BY Ange de la Victoire DUSABEMUNGU
While Hepatitis C and Hepatitis B cases continue to occur in Africa, especially in Sub-Saharan Africa, some countries, including Rwanda, Uganda and Egypt, continue to show positive progress in the elimination of those viral diseases.
This was revealed on Friday, 22 April 2022 during a media round table which was organized by Abbott, a global healthcare leader, to discuss the prevalence and impact of hepatitis B (HBV) and hepatitis C (HCV) in sub-Saharan Africa.
Speaking on the journey in Sub Saharan Africa, particularly in Rwanda, Dr. Janvier Serumondo, Director of Sexually Transmitted Infections and Viral Hepatitis Unity in Rwanda Biomedical Centre said that Rwanda launched Hepatitis elimination in December 2018, and the plan was for five years, starting 2019 and ending in 2024.
Dr. Serumondo reminded that the plan aims to screen 7 million people aged 15 years and above, to treat all confirmed positive cases and reduce HCV prevalence to around 1%.
“Obviously, in the beginning, we started by high-risk groups, and we screened people living with HIV, prisoners, people aged 45 years and above, men having sex with men, sex workers and refugees.” He said.
“That was the first phase and the second phase was the general population.” Dr. Serumondo added.
Among the key achievements in Hepatitis elimination in Rwanda, Dr. Serumondo highlights the development of national strategic plans which is now updated.
“But also practically, we have trained healthcare providers at all levels of the health facilities. They include doctors, nurses, lab techs, data managers, they were all trained on the management of HBV and HCV.” He said.
“And now, it allows us to do a task shifting from hospitals to health centres, but also a decentralisation of services from hospitals to health centres, which is the lowest level of health facilities. So, the prevalence decreased from 4% in 2017 to 1% Currently, and all HBV and HCV services provided at no cost.” Said Dr. Serumondo.
He revealed that Rwanda has been able to screen more than 6 million people and treat more than 50,000 people by the end of December 2021.
However, Dr. Serumondo, added that “despite the efforts deployed in combating Hepatitis B and C, the number of deaths caused by variables B and C keeps increasing if compared by the number of deaths caused by HIV, TB, and malaria.”
“That’s why the World Health Organisation in 2016 launched a global health sector strategy on viral hepatitis with the aim of ending virus fatalities by 2030.” He said.
The Global Health strategy includes a lot of indicators to be fulfilled by countries and those indicators include programmatic indicators, such as diagnostic and treatment coverage, but also blood safety, safe injections, harm reduction, and so on.
“We also have impact indicators such as incidence and mortality. And all of those indicators are required to be fulfilled by the country so that they can be validated for a particular nation.” Dr. Serumondo added.
Many countries adopted the WHO strategy for Hepatitis elimination and Rwanda was part of those countries as well.
All this process has been supported by the government and championed by Rwanda’s First Lady and the support by the government initiated a collaboration with many partners, many public and private sectors and the commitment of many funders, donors, as well the domestic funding model has been used to fund the HCV elimination process.
Note that Rwanda underwent a first phase which was the validation pilot as Rwanda was selected among the six countries that were part of that process.
According to Prof. Wendy Spearman, Head of the Division of Hepatology at the University of Cape Town & Groote Schuur Hospital, “if we’re going to really have any attempt to achieve the WHO targets for elimination of Hepatitis B and C, we need to have political will to recognise viral hepatitis as the health priority, set national elimination targets, implement effective programmes, but importantly, these programmes need to be adequately funded and we must have universal access to affordable diagnostics and therapeutics.”
“I think as a whole in WHO, Africa region, Hepatitis B is probably still the leading problem, but we know that if we look at Sub Saharan Africa, the overall prevalence of hepatitis C is about 5.3% and we have different regions within Sub Saharan Africa, which have higher prevalence with 6% in Central Africa, followed by West Africa, 2.4%.
And I think if we look at why we have the different prevalence and the different regions of Sub-Saharan Africa, it really relates to historical acquisition. So, we know that we could really only test appropriately for hepatitis C, in the mid-90s. It was only discovered in 1989. So, we have a large proportion of individuals within Africa, who have yet had to be diagnosed as required in the early stages either from blood transfusions, safe injection practices, and dental work.” Explains Prof. Wendy
“As Rwanda showed, it’s very easily treatable, and it’s curable.” She added.
In Rwanda, the earliest prevalence of the viral hepatitis (HBV & HCV) was 2% of the population when the country’s Hepatitis program commenced in July of 2016, with people aged 55 and above accounting for 16% of infections. The rate of HBV and HCV is higher in rural communities. A precursor to bolstering the nation’s healthcare system, in 2005, the Rwandan government launched a performance-based financing system that rewarded community health centres and district hospitals for better patient follow-up, which drastically improved existing services.