Screen-and-Treat Program May Reduce Hepatitis B Mortality

A screen-and-test program may help reduce deadly complications of hepatitis B virus (HBV), a study published in The Lancet Global Health suggests.

HBV infects approximately 250 million people worldwide, but the sub-Saharan region of Africa has the highest incidence of the virus, and affects 80 million people in this region.

“Hepatitis B is the leading cause of liver cancer and cirrhosis in sub-Saharan Africa, yet most patients do not realize they are infected until they develop severe symptoms,” said lead study author Maud Lemoine, MD, MSc, PhD. “In our clinic in the Gambia we would often see patients, in their 20s or 30s, with liver tumors 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.”

In an attempt to identify hepatitis infection earlier, researchers conducted a pilot study that tested individuals for the virus in communities in The Gambia, West Africa. The screen-and-treat program called Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) was conducted between December 2011 and January 2014.

Researchers used a cheap instant test in order to screen approximately 6000 people for the virus in the Gambian community. Those who were found to be infected were referred for further liver tests and treatment.

Approximately 6000 blood samples taken from blood banks were also screened, because prior research suggested that some donor blood is infected with HBV. If HBV was detected in a sample, the team contacted the donor and referred them for tests and treatment.

Since 1990, there has been an effective vaccine available for HBV; however, about one-third of Africa’s population remains unvaccinated. Furthermore, only 1 in 10 infants are vaccinated at birth, which is recommended by the World Health Organization (WHO), since many areas lack the resources and infrastructure to administer the vaccine.

It’s also important to note that those who were born before 1990 will not be protected. As far as treatment for HBV, antiviral medications can successfully treat the virus, but many individuals are not routinely tested for HBV unless they have other conditions, such as HIV, causing many cases to go undetected.

Furthermore, the medications are expensive.

“In Africa, access to screening and treatment for hepatitis B is almost non-existent,” said study co-author Dr. Ramou Njie. “Yet, viral hepatitis kills thousands of people each year. The disease can be successfully controlled with medication, but in many countries access to treatment is not available at low cost, and remains restricted to people who are affected with HIV/AIDS.”

The results of the current study showed that 9% of individuals, and 13% of potential blood donors, tested positive for HBV. However, of these tested patients, only 4% were deemed to have an infection severe enough to require antiviral treatment.

“A relatively small number of people needed antiviral treatment, and the cost of this medication is far less than treating complications further down the line such as liver damage and cancer,” Lemoine said.

Authors noted that the screen-and-test treatment had good screening coverage of 70%, and that the patients who required antivirals adhered to their medication schedule of the next year.

“Our study shows that the screen-and-test programs targeting the general population are feasible — and successful – intervention in sub-Saharan Africa, and should be implemented in other areas in the continent,” Lemoine said.

The findings suggest that this program approach would be a cost effective way to address HBV, and to prevent complications of the disease.

“Hepatitis B and its consequences represent a major but often underestimated public health problem in Africa,” said professor Umberto D’Alessandro, director of the MRC Unit The Gambia. “This is clearly shown by the PROLIFICA program which also underlines the importance of research in informing health policies and practices.”

Recently, the WHO adopted a global strategy to try and eliminate viral hepatitis infection by 2030, and to achieve this, new approaches need to be made.

“In May the world adopted targets for the elimination of hepatitis B,” said Charles Gore, president of the World Hepatitis Alliance. “The most challenging of these is to diagnose 90% of those living with the virus by 2030 because this requires a public health approach that has been noticeably lacking to date. This project and its results are so important because they show not just that this can be done cost-effectively but how it can be done.”