Viral hepatitis poses a significant economic burden worldwide and has hampered the health systems in many countries. According to World Health Organization (WHO), hepatitis accounts for approximately 1.4 million deaths per year globally; more than HIV/AIDs or malaria. Of the total hepatitis deaths, hepatitis B and C viruses contribute to around 47% and 48% of cases respectively, and the remainder succumb to hepatitis A and E viruses. Adding to the burden, the alarming rate of HIV co-infection in viral hepatitis patients is a growing concern. It is estimated that around 2.9 million people with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus.
Recent advancements in hepatitis research led to the emergence of new preventive and treatment solutions to manage viral hepatitis. Among the major milestones achieved, the world witnessed a cure for hepatitis C with a drastic reduction in the duration and dosage of treatment from multi-dose regimens to once-daily. Protease inhibitors, polymerase inhibitors and direct acting anti-virals replaced interferons and common anti-virals. Also, the duration of treatment is considerably reduced and multi-dose regimens has shifted to once-daily. The world witnessed a highly effective preventative vaccine and treatment for hepatitis B.
Despite the availability of novel drugs and an array of treatment choices, lack of awareness, advocacy and resources still remain as stumbling blocks for enhanced patient access in hepatitis. In an attempt to resolve such healthcare access related issues, there is a need for collaboration between stakeholders: both organizations and individuals. As part of the initiative, the WHO in 2010 framed the 28th of July ‘as World Hepatitis Day’. Since 2011, World Hepatitis Alliance (WHA) commemorates the World Hepatitis Day each year by focusing on a specific theme and encouraging organizations around the globe to join hands with a common goal. Below are the themes:
Since 2013, focus scientific research center (FSRC) joined forces with WHA’s initiatives and focused on paving a way for patient access through healthcare advocacy and policy shaping initiatives.
2013: More must be done to stop this silent killer.
During 2013, viral hepatitis was the seventh highest cause of mortality globally. Africa, especially Sub-Saharan Africa has the highest number of viral hepatitis infected individuals in the world. As a research organization committed to control the viral hepatitis menace, FSRC made a pioneering step in bringing together various experts such as pharma, physicians, policy makers and patient organizations of both Anglophone and Francophone Africa. As part of the initiative, FSRC team provided a platform for key healthcare experts from Africa and Europe to engage and devise plans to impede the rising burden of viral hepatitis in Africa. Some of the outcomes of the workshops were awareness initiatives, assessment of the disease burden including economic impact in various countries of Africa, devising management strategies and policy shaping. Not only did FSRC play a major role in commencing such; programs but also measured the outcomes of the initiatives through Knowledge Attitude Practice surveys (KAP) and follow-up with experts periodically.
Despite viral hepatitis affecting around 24 million Indians, it did not garner much public attention in India. To enhance the public focus, FSRC conducted a scientific panel discussion in Bangalore, India. As a result, many recommendations emerged such as immunization against hepatitis B, adopting safe clinical practices, knowledge dissemination through effective utilization of technology and advocacy though NGOs. Furthermore, a KAP survey and an awareness campaign were held at a major college in Bangalore, India. Collectively these events commemorated WHD 2013.
2014: Hepatitis: Think Again
Throughout the year FSRC connected with international stakeholders through its scientific platform Dendron. Knowledge was disseminated through publications, live webinars and videos. FSRC team members participated in one of the largest events on liver diseases, the “The International Liver Congress 2014” in London, UK. The event served as an opportunity to engage with experts from different countries to discuss issues related to management of hepatitis. FSRC interviewed experts like Prof. Dr. Mark Thursz (Professor of hepatology at The Imperial College and consultant in hepatology at St. Mary’s Hospital, London), Dr. Mohamad Kamal Shaker [Prof. of Tropical Medicine and Hepatology and Vice Director of hepatocellular carcinoma (HCC) and Dr. Marina Alois Njelekela (Executive Director and Chair of the Department of Physiology at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania) for an update on the strides taken to manage viral hepatitis. The insights were:
– Cost-effective screening methods of hepatitis at a national level
– Importance of screening in resource constrained settings and the importance to link access to care and treatment post screening
– Correlations between high prevalence of hepatitis C and hepatocellular carcinoma (HCC)
– The difference novel HCV drugs would make and the challenges of providing access to HCV treatment in Tanzania
– The application of lessons learnt from the successful management of HIV in the African countries that can be utilized for HCV
Additionally, a KAP on viral hepatitis assessment was done in rural Karnataka, South India and an awareness campaign followed it. On WHD 2014, FSRC team members distributed fact sheets on viral hepatitis to the public, thereby increasing awareness and knowledge about the disease, diagnosis, management and prevention.
2015: Prevention of viral Hepatitis. Act now
It was estimated in 2015 that almost 400 million people were infected with viral hepatitis worldwide, and 4,000 deaths per day were attributed to the disease. As a part of FSRC’s continued efforts to battle viral hepatitis through healthcare advocacy, FSRC interviewed an expert striving to curb the burden imposed by the disease in Ghana. Mr. Theobald Owusu-Ansah is the CEO and President of Theobald Hepatitis B Foundation and Hepatitis Coalition of Ghana and a Board Member of National Association of Hepatitis Taskforce, USA and a Patient Advisory Council Member, Hepatitis Foundation International, USA.
The key opinions from the interview indicated that measures need to be taken to enhance the awareness levels in countries that lack the same. Implications were that imperative actions such as building effective patient advocacy models or framework through collaborative approach would aid in prevention and facilitating patient access in emerging countries. Hence, FSRC shared these suggestions amongst the stakeholders to encourage their efforts towards prevention of hepatitis.
With groundbreaking drugs and effective treatments for Hepatitis C, cure for the disease coupled with the possibility of eradication has become a reality. However, diagnosis and treatment of existing cases is not an easy task. Challenges exist especially in the developing countries. Dr. Arun Gowda, Senior Director of FSRC proposed a framework of action for eradication of the disease (published in pharmaphorum) called CA2RE (Collaboration, Awareness, Access to care, Resource optimization, and Epidemiology and research) to overcome these challenges.
In a nutshell, there is a scope to eliminate viral hepatitis by 2030. But, we cannot be oblivious to the fact that there are obstacles in the way. To succeed, collaboration and application of effective strategies are essential. The year 2016 is a pivotal year for viral hepatitis as WHO Member States are set to adopt the first ever Elimination Strategy for Viral Hepatitis and for the first time national governments will be signing up and committing to the goal of eliminating viral hepatitis. In accordance with the WHA’s NOhep, a global elimination movement, FSRC will continue to raise knowledge and awareness amongst stakeholders and lay emphasis on the importance of implementing the CA2RE framework.