Today the globe marks World Hepatitis Day, but not enough is known about this infection which is more common than HIV.
The facts are there for everyone to see. Someone dies from viral hepatitis every 30 seconds, and more than 300 million people live with chronic hepatitis B or C infection worldwide. On a local front, the National Department of Health states that South Africa has one of the most significant hepatitis B burdens globally. There is an estimated surface antigen (HBsAg) prevalence of 6.7% (3.4 million individuals).
A further 400 000 South Africans live with hepatitis C, but many more are unaware they have hepatitis.
Prevalence of HIV and hepatitis
Dr Harald Nusser is the Head of Global Patient Solutions at Gilead Sciences. Here he works on sustainable business models to ensure that medicines for patients are affordable and accessible.
Nusser shared the implications of hepatitis in South Africa with the growing prevalence of HIV.
“The beauty about Hepatitis C is that it is curable. However, for HIV, tuberculosis and malaria, some global donors procure commodities and help save up on testing and treating infrastructure. But for viral hepatitis, that is not the case,” he explained. The pressure of health finance always plays a vital role.”
He also spoke on the impact the COVID-19 pandemic has had on hepatitis.
“It had a huge impact on hepatitis programmes globally. You need to screen people because the disease does not initially manifest in symptoms. If all the resources go into testing for COVID-19, it’s clear that it is causing a disruption,” he said.
Dr Nusser also touched on the impact co-infection has on the burden of liver disease.
“We do not have the full data on the number of co-infections. But, we know from certain settings, for example in prisons or people who inject drugs and MSM (men who have sex with men) groups, that there are quite a lot of people who have co-infections,” he added.
Nusser further stated that parts of the existing infrastructure for HIV could be leveraged to treat or identify patients who benefit from hepatitis intervention.
‘SA’s capabilities are in place.’
Nusser also commended South Africa for its excellent laboratory capacities and capabilities.
“South Africa was the country that identified and sequenced the Omicron variant. Unfortunately and unfairly, that was associated with it being a variant from South Africa, which was not the case,” Nussar said.
He continued: “The capabilities are in place. Technically it is not more complicated to diagnose Hepatitis than COVID-19. It’s feasible. You need capable health workers who are aware of the disease and who know how to test it and link it to care. You also need IT infrastructure and coordination capabilities to reach patients living in remote areas.”
Nusser believes that because of a lack of awareness and stigma, people don’t consider the importance of testing for hepatitis.
“Often, it’s associated with stigma because some specific key populations have more or higher prevalence of the disease. Not all families are open to discussing hepatitis,” he noted.
He added that opinions often differ when several generations live in the same households. Young people are told how to live their lives, which doesn’t create an encouraging environment for one to get tested.
Dr Nusser also shared that he would love to contribute more to integrated care programmes where infrastructure and capabilities, like HIV, are being utilised to manage viral hepatitis.
“Sometimes it’s just the question of how the different stakeholders interact. To put it simply and bluntly, the private sector, for example, is very much used to looking at diseases as a single disease,” Nusser explained.
“We develop medicine and therefore comes a vertically centred approach to solving that problem, which is a specific disease. When I, as a human being, approach a doctor, I can present symptoms of hypertension, malaria, HIV and hepatitis C at the same time. So you would try to treat me and not the disease.”
Not enough attention
Nusser is also adamant that hepatitis doesn’t get enough attention.
“I’ve heard people in prominent global health positions say that hepatitis is hopeless. On the other hand, I see engagement from First Ladies, for example. They come together and strongly advocate that this is important, especially for the younger generation to become aware of,” he said.
Dr Nusser also stated that the key to ending diseases is at the community level.
“Epidemics start and end at the community level. Primary and community health service delivery models need to be strengthened. However, at the community level, the patient, not the particular disease, is the key. This is fantastic from a public health perspective, but it creates less incentive for private organisations to support primary healthcare service delivery,” said Dr Nussser.
Hepatitis types explained
According to the Avona Health Institute, viral hepatitis is an infectious condition caused by various viruses, some of which are transmitted sexually.
These viruses have a predilection for the liver and affect liver cells resulting in liver scarring and abnormal liver function. In some cases, years of liver scarring can lead to end-stage liver disease.
Viral hepatitis A is usually spread via contaminated food prepared by someone with the disease, where hygiene has been compromised.
This virus is spread through the gastrointestinal tract and can also be transmitted through anal sex.
Viral hepatitis B is relatively common in South Africa. It spreads via body fluids, including semen, blood, saliva, urine, and faeces.
Vaccines and treatment
The hepatitis B vaccine was only introduced to children in South Africa in 1998, and many adults were never vaccinated and remain susceptible.
Hepatitis B infection sometimes clears on its own without treatment. A single tablet a day is often enough to prevent symptoms or complications of the infection.
Viral hepatitis C is an uncommon disease in the heterosexual population of South Africa. However, it is more common among men who have sex with men (MSM), especially those who use and inject recreational drugs.
There is no vaccine to prevent infection with this virus. The virus spreads through sexual fluids and blood.
According to the World Health Organisation (WHO), timely testing and treatment of viral hepatitis B and C can save lives. At least 60% of liver cancer cases are due to late testing and treatment of viral hepatitis B and C (43% due to hepatitis B and 17% due to hepatitis C). Defeating hepatitis means defeating liver cancer.
Dr Nusser believes that coordination is critical.
“This is a skill that the private sector is particularly good at, but the public service providers, not so much. It would just be too good if there were a collaboration on that coordination part. The general scepticism of my industry comes into play. My team is trying to earn credibility, have a pharmaceutical company sit at the table, co-create solutions,” said Nusser.
He added, “It’s not more complicated than eliminating malaria or polio, for example. We need more voices. We need to make sure that it becomes part of the routine of a community health worker, a midwife, or even diagnostic centres.”
By doing this, Nusser believes the theme of this year’s World Hepatitis Day, ‘Bringing hepatitis care closer to you’, could materialise. – Health-e News