Published 07/28/2023

World Hepatitis Day

Hepatitis B virus (HBV) infection is a public health problem in many parts of the world, due to its frequency, complications and socio-economic consequences. Half the world's population lives in regions with a high prevalence of HBV.

Two (2) billion people are known to be infected with HBV, including 350 to 400 million chronic HBV carriers. In 15-20% of cases, these people are at risk of developing cirrhosis or liver cancer, the 3rd leading cause of cancer deaths in Africa and worldwide by 2020. The number of deaths caused by complications of hepatitis B varies between 500,000 and 1,200,000 a year, on a par with those caused by HIV, tuberculosis or malaria.

But for the time being, the means of combating the disease are not at all of the same order as for these three pathologies. Hepatitis (B/C) is the only infectious disease to cause more deaths today than in 1990.

Based on these findings, the WHO has set itself the target of reducing new infections by 90% and mortality from viral hepatitis by 65% worldwide by 2030. The roadmap for this program calls for the implementation of key strategies for prevention, diagnosis, treatment and community intervention.

In May 2022, the Seventy-fifth World Health Assembly took note of a new integrated set of Global Health Sector Strategies against HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030. On the basis of these strategies, many Member States have developed comprehensive national hepatitis B control programs and elimination strategies based on the Global Health Sector Strategy.

Senegal is an area of high hepatitis B endemicity and low hepatitis C endemicity. Recent studies have revealed respective prevalence rates of 8-9% and 2%. The Ziguinchor region, like the rest of the country, is highly endemic for the hepatitis B virus, with a prevalence of HBS Ag carriage close to 10% in certain populations. In Casamance, the prevalence of HBs antigen among blood donors is 12.1%.

The work of ENDA Santé

The Prolifica (Prevention of Liver Cirrhosis and Cancer in Africa) study was the first in Africa to investigate the feasibility of large-scale screening and treatment for HBV. In the Gambia, this study showed that community screening with rapid tests was feasible and cost-effective, with a high proportion of HBSAg-positive patients effectively referred for antiviral treatment if necessary.

This is why ENDA Santé, as part of the CARES project " Casamance Research-program on HIV-Resistance and SexualHealth has developed a major hepatitis prevention and treatment program for pregnant women and the general population.

CARES is a research and skills development project aimed at increasing access to diagnosis and treatment for 3 infections (HIV, HBV and HPV). Co-funded by the French Ministry of Foreign and European Affairs, the project aims to estimate the prevalence of HBV infection in target populations, identify patients in need of tenofovir treatment, assess virus transmission in vaccinated children born to mothers treated with tenofovir, and validate a hepatitis B management algorithm for the Ziguinchor region.

20360 people screened, with an HIV-positive rate of 8.1%. 

This project has been running since 2018 and covers Casamance, notably at Ziguinchor ( 21 health structures and community level with advanced strategies) but also in Guinea Bissau, Hospital Cumura and Simon Mendes. Between 2018 and 2022, it will achieve the following results:

2 fibroscan units, 1 portable abdominal ultrasound unit, 1 hepatitis viral load machine and a biochemistry unit were donated to health facilities in the project areas.

20360 people were screened , with a seropositive rate of 8.1% .

1,692 people enrolled and monitored;

157 treatment-eligible patients started on tenofovir ;

2213 viral expenses incurred ;`

1047 fibroscan examinations performed ;

97 ultrasounds performed. The CARES project strengthens the capacity of health care providers in Ziguinchor in the use of Fibroscan, abdominal ultrasound, HBV PMTCT and support for the development of a national plan to combat hepatitis in Guinea Bissau.