.

According to WHO, 95 per cent of people infected with HCV can be cured within 2 to 3 months with highly effective direct-acting antiviral (DAA) drugs. On the basis of the 2015 WHO guidelines on injection safety, the NHSF introduced a policy to ensure that syringes used in the health sector are auto-disabled, thus preventing the reuse of syringes and eliminating a major risk factor for HCV in the country.

In recognition of Pakistan’s high political commitment to fight the scourge of hepatitis, despite huge challenges, WHO had given the baton of hosting global events on the World Hepatitis Day 2019 to Pakistan.

To mark the significance of the day, the government announced its flagship project titled Prime Minister’s Programme for Prevention and Control of Hepatitis. The overarching aim of the programme is to not only reduce the burden of viral hepatitis but to also financially facilitate people who are unable to afford the treatment because of high cost of medicines and related diagnostic tests. Furthermore, within the programme an elaborated mechanism has been planned for the reduction of hepatitis B and C, through advocacy and behaviour change communication, hepatitis B vaccination for high risk group, establishment of screening, diagnosis and treatment facilities in District Headquarter Hospitals, safe blood transfusion, and prevention of hepatitis A and E.  Being one of the major carriers of viruses, blood transfusion is at the centre of all the healthcare projects undertaken by the federal government.

In support of the above initiative, the Ministry of Health Services, Regulations and Coordination also announced plans for injection safety, safe blood transfusion and national infection control guideline.

Usually people from poor socio-economic background, with insufficient health facilities and having minimum awareness about communicable diseases get easily infected. At the greatest risk of disease are also some of those who are hardest to reach, such as prisoners, refugees, people who inject drugs and indigenous communities.

Another dimension leading to the spread of hepatitis is the inability to access timely and right diagnosis and treatment, which often takes people to quacks — one of the significant challenge in the spread of hepatitis because of medical instruments that are used without proper or no sterilisation. The quacks administer intravenous medication high on antibiotics that ultimately leads to both infectious diseases and resistance to antibiotics.

Therefore, by introducing the culture of safe medical practices that include taking up cudgel against quackery and managing waste through a proper system of disposal, the spread of not just hepatitis, but also other contagious diseases like HIV, can be largely controlled.

Furthermore, purging contamination from drinking water and improving sanitation services are considered important interventions in controlling the spread of viral diseases.

Part of pledges, made at the time of the adoption of the Sustainable Development Goal in September 2015, was the determination to combat hepatitis and other communicable diseases by 2030. A similar plan was outlined in 2016 by WHO’s Global Health Sector to eliminate hepatitis as a threat to public health. Thus a target was set for a global reduction in hepatitis-related diseases by 65 per cent and new infection by 90 per cent by 2030.

Experts do not consider impossible stemming the tide of hepatitis epidemic. Medical advances and cheaper drugs have dramatically reduced the length of treatment and risks of side effects, and improved patient outcomes, in recent years.

Notwithstanding the importance of diagnosis and treatment, the engagement of civil society to mitigate the burden of hepatitis cannot be ruled out. Community engagement through public service awareness campaigns on preventive and curative measures have the potential to create a climate of “all-teach, all-learn” approach that pervades information across various geographical region and sociocultural contexts. Countries low on budget for developmental projects — like Pakistan — are usually faced with a dearth of specialists and preventive measures to control viral diseases.  Therefore, adopting this inclusive approach becomes all the more important and a sine qua non for reduction in hepatitis.

Published in The Express Tribune, January 23^rd, 2020.

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