A new approach to prevent, diagnose, and treat hepatitis B in Africa
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Published:2023-11-02
Issue:1
Volume:1
Page:
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ISSN:2731-913X
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Container-title:BMC Global and Public Health
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language:en
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Short-container-title:BMC Global Public Health
Author:
Spearman C. Wendy,Andersson Monique I.,Bright Bisi,Davwar Pantong M.,Desalegn Hailemichael,Guingane Alice Nanelin,Johannessen Asgeir,Kabagambe Kenneth,Lemoine Maud,Matthews Philippa C.,Ndow Gibril,Riches Nicholas,Shimakawa Yusuke,Sombié Roger,Stockdale Alexander J.,Taljaard Jantjie J.,Vinikoor Michael J.,Wandeler Gilles,Okeke Edith,Sonderup Mark,
Abstract
AbstractThere are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB.
Funder
GILEAD Sciences for the Women Hepatitis Champions Training in Mauritius, Nigeria and Egypt
Received funding from GILEAD Sciences for NOPLHB
Received funding from MRC UKRI.
Wellcome Trust
The Francis Crick Institute
UCL NIHR Biomedical Research Centre
Received funding from GILEAD Sciences for research
Research funding from GILEAD Sciences and research materials from Abbott and Fujirebio Inc.
National Institute for Health and Care Research (UK) Senior Clinical Lectureship at the University of Liverpool
U.S. National Institutes of Health Grant
Supported by a Professorship grant from the Swiss National Science Foundation
Received unrestricted research grants from Gilead Sciences and Roche Diagnostics
Publisher
Springer Science and Business Media LLC
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