On this interview, we discover international and native efforts to fight viral hepatitis with Lindsey Hiebert, Deputy Director of the Coalition for World Hepatitis Elimination (CGHE), and James Amugsi, a Mandela Washington Fellow and Doctor Assistant at Sandema Hospital in Ghana. Collectively, they supply useful insights into the challenges, successes, and the significance of partnerships within the combat towards hepatitis.
Might you each briefly introduce yourselves and describe your roles?
Lindsey Hiebert: My identify is Lindsey Hiebert. I’m the Deputy Director of the Coalition for World Hepatitis Elimination. I joined the Coalition shortly after it was launched in 2019. On the Coalition, I lead the event of the Coalition’s total technique and handle tasks akin to our technical help, strategic data and knowledge dashboard, and webinar sequence initiatives.
James Amugsi: I’m James Amugsi, a Mandela Washington Fellow, a viral hepatitis advocate, and a Doctor Assistant on the Sandema Hospital within the Higher East of Ghana. Within the “STOP HEPP C” challenge, I prescribe antiviral medicines to hepatitis C sufferers and likewise observe up on their response to remedy. I work in collaboration with a gastroenterologist from the College of Ghana Medical Middle. Apart from, I conduct hepatitis B and C consciousness creation and screening companies to group members, in addition to linking individuals dwelling with continual hepatitis C to care in varied remedy facilities inside Northern Ghana.
Are you able to give us an outline of the Coalition for World Hepatitis Elimination and its essential targets, each globally and particularly in Ghana?
Lindsey Hiebert: The Coalition for World Hepatitis Elimination (CGHE), a program of the Activity Power for World Well being, is a nonprofit group that brings collectively international companions to realize the worldwide elimination of viral hepatitis.
The Coalition strengthens native capability by constructing the required information base, offering technical help, and mobilizing dedication to realize elimination targets. The Coalition focuses totally on hepatitis B and C in accordance with WHO 2030 elimination targets. The Coalition works to convey an finish to hepatitis B by selling vaccination, testing, and larger entry to remedy. To fight hepatitis C globally, the Coalition promotes screening and linkage to healing care, significantly for weak communities.
The three strategic areas of the Coalition’s work are:
- Connecting and supporting applications: Join applications in a Group of Follow to facilitate peer studying and assist applications with evidence-based instruments, technical help, and techniques that construct native capability to stop, diagnose, and deal with hepatitis.
- Constructing the proof base: Replace present hepatitis elimination knowledge and instruments, spearhead knowledge analyses and new analysis, and develop new technical help instruments.
- Mobilizing dedication: Mobilize dedication for international hepatitis elimination amongst public and coverage stakeholders in partnership with civil society, advocacy organizations, and different essential companions all over the world to construct consciousness, instill urgency, and safe funding for elimination
Are you able to clarify hepatitis, the differing types, and why it’s such a big public well being challenge?
James Amugsi: Hepatitis refers to irritation of the liver and has quite a lot of causes. Hepatitis can current as acute an infection (lower than six months) or continual an infection (greater than six months), and there are differing types, that are categorized broadly as viral hepatitis and nonviral hepatitis. The most typical sorts of viral hepatitis are Hepatitis A, B, C, D, and E. Nonviral hepatitis contains Alcoholic hepatitis/liver illness, autoimmune hepatitis, and drug-induced hepatitis.
Whereas viral hepatitis is brought on by a virus – e.g., hepatitis A, B, C, D, and E viruses, nonviral hepatitis could also be brought on by extreme alcohol consumption, autoimmune problems, consumption of sure medication, or publicity to chemical compounds or toxins, amongst different components.
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Hepatitis A and E are related of their mode of transmission and illness severity, whereas hepatitis B and C additionally share similarities and often trigger continual an infection. Individuals contaminated with the hepatitis B and C viruses might not present signs initially or have non-specific signs, so one of the best ways to know whether or not one is contaminated or not is to get examined.
Hepatitis A and E can unfold via contaminated meals and water, whereas hepatitis B and C are generally unfold via blood-to-blood contact, from contaminated moms to their kids throughout childbirth and unprotected sexual contact. It is very important word that informal contacts akin to handshake, hugging, kissing, or sharing of meals or drinks don’t usually transmit hepatitis B or C. Nonetheless, any exercise that would outcome within the trade of blood, such because the sharing of razors or toothbrushes, needs to be averted to stop the transmission of hepatitis B and C.
Problems of hepatitis embody liver cirrhosis, liver failure, or most cancers. The hepatitis B vaccine can forestall hepatitis B, however there’s presently no vaccine for hepatitis C. One must undertake a wholesome life-style to scale back the danger of an infection with the hepatitis C virus. The excellent news is that hepatitis C is curable!
Hepatitis is a public well being downside globally and, particularly in Ghana, as a result of new infections, in addition to mortalities, preserve growing in distinction to WHO’s viral hepatitis goal of 2030.
Lindsey Hiebert: The Coalition focuses on the elimination of viral hepatitis B and C, that are blood-borne infections that trigger liver illness. As of 2022, 304 million individuals live with continual hepatitis B (HBV) or C (HCV) virus an infection. Of the 254 million individuals dwelling with HBV, 86% are unaware of their an infection, and 97% haven’t been handled. Of the 50 million individuals dwelling with HCV, 63% are unaware of their an infection, and 80% haven’t been handled.
At the moment, viral hepatitis is the second main infectious explanation for dying, solely after COVID-19.
The elimination of viral hepatitis as a public well being risk by 2030 will forestall 7.1 million deaths.
Please see WHO’s webpage: https://www.who.int/health-topics/hepatitis#tab=tab_1
What are some frequent misconceptions about Hepatitis amongst sufferers in northern Ghana, and the way do you tackle them?
James Amugsi: Some individuals are nonetheless of the view that Hepatitis has a non secular trigger – the work of witches or different deities. Many individuals additionally imagine that hepatitis B and C might be transmitted via consuming collectively and phone with an contaminated individual’s sweat or saliva. Correcting the myths about viral hepatitis is a herculean job and requires concerted efforts. On my half, I tackle these misconceptions via steady well being schooling for each well being staff and non-health staff on the causes and transmission of viral hepatitis.
What impressed you to develop into concerned in hepatitis advocacy in northern Ghana, and what are the important thing challenges you face on this position?
James Amugsi: As a Mandela Washington Fellow, I’ve realized to present again to society irrespective of how little it could be. Apart from, as a well being skilled, I’ve seen many individuals die of Hepatitis, together with shut family. The best motivation for me is that hepatitis C is curable whereas hepatitis B is preventable, however many individuals do not know, so I’ve determined to be a service of hope for the hopeless in society. Combining my skilled paid job as a Doctor Assistant and hepatitis advocacy, in addition to household commitments, has been very difficult. Though I prioritize the wants of others, I accomplish that with out neglecting my career and household. I’ve, subsequently, managed to keep up a stability for the advantage of my group and Northern Ghana at massive.
Might you focus on the important thing companions concerned within the Coalition’s efforts to get rid of Hepatitis, significantly in Ghana? How do these partnerships improve this system’s influence?
Lindsey Hiebert: The Coalition works with greater than 350 companions throughout greater than 60 nations, representing all WHO areas. The Coalition works via constructing partnerships to strengthen nationwide hepatitis applications.
The Coalition has various applications to empower native communities, policy-makers, and clinicians to advance progress towards elimination of their settings. In Ghana, the Coalition has collaborated to implement these applications to enhance our understanding