Screen and treat for HepB

Hepatitis B is a devastating virus that infects around 250 million people worldwide and is endemic proportions in parts of Africa. Left untreated, it can cause cirrhosis, liver cancer and early death. Tackling the spread of this virus is essential and vaccination programmes have been started in many countries since 1990 including the Gambia, with some beneficial effects. However, the fact remains that around one-third of the population of Africa are still not vaccinated and only one in ten infants are vaccinated at birth, as recommended by the World Health Organisation, as many areas lack the infrastructures and resources to administer the vaccine.

Five years ago, I was involved in starting a ‘screening and treat’ scheme for hepatitis B in Gambia which aimed at finding adults in communities who had been infected so they could be given anti-virals, provided by Gilead, before their disease became terminal. I was part of a team that included researchers at a number of international institutions including Imperial College London and the Medical Research Council Unit. The programme, called PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), was carried out between December 2011 and January 2014.

In our clinic in the Gambia, we would often see patients, in their twenties or thirties, with liver tumours the size of footballs. They had probably been infected with the virus since childhood, but by the time they came to us in the clinic there was little we could do for them.

We screened adults 16 years and over at blood banks and in communities. Altogether, nine per cent of the adults from the communities we screened tested positive for HepB and around 13 per cent of the samples in the blood bank were contaminated. This was worryingly high, but could reflect the fact that males disproportionately donate blood and also are more likely to carry HepB. When we found a contaminated blood supply, we contacted the donor and got them onto a treatment path.

Our findings, published in the latest issue of The Lancet Global Health, suggest that the scheme has successfully helped to prevent deadly complications in many people who might otherwise die. It has also proved to be cost-effective and simple to administer. The pin prick tests can be done in the field and give results within 15 minutes. Now we need to ensure that this scheme is rolled out to more communities and countries in Africa. Blood banks need to be checked and donors should be screened before they are asked to give blood for transfusions.

Drugs need to be made available at low cost to countries where the problem is already severe. In my opinion, the Global Fund or other international health agencies need to rethink its policy of ring-fencing anti-viral drugs which work against HepB as well as HIV for HIV– positive patients only. At the moment, sufferers with HepB are not seen as a priority. But as someone who has seen young men in their 30s dying of cirrhosis because of hepatitis B, I am convinced that this attitude now needs to change.

 

Dr Maud Lemoine
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