• Cost of test, care records over 100% spike in five years
• Less than 200 gastroenterologists actively practising nationwide
• Nigeria ranks third on global viral hepatitis burden, highest in Africa
• Country, nine others account for 69 per cent of global hepatitis B deaths in 2024
• Experts demand subsidies, wider screening to improve outcomes
• Treatment interruption may fuel drug resistance, worsen liver disease burden

As Nigeria joins the global community to commemorate World Hepatitis Day, stakeholders have raised an alarm over the high cost of diagnosis and treatment, describing them as the main barriers to controlling viral hepatitis B and C in the country.

They warned that over 80 per cent of the 20 million Nigerians infected with viral hepatitis are undiagnosed, leading to delayed care, a high rate of severe liver complications and preventable deaths yearly.

While awareness of viral hepatitis is growing and drugs are more available than ever before, experts noted that a devastating gap in affordability and specialised care is leaving the country’s most vulnerable populations behind.

Viral hepatitis is an inflammation of the liver caused by infectious viruses. It is a major global public health threat capable of causing severe liver damage, cancer, and death.

Experts warned that diagnosis remains one of Nigeria’s weakest links in the fight against the disease, adding that early testing and treatment may help lower the risk of serious liver damage such as cirrhosis, liver failure or liver cancer.

Findings by The Guardian showed that out-of-pocket spending remains the primary barrier to proper care, as over 70 per cent of financing for viral hepatitis in Nigeria is heavily out-of-pocket, thereby causing many patients to drop out of care or resort to cheaper, unverified herbal alternatives.

Over the past five years, the cost of diagnosing and managing viral hepatitis in Nigeria has surged, driven by inflation and out-of-pocket medical costs, making treatment unaffordable for the average patient.

The cost of Basic Rapid Diagnostic Tests (RDTs) for Hepatitis B (HBsAg) or C (HCV), which was about N1,000 to N2,000 in most laboratories five years ago, now ranges from N2,000 to N5,000 depending on the facility.

Further checks by The Guardian showed that Viral Load PC, which cost about N20,000 to N35,000 in 2021, now costs about N40,000 to N90,000, depending on the lab and the specific viral strain (e.g., Hep C vs Hep B).

Additional Workups (Liver Function, Scan, Blood Counts), which cost about N50,000 to N80,0000 now cost over N150,000 to complete the comprehensive investigations required before starting long-term hepatitis treatment.

The World Health Organisation’s (WHO) Global Hepatitis Report 2026 ranked Nigeria the third country with the largest number of people living with hepatitis B and hepatitis C in the world, and as the country with the highest burden in Africa by total infections.

This is despite the availability of effective vaccines and treatment.

The report also showed that Nigeria, among nine other countries, accounted for 69 per cent of hepatitis B-related deaths worldwide in 2024.

The Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) data paints a sobering picture showing that about 8.1 per cent of the Nigerian population is living with Hepatitis B. In comparison, 1.1 per cent carry Hepatitis C.

According to the Federal Ministry of Health and Social Welfare, about 20 million Nigerians are living with viral hepatitis, Hepatitis B and C, further confirming Nigeria as one of the countries with the highest burden of the disease globally.

Over 80 per cent of those infected are undiagnosed, which causes silent liver damage and thousands of preventable deaths yearly. While about 18 million Nigerians live with Hepatitis B (HBV), Hepatitis C (HCV) affects approximately two million Nigerians.

The scale of the challenge extends beyond national borders. According to the World Health Organisation (WHO), an estimated 240 million people were living with chronic hepatitis B infection globally in 2024, resulting in approximately 1.1 million deaths, largely from liver cirrhosis and hepatocellular carcinoma, the most common form of primary liver cancer.

Experts said that the widespread transmission nationwide is driven by unsafe practices such as local scarification, tribal marks, use of unsterilised equipment for traditional circumcision and lack of awareness, as many individuals live with the virus unaware of their status because symptoms often do not show up until advanced stages, like liver cirrhosis or cancer.

Against this backdrop, medical experts are renewing calls for urgent government intervention through subsidised treatment, expanded screening programmes, wider access to diagnostic services, improved insurance coverage and sustained public awareness campaigns.

They warn that unless financial and structural barriers to hepatitis care are addressed, more Nigerians will continue to present with preventable complications, undermining both national efforts and the global target of eliminating viral hepatitis by 2030.

