In Nigeria, boosting viral hepatitis awareness and treatment

Four months before her wedding and on the eve of starting a new job, Dada Titilope went in for a routine medical check. It was then that the 36-year-old resident of Ile-Ife Osun State in Southwestern Nigeria discovered that she had hepatitis B.

“I was very scared,” Titilope recalls, describing the horrors she read online about the disease. “I thought it was a death sentence.”

She considered calling off the wedding. But her fiancé and family wouldn’t hear of it, encouraging her instead to focus on staying well.

“The doctors were able to calm me down,” she recalls. “I had to start treatment as soon as possible.”

Hepatitis B infection (HBV) is preventable and treatable, and hepatitis C virus (HBC) infection is now curable. Yet more than 90% of those living with hepatitis B and C in Africa lack much-needed care.

In Africa, including Nigeria, hepatitis is a silent epidemic. More than 90 million people are living with hepatitis in the Region, accounting for 26% of the global total. Nigeria has a prevalence rate of 8.1 and 1.1% for HBV and HCV among adult aged 15-64 years respectively according to the Nigeria HIV-AIDS Indicator and Impact Survey, 2018 (NAIIS 2018). The country has more than 20 million people living with hepatitis B, C, or both; yet more than 80% of the people who have the disease do not know their status, according to some estimates.

“Most patients have the wrong impression of the disease and what they know is often only the negative,” says Professor Dennis Ndububa, head of gastroenterology at the Obafemi Awolowo University Teaching Hospital, where Dada’s diagnosis was confirmed. Many patients, he says, discover their diagnosis accidentally while donating blood or undergoing medical screening for other ailments.

To expand awareness and improve detection and treatment, World Health Organization (WHO) has been supporting the Government of Nigeria in its National Hepatitis response.

“One of the things that we want to do differently now is to try to mirror the kind of mass awareness programme that we have from HIV, and we know the results: many more people know their status. There has been an increase of people on treatments. And so for hepatitis, we’re taking on the lessons from the HIV programme,” says Dr Akudo Ikpeazu, Coordinator, National AIDS and STI Control Programme (NASCP) at the Ministry of Health.

WHO supported the country in developing policy and guidance documents to prevent and treat viral hepatitis across the 5 core intervention areas (e.g., vaccination, prevention of mother to child transmission, blood and injection safety, harm reduction and hepatitis B and C testing and treatment.

“Nigeria has established capacity for viral hepatitis response at all levels,” says WHO Country Representative Dr Walter Kazadi Mulombo, “Including strategies centred on primary health care and universal health coverage.”

At Obafemi Awolowo University Teaching Hospital, all pregnant women are screened for hepatitis B and C. At the national level, hepatitis B vaccination is included as part of routine vaccination for children. Guidelines have also been introduced recommending that any patient seeking treatment for any reason be automatically screened for hepatitis.

“Our goal is to have many more people … getting tested for hepatitis, knowing their status, and then taking the next step of accessing those services that are already available,” says Dr Ikpeazu.

But awareness is only one obstacle. Another is the cost of treatment.

Bamidele Ogbe Solomon suspects that it was a blood transfusion that infected him with hepatitis C. Diagnosed in 2000, the 67-year-old Ife Osun resident has had to contend not only with the painful effects of the disease, but with drug shortages and treatments beyond his financial reach.

“I was told there was a cure in Nigeria for hepatitis C, but it is quite expensive, about 510 000 naira [US$ 1167] for a three-month supply,” he says. “The treatment has not been easy. We have been trying to purchase the drugs and it has been quite expensive for an old man like me. My children have been very supportive.”

“I would like to urge the government to look into how the treatment of hepatitis C can be made easily accessible and treatable for Nigerians,” he adds.

Dr Ikpeazu shares Bamidele’s concern. His team is currently advocating hepatitis treatment to be free, like HIV treatment.

“Hepatitis B treatment can be mainstreamed into health insurance, into the basic services that are provided through the basic health care provision funds,” he says. “For hepatitis C, the good news is that it can be cured after three months, which shortens the span and the costs in total. There is grounds for hope that treatments can be more widespread and more people can have access.”

In the meantime, patients like Bamidele and Dada continue to rely on friends and family for material as well as moral support.

“For those who have had the test and turn out negative, please get vaccinated,” urges Dada. “But if it turns out positive, know that treatment is available. I’m living a healthy life, I’m expecting my first baby, I’m moving on in my career, and I’m really happy. It’s not the end of the world.”