BLANTYRE, March 02 (IPS) – Researchers have found that cheaper and more accessible blood testing methods could improve care for patients with chronic hepatitis B in Africa.
In a study published in Nature Communications, the researchers recommend revising current World Health Organization (WHO) guidelines for managing the condition.
“Our data are important for informing clinical practice and should be considered in the next revision of WHO guidelines for hepatitis B,” say the researchers who are part of the Hepatitis B in Africa Collaborative Network (HEPSANET).
Lead author of the study, Asgeir Johannessen, tells IPS that doctors working in Africa have “repeatedly reported that very few patients in Africa” are eligible for treatment under current WHO guidelines published in 2015.
“The lack of data from Africa is a major challenge, and we wanted to use African data from African patients to inform African treatment guidelines,” said Johannessen, an internal medicine and infectious disease specialist at the Institute of Clinical Medicine, University of Oslo in Norway. .
According to the study, Africa represents one of the most heavily burdened regions for the chronic hepatitis B virus. Of the estimated 316 million people living with chronic hepatitis B virus infection worldwide, 82 million live in Africa.
The study further says that antiviral therapy effectively reduces the risk of complications due to infection with the hepatitis B virus.
But with current guidelines recommended by the WHO, early diagnosis and treatment are affected, as they are often picked up only when there is advanced liver damage.
The challenge in clinical practice in Africa has been to identify patients at risk of progressive liver disease who should start antiviral therapy in a timely manner.
“However, in resource-limited settings, these tools for assessing fibrosis are rarely available, and antiviral treatment is therefore often delayed until patients have developed symptoms of advanced chronic liver disease,” the research article said.
So the researchers set to work with this question: “Can we diagnose advanced liver fibrosis in the African region, using routinely available and inexpensive blood tests for patients with hepatitis B?” says Alexander Stockdale, a member of the team and senior clinical lecturer at the University of Liverpool and the Malawi Liverpool Wellcome Program.
In the study, the 23 researchers reviewed data from 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries, namely Burkina Faso, Ethiopia, Gambia, Malawi, Nigeria, Senegal, South Africa and Zambia.
They evaluated existing WHO treatment guidelines and a simple biomarker for liver damage that had been developed in West Africa.
They determined that conventional hepatitis B standards of care are not appropriate for patient management in Africa. They found that the level of diagnosis as set by the WHO is “inappropriately high in sub-Saharan Africa”, which is often constrained by a lack of resources.
The problem, according to the researchers, is that the existing WHO guidelines are not adapted to the African population.
The study on which these guidelines were based was conducted in active chronic hepatitis C patients in the US, much older than the African hepatitis B virus population and in a very different patient population compared to African chronic hepatitis B patients.
“Our data are important for informing clinical practice in SSA and should be considered in the next revision of WHO guidelines for hepatitis B,” says Johannessen.
He says they have shared their findings with WHO and the Center for Disease Control (CDC) in Africa.
“We believe our findings will lead to the very first treatment guidelines for African Hepatitis B, and even the WHO is now changing their guidelines because of our work,” he told IPS.
“Africa is now the epicenter of the hepatitis B epidemic. In fact, 2 out of 3 new infections occur on the African continent. To fight the hepatitis B pandemic in Africa, we need African data to inform practice,” says Johannessen.
Initially, the researchers thought their biggest challenge would be getting people to share data.
“But actually everyone we approached was excited to participate. It is clear that this is an issue that feels like a priority for colleagues working across Africa,” he says.
The study is the largest, most comprehensive and geographically representative analysis ever conducted in Africa.
“We therefore believe that our results are generalizable,” the researchers conclude.
However, they acknowledge some limitations of their study. For example, the method used to assess liver injury is associated with technical limitations, including measurement failures reported in patients with certain health conditions, such as obesity. The researchers did not determine the failure rates of these tests.
“This may affect the overall applicability of our findings to the entire population with HBV,” they say.
But Adamson Muula, professor and chief of Community and Environmental Health at Kamuzu University of Health Sciences (KUHES) in Malawi, says in terms of the methodology used in this study, the systematic review of data was relevant in answering the asked question.
“In the hierarchy of evidence, systematic reviews and meta-analyses rank high when it comes to the rigor of the findings,” says Muula, who was not part of the study.
However, he noted that there are drawbacks to this approach, including the fact that there is an implicit sense in interpreting the findings that Africa is one place. Muula argues that African health systems can differ even within the same country.
Within a country, you can find a health system similar to developed countries; others are more focused on developing countries. The studies were more applicable to people with less advanced health systems.
Either way, the study is vital, he acknowledges.
Hepatitis B diagnosis on the continent has been a luxury. In Malawi, for example, where an estimated 5 percent of adults are infected, there is virtually no screening or diagnostic system.
Individual patients can interact with the health system, but even more so when things are already spiraling out of control when irreversible liver damage has already occurred.
“Efforts to shorten the time to diagnose are therefore commendable. This study adds guidance on when such an earlier diagnosis can be achieved.
“However, research is one thing, strengthening health systems is another. Studies like this add to the momentum and arm policymakers to make the right decisions,” he says.
But he urges communities to take charge of these findings rather than leaving action to “sometimes incapacitated policymakers.”
“The question should be: what is the community saying about findings like this? If we wait for policymakers to decide when to invest in hepatitis B interventions, we’ll be waiting for the rest of our lives.
“The time has come for community groups to work with duty bearers in such a way that hepatitis B is no longer a neglected tropical disease,” he says.
The WHO’s goal is to eliminate hepatitis by 2030.
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© Inter Press Service (2023) — All rights reservedOriginal source: Inter Press Service