Speaking with The Guardian, President of SOGHIN, Prof. Abdulfatai Olokoba, lamented that despite the massive patient load, Nigeria has fewer than 200 actively practising gastroenterologists, leaving a huge mismatch between those who are suffering from the disease and the specialists who care for them.

He observed that because nearly all chemical reagents used in these tests are imported, prices have surged beyond the reach of ordinary citizens.

Olokoba said that although the basic screening for Hepatitis B or C is relatively inexpensive, costing between N1,000 and N3,000, the real crisis begins when a patient tests positive.

He said: “Being positive merely tells a doctor that the virus is present. To understand what the virus is actively doing to the liver, a patient must undergo an extensive medical workup. This includes a complete blood count, blood chemistry, urinalysis, serum alpha-fetoprotein, abdominal ultrasound scans, and quantitative viral load tests (Hepatitis B DNA or Hepatitis C RNA).

Olokoba explained that quantitative tests indicate the viral load in the blood, which is directly proportional to the risk of long-term damage.

“Ultimately, the virus resides in the liver, replicates, and causes damage. In the long term, the patient may develop liver cirrhosis or cancer of the liver. This is what we want to prevent.”

He pointed out that the total cost for baseline workup is at least N100,000 and could be higher in cosmopolitan hubs like Abuja, Lagos, or Port Harcourt, while the Viral Load Test (PCR DNA/RNA) costs between N30,000 and N35,000 per test.

Olokoba stated that for individuals co-infected with both strains, the viral load tests alone cost roughly N70,000, adding that if a patient successfully navigates the diagnostic hurdle, the cost of survival remains astronomical.

He said: “Modern medicine has shifted away from expensive, painful interferon injections to direct-acting oral antiviral tablets. A single monthly bottle costs between N60,000 and N70,000, and treatment must be maintained for up to a year.

“For Hepatitis B, there is no cure, only lifelong management to keep the virus suppressed, and standard daily medication like Tenofovir Alafenamide costs between N15,000 and N20,000 per month. For many, this is a permanent bill they must pay for the rest of their lives.”

Olokoba lamented that, given Nigeria’s current economic climate and the devaluation of the naira, these diagnostic costs are forcing patients to withdraw from treatment early.

He added that compounding the financial burden is the reality of Nigeria’s healthcare infrastructure.

He noted that the National Health Insurance covers less than 10 per cent of the population, stressing that while those fortunate enough to be insured pay only 10 per cent of the cost for some of these procedures, most Nigerians are completely uncovered.

Olokoba recommended that the government could close the gaps by simply deploying the resources more strategically, leveraging the HIV infrastructure, and integrating viral hepatitis into the existing HIV lab networks to eliminate the baseline diagnostic barrier.

He said: “Over the last two decades, billions have been funnelled into Nigeria’s HIV response, making treatment and testing entirely free or heavily subsidised. The PCR machines used to track HIV viral loads and CD4 counts are the same machines needed for Hepatitis B and C. By integrating viral hepatitis into the existing HIV lab networks, the government could instantly eliminate the baseline diagnostic barrier.”

He also urged the government to subsidise and decentralise care, adding that because hepatitis medications are entirely imported, the federal government should implement immediate import duty waivers and tax holidays for pharmaceutical companies bringing these life-saving drugs into the country. In the long term, policies must support local manufacturing plants to produce these formulations domestically.

“Government can legislate mass, mandatory screenings at every healthcare touchpoint. Whether a patient walks into a clinic for diabetes, malaria, or high blood pressure, screening should be free or heavily subsidised. Furthermore, hepatitis management needs to be scaled down from overwhelmed tertiary teaching hospitals to secondary health facilities,” he added.

A Consultant Physician and Gastroenterologist at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Dr Jennifer Aloh, said the country remains one of the highest-burden nations in sub-Saharan Africa, though warned that the official prevalence figures likely underestimate the country’s true disease burden because less than 20 per cent of infected persons know they are living with the virus.

Aloh explained that patients receiving treatment for hepatitis B usually require long-term therapy lasting several years, with monthly medication costs ranging between N15,000 and N30,000 depending on the prescribed drug and brand.

She added that hepatitis C treatment is considerably more expensive, with newer medicines costing between N200,000 and N500,000 per month, although some older, less expensive drugs are gradually being phased out of clinical use.

Beyond medications, she identified the cost of investigations as another major challenge, explaining that patients require several laboratory tests throughout treatment. According to her, hepatitis B viral load testing alone costs an average of about N50,000 in many laboratories, while some facilities charge as much as N205,000 for a single test.

The physician lamented that most Nigerians pay for hepatitis care entirely out of pocket because the necessary drugs are not covered under health insurance, adding that there is currently no government subsidy to ease the financial burden on affected patients.

The gastroenterologist further observed that worsening economic conditions have made it increasingly difficult for many patients to continue treatment as prescribed. She said some discontinue their medications because of financial constraints, while others abandon follow-up appointments altogether and only return after developing severe complications.

She warned that inconsistent treatment not only increases the likelihood of liver damage but may also encourage drug resistance, making future management more difficult. Aloh urged Nigerians to embrace testing and vaccination, particularly against hepatitis B, for which an effective vaccine provides more than 97 per cent protection and lifelong immunity.

In an interview with The Guardian, the National Coordinator of the National AIDS and STDs Control Programme, Dr Adebobola Bashorun, said that about 20 million Nigerians live with viral hepatitis adding that Nigeria’s prevalence rates are estimated at 8.1 per cent for hepatitis B virus and 1.1 per cent for hepatitis C virus among people aged 15 to 64 years, according to the Nigeria AIDS Indicator and Impact Survey 2018.

Bashorun listed the key drivers of hepatitis in the country to include mother-to-child transmission, transfusion of infected blood and blood products, unsafe injection practices, use of inadequately sterilized medical equipment, needle-stick injuries and occupational exposure among healthcare workers, haemodialysis procedures, organ transplantation from infected donors, tattooing with contaminated instruments, scarification using unsterilized instruments, circumcision performed with contaminated instruments, unprotected sexual intercourse and multiple sexual partners among others.

He highlighted challenges facing diagnosis, treatment, and Management in the country, including inadequate funding for the hepatitis programme, limited access to testing and treatment services, a shortage of trained healthcare personnel, inadequate diagnostic infrastructure, low coverage of birth dose vaccination, high cost of viral hepatitis essential commodities, and inadequate infection prevention and control measures, among others.

He also stressed the importance of preventing mother-to-child transmission, scaling up vaccination among children, and implementing catch-up vaccination for adolescents and adults to enable the country to eliminate viral hepatitis by 2030

Bashorun stressed that these challenges could be addressed by increasing awareness of the hepatitis epidemic, ensuring individuals utilise health insurance and the Basic Health Care Provision Fund, replacing cultural and traditional beliefs with evidence-based medicine, improving health-seeking behaviour, and ending stigma and discrimination.

He stated that there is no explicit national subsidy programme for viral hepatitis diagnosis and treatment, adding that interventions are mostly out-of-pocket.

The Coordinator noted that to eliminate Viral Hepatitis by 2030, the government has developed policy documents and standard operating procedures that include National Viral Hepatitis guidelines, National Strategic Framework (2022 – 2026), Roadmap to setting up state viral hepatitis programme and had integrated HBV into the national Triple Elimination Initiative targeted at the prevention of mother-to-child transmission of HIV, HBV and Syphilis, and also integrated HBV and HCV into the Sexual and Reproductive Health and Rights and Communicable Diseases.

He said: “The government has developed National tools for monitoring and evaluation of HBV and HCV, expanded hepatitis B birth dose and vaccine series for infants coordinated by the NPHCDA. We are also promoting hepatitis B birth-dose vaccination within 24 hours of birth, strengthening blood safety measures and implementing harm-reduction interventions.”

Founder and Team Lead of the Hepatitis Advocacy Foundation Nigeria (HAF), Okinedo, said Nigeria’s response to eliminating viral hepatitis B and C remains inadequate, and warned that government inaction has continued to endanger the lives of people living with the diseases.

Okinedo argued that efforts aimed at combating viral hepatitis have failed to provide the level of treatment and care required to meet elimination targets.

He added that the lack of meaningful commitment has placed patients requiring treatment and care in harm’s way, resulting in poor health outcomes for many people living with viral hepatitis B and C.

He called for stronger political commitment, improved access to treatment and sustained investment in hepatitis prevention, if Nigeria is to reverse the trend and make meaningful progress towards elimination targets.