Why Nigerians should know their hepatitis status

Tina Adesina is a Senior Public Health Specialist and Data Monitoring Coordinator at the University of Maryland, Baltimore (UMB), United States, Nigeria Programme. She said people needed to be more informed and aware of their hepatitis status and get vaccinated. NKECHI ONYEDIKA-UGOEZE writes. Excerpts:

What is hepatitis?
HEPATITIS is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections such as toxic substances (for example alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. The five unique hepatitis viruses are A, B, C, D, and E.

Hepatitis A and E are spread by the ingestion of contaminated food and water, which is through fecal-oral routes. Hepatitis B, C, and D are spread by contact with infected body fluids, blood or blood products or contaminated blood. Hepatitis B virus can be spread by other body fluids, like amniotic fluid, saliva, and semen.

How can it be prevented?
Good handwashing practices. Use soap and water immediately after using the restroom, before serving food and when or if you come in contact with blood, stool or body fluid. Avoid unclean food and water. Avoid raw or undercooked meat and fish to prevent infections from hepatitis A and E.

Generally, individuals should practice safe sex and injection practices to minimise their personal risk contacting Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Avoid intake of excessive alcohol to prevent alcohol-induced hepatitis. Do not practice self-medication as some drugs could cause hepatitis.

Why did UMB decide to conduct hepatitis survey aside from HIV for NAIIS?
UMB is a multi-national organization that identifies with infected and affected persons living with Human Immuno-deficiency Virus (HIV), tuberculosis (TB) and/or hepatitis. As an organisation involved in program implementation and servicing healthcare systems in Nigeria, UMB seeks to support the implementation of treatment and safe practices that will alleviate the disease burdens on Nigerians.

The Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018 was a national household-based survey that assessed primarily the prevalence of HIV and related health indicators, and secondarily assessed the national prevalence of Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), as well as HIV/hepatitis co-infections.

HBV and HCV infections constitute major public health problems in Nigeria and are commonly found in people with HIV. This increases the morbidity and mortality of people living with HIV and shares the same routes of transmission. It was based on this premise that UMB decided to survey the estimated prevalence of HBV, HCV infections, and HBV/HIV and HCV/HIV co-infections. This survey has given an insight into the number of people with HBV and HCV as well as HIV and HBV/HCV co-infections and will inform programmes that will help curb the spread.

Which of the hepatitis was tested?
Participants in the survey were tested for Hepatitis B virus (HBV) and hepatitis C virus (HCV).

Age grade tested?
All consenting participants aged 15-64 years in preselected households who tested HIV positive and a selected number of those who tested HIV negative were tested for hepatitis.

Response rate during the survey
Of 11,991 eligible individuals, the response rate for hepatitis was 87.1 per cent representing individuals that were tested for hepatitis. Only 54 per cent and 42 per cent of the enumeration areas in Zamfara and Borno States, respectively, were accessible during the survey due to security restrictions.

Testing method adopted
Rapid HBV and HCV antibody tests were performed for the selected individual’s age 15–64 years and all PLHIV. Determine the HBSAg Test kit and OraQuick® HCV Rapid Antibody Test were used for HBV and HCV, respectively. For all participants with rapid HCV positive results, HIV antibody testing used the serological rapid diagnostic testing algorithm based on Nigeria’s National HIV Testing Guidelines, with laboratory confirmation of seropositive samples using a supplemental assay.

Where can people access treatment?
Most secondary and tertiary healthcare facilities offer diagnostic and treatment services. To commemorate last year’s (2018) World Hepatitis Day, the former Honorable Minster of Health-Professor Isaac Adewole launched the Nigerian Viral Hepatitis Health Facility Directory. The directory provides information on existing health facilities where Hepatitis diagnostic and treatment services are provided.

What do you think is responsible for the increasing rate of Hepatitis?
There is low knowledge of HBV and HCV infections in Nigeria; hence most of the chronically infected Nigerians have been undiagnosed leading to increased transmission within the community and exposing them to the risk of developing severe complications (liver cirrhosis and liver cancer). Most people are not aware of the risks involved or even the modes and routes of transmission, thus spreading the virus.

Why is there a low level of awareness of hepatitis in Nigeria?
Very little is said about hepatitis in the country and some people are unaware of available laboratory tests and vaccines. However, there is more focus on malaria, HIV, and cancer. According to the World Health Organisation (WHO) scorecard report on hepatitis prevalence, dying of hepatitis is a big threat in Africa. We need to do more to create awareness in the country.

Is hepatitis vaccine available?
As stated earlier, hepatitis vaccines are readily available for children and for adults as well. Secondary and tertiary institutions offer the vaccines at subsidized prices. People need to be more informed, aware of their Hepatitis statuses and vaccinated.

Is there a cure for hepatitis C?
Hepatitis C is a virus and one of the most lethal types of hepatitis viruses. It is can be managed and can be cured if treatment is sought early.
For some people, the Hepatitis C virus can be cured without treatment, while for some people, it can gradually progress into chronic condition that damages the liver and degenerates into liver cirrhosis and cancer. It is not wise to gamble with health, so it is best if people can get tested early and seek treatment if identified Hepatitis positive.

Is the Nigerian government doing enough to contain the spread of hepatitis?
The government is working to eliminate Hepatitis B and C viruses. The Federal Ministry of Health has been working with partners and Pharmaceutical companies to ensure that anti-viral drugs are available at cost-effective prices for the treatment of Hepatitis B and the treatment of Hepatitis C infections.

It is therefore advisable that everyone should get tested for hepatitis B and C and seek appropriate vaccinations if test results are negative to prevent the risk of infection. Where hepatitis test results are positive, he/she should consult with a physician for adequate advice on the next steps to take.

Hepatitis affects all and should be seen as an urgent call for action for all stakeholders in all sectors.