Friday the 28th July will mark World Hepatitis Day. Hepatitis B is endemic in South Africa, but up until now, little has been known about the local prevalence of hepatitis C, especially in high-risk populations such as men who have sex with men, sex workers and people who use drugs. Today an ongoing study has released preliminary results. These raise concerns over hepatitis C prevalence among certain groups.
High prevalence makes affordable treatment an urgent priority
“I don’t think anyone was expecting to see the kind of prevalence we’ve seen so far with 54% of people who use drugs testing positive for hepatitis C, and in some areas, up to 77% testing positive. This underscores the urgency for us to explore affordable treatment options as soon as possible,’ says Dr Andrew Scheibe, one of the researchers working with TB/HIV Care Association (TB/HIV Care) on this project.
Although hepatitis C is curable, the cost of current treatment puts it out of reach for many. There is a vaccine for hepatitis B, but it is not readily available for adults through the public health system.
Viral hepatitis is a public health threat worldwide, but a particular danger in South Africa because of the high prevalence of HIV.
Hepatitis B and hepatitis C are infectious diseases that affect the liver. Those who are infected can silently develop progressive liver damage and can unknowingly be infectious.
A life-threatening disease, viral hepatitis is a particular concern in regions with a high HIV prevalence regions, such as South Africa, because co-infection can result in more rapid progression of both diseases.
The World Health Organization (WHO) estimates that globally 150 million people are infected with hepatitis C and that the disease causes half a million deaths a year. Last year the WHO released the first Global Strategy for Viral Hepatitis. This aims to eliminate viral hepatitis as a public health threat by 2030. South Africa has adopted the same vision.
The early findings of the South African study conducted in seven cities (in Cape Town, Johannesburg, Pretoria, Mthatha, Pietermaritzburg, Port Elizabeth and Durban), put the overall prevalence of hepatitis C among the populations under study (sex workers, men who have sex with men and people who use drugs) at 13%, with the prevalence of hepatitis B at 4%. The study is being implemented by TB/HIV Care, the University of Cape Town, Anova Health Institute, OUT LGBT Wellbeing and the National Institute for Communicable Diseases with funding from the Bristol-Myers Squibb Foundation.
Difficulties in accessing treatment go beyond access to medication
The study has also unearthed disturbing trends relating to treatment. It seems that the difficulties in providing hepatitis C treatment and hepatitis B vaccination may go beyond access to medication alone. Clients who were diagnosed with hepatitis by the study were all referred on for specialist care, but many did not appear for subsequent appointments. The reasons for this are still under study, but early reports suggest that other experiences of discrimination and stigma in the health care system, confusing systems in facilities, the possibilities of a long wait for service and the costs associated with travelling to a different site may all play a role in discouraging clients from continuing care.
Prof. Harry Hausler, the CEO of TB/HIV Care, explains, “Research such as this is critical to understanding the viral hepatitis burden among vulnerable people. Next we will have to work with partners to develop cost-effective ways to provide prevention, screening, diagnosis and treatment services to those who need them, where they need them, and in appropriate ways.”