The primary challenges in combating viral hepatitis are inadequate funding, low diagnosis rates, and insufficient awareness. Danjuma Adda, the former president of the World Hepatitis Alliance highlights these challenges and offers solutions to combat them.

“Only 4.3% of people have been diagnosed with Hepatitis B, and Hepatitis C kills 3,500 people daily. This lack of investment affects diagnosis rates, treatment availability, and access to care.”

Being diagnosed with Hepatitis B in 2004 and having lost his mother to Hepatitis C in 2007, Adda’s personal experience has been a driving force behind his work as a patient advocate both in Nigeria and on the global stage.

“If we had increased investment, driven by political will and the commitment of funders, donors, and governments to domestic financing and healthcare systems, we could make significant progress. We would have programs to test more people, provide national treatment programs, and ensure access to services. The lack of commitment through financing is one of the major barriers to improving testing, diagnosis, and access to care for hepatitis patients.”

Current WHO Hepatitis B and C Treatment Guidelines

The guidelines will expand access to care and ensure more healthcare workers are trained and equipped to manage patients appropriately. We have the tools, we don’t need to reinvent anything about hepatitis prevention or treatment. Effective vaccines and treatments are available, but what is lacking is the funding and awareness to drive hepatitis elimination towards the 2030 goals.

Despite advances in infant vaccination, global birth-dose coverage is only 45% overall and 18% in Africa. Chronic Hepatitis B treatment remains underused, with only 13% diagnosed and 3% treated. New guidelines expand treatment criteria to include liver fibrosis, HBV DNA levels, co-infections, or abnormal ALT levels. They also introduce prophylaxis for HBsAg-positive pregnant women and emphasize improved testing, including point-of-care HBV DNA assays and universal HDV antibody testing.¹

WHO recommends pan-genotypic direct-acting antivirals (DAAs) like sofosbuvir and daclatasvir for all chronic Hepatitis C patients, including children over 3. Treatment lasts 12 to 24 weeks and is now much cheaper in low- and middle-income countries, with prices under $50 in some areas. However, by the end of 2022, only about 20% of diagnosed patients had received DAAs.²

“We are off track with treatment rates for hepatitis B at just 1% in Africa and 3% globally. We need to scale action to achieve hepatitis elimination by 2030, aiming to reduce mortality by 65% and incidence by 90%, and to diagnose 90% of people and treat 80%. We need to scale diagnosis and access to treatment for all populations in need, within the context of universal health coverage and leaving no one behind, especially in low- and middle-income countries,” Adda explains.

Misconceptions

“People often don’t understand that even if they appear healthy because they’re undiagnosed with hepatitis B or C, they are still at risk of developing liver cirrhosis or liver cancer,” explains Adda. “There’s a misconception that there’s no urgent need for testing and treatment, partly because hepatitis is a slow-progressing disease. People often assume that if they don’t have obvious symptoms, there’s no need to worry.”

Hepatitis has been called the silent killer because many people who have the disease often are not aware they have it. It can quietly linger in the body for years and lead to serious consequences including liver disease, cancer, and death.³

“End-stage liver disease doesn’t develop overnight. Many people who are not diagnosed today may end up with liver cirrhosis or liver cancer in the next one or two years. We need to emphasize that symptoms might not appear until it’s too late. The liver is a large organ that heals itself, so early diagnosis is crucial.”

Need for Enhanced Training for Healthcare Providers

Adda advocates for expanded testing beyond hospital settings, “testing goes beyond hospital-based clinicians. Testing now should be done at community and primary levels of care. Testing needs to be simplified and decentralized, where people can access care more easily. I hear a lot of community people say,

“Why should I be tested if I don’t have treatment or drugs available?”

“Many providers are not updated with recent clinical guidelines, so we need investment to train more healthcare providers, more general practitioners, and non-specialists, so they have the confidence and competence to manage and treat viral hepatitis cases,” Adda says while continuing to highlight the necessity for improved training among healthcare providers:

About The World Hepatitis Alliance

The organization’s mission is a world free from viral hepatitis, and their mission is to harness the power of people living with hepatitis to achieve this goal.1

The organization is a global network operating in over 100 countries, committed to eliminating hepatitis by 2030. It includes civil society and community groups from around the world, all guided by individuals with lived experience of hepatitis. This network drives efforts against hepatitis through advocacy, capacity building, and raising awareness, with a strong focus on ensuring that those affected by the disease are at the core of their initiatives.

While discussing this organization Adda states, “We work towards breaking down stigma challenges that affect communities and limit their ability to access care. We’re working with global partners to achieve this goal by empowering communities and advocating for them to be in the driver’s seat. Communities need to be empowered to deliver services, provide peer support, and facilitate testing to break down barriers that patients face.”

References

1. Easterbrook P, Luhmann N, Bajis S, et. Al. WHO 2024 hepatitis B guidelines: an opportunity to transform care. The Lancet. Published April 10, 2024. Accessed August 1, 2024. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00089-X/fulltext

2. WHO. Hepatitis C. Published April 9, 2024. Accessed August 1, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

3. Parkinson J. The Means for Curative Hepatitis C Care are Available, But Many Still Don’t Utilize. Contagion. Published May 22, 2024. Accessed August 1, 2024. https://www.contagionlive.com/view/the-means-for-curative-hepatitis-c-care-are-available-but-many-still-don-t-utilize

4. World Hepatitis Alliance. Who we are. https://www.worldhepatitisalliance.org/about/