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Hepatitis B: a case for increased access to affordable treatment

Hepatitis B: a case for increased access to affordable treatment

Govt’s continued neglect for people living with Hepatitis B in Nigeria is affecting timely access to treatment and increasing the number of people dying from this treatable disease. HIV/AIDS has been the main attraction for a long time. Perhaps it’s time we give a thought to Hepatitis B writes, CHUKWUBUIKE OGUH

One of the greatest concerns of Dr. Charles Onyekwere is being able to convince the Nigerian government about the critical state of Hepatitis B management and the need to declare the disease a national emergency just like HIV was declared in 2001 by the Olusegun Obasanjo administration.

“Hepatitis is an orphan disease,” said Dr. Onyekwere “and this attitude is simply because we have refused to see the need to give it the attention it deserved especially because it is several times more infectious than HIV”.

Onyekwere who is consultant Physician and Gastroenterologist at the Lagos University Teaching Hospital(LASUTH) was speaking during a press briefing organized by the Society of Gastroenterologists and Hepatologists in Nigeria (SOHGIN) to advocate for increased Hepatitis B testing and treatment in Nigeria.

Even though one out of every five Nigerians has Hepatitis B virus (HBV), which attacks the liver, Dr. Onyekwere said local and foreign agencies pay more attention to HIV, which affects one out of every 400 Nigerians. “At one time HIV and AIDS had a prevalence rate of 6 percent but local and foreign intervention brought it down to 3.8 percent today,” Dr. Onyekwere said.

In fact, in 2008 alone local and foreign agencies spent about N45 billion (or about $400 million) to combat HIV and AIDS, according to the National Agency for the Control of AIDS (NACA). NACA says foreign agencies donated about 92 percent of the total funds. Yet, Hepatitis receives no foreign support, Dr. Onyekwere said. “Nigeria must design a local model for fighting Hepatitis B because the disease is not a priority to foreign donor agencies,” Dr. Onyekwere added.

However, Hepatitis B can be as deadly as HIV and AIDS. In Nigeria, WHO estimates that about 19 million people, about 20 percent of the population, are chronic carriers of Hepatitis B virus. In addition, WHO says about 40 percent of HBV carriers will eventually die from liver cancer or liver cirrhosis. “The danger of Hepatitis is that many people are unaware that they are carriers and by the time symptoms begin to appear, 95 percent of the liver has been damaged,” Dr. Oladipupo Hameed, a member of SOHGIN, said.

Aside from facing a disease as deadly as HIV and AIDS, Dr. Hameed said, people with Hepatitis face stigmatization when symptoms like jaundice and abdominal swelling begin to show. A university ejected a final year student from campus and warned him to treat himself for one year before sitting for his exams, Dr. Hameed said. One company sacked one of its staff after she developed jaundice. “It’s only in Hepatitis where young people between ages 18 to 24 can have liver cancer,” Dr Hameed said.

According to the World Health Organization (WHO), Hepatitis is an inflammation of the liver caused by an immune response to the presence of Hepatitis virus in the liver cells. More than 350 million people are infected with chronic Hepatitis B and C, which are the most common causes of liver cancer and liver cirrhosis. The Hepatitis virus is transmitted through contact with body fluids e.g. unprotected sex with an infected person and sharing of infected needles or other sharp objects that can break the skin. In addition, babies born to an infected mother have a 90 to 95 percent chance of contracting HBV during childbirth. Fortunately, babies born in Nigeria receive Hepatitis vaccines that protect them from developing full-blown Hepatitis as adults.

Yet, the biggest obstacle confronting Hepatitis treatment in Nigeria is not the virulence of the Hepatitis virus or even the spread of the disease but a lack of awareness among Nigerians of the importance of discovering their Hepatitis status. There is also the issue of not knowing what to do, where to go to and who to see when it comes to hepatitis. These anomalies are worrisome even though they are the least government could do in ensuring effective Hepatitis B control.

“Hepatitis is an entirely preventable disease if detected early,” Dr. Remi Oluyemi, a member of SOHGIN, said. “Just as people want to discover their HIV status, they should also try to know their Hepatitis status.” The screening costs about N1, 000 and is available at most hospitals. Without this first-line screening, Dr. Oluyemi said doctors cannot move to the next stage of treatment which is determining the quantity of the virus in the blood and prescribing drugs before patients develop full-blown liver cancer or liver cirrhosis. “If people don’t get screened, when they come for treatment after symptoms have developed, their liver already has cancer. It’s like medicine after death,” Dr. Oluyemi said.

For gastroenterologists and hepatologists – doctors who specialize in Hepatitis treatment – it is at this stage of determining the viral load, which involves numerous tests, that they need more local and foreign intervention. Only one institution in Nigeria, the National Institute for Medical Research in Lagos, has the equipment to perform such laboratory diagnosis. “Imagine a Hepatitis patient in Sokoto travelling to Lagos just to get his samples examined,” Dr. Hameed said. And depending on the level of liver damage, that patient must make this pilgrimage every six months during his or her entire life. A single test costs N28, 000 and numerous tests must be undertaken. “Treatment costs are unaffordable for most Nigerians,” Dr. Hameed said.

Even if Nigeria had enough centers for diagnosis of the viral load, few specialists have the skills to manage patients with Hepatitis. Dr. Onyekwere said there are less than 80 consultant gastroenterologists and hepatologists in Nigeria. “The practice is not very lucrative,” he said.

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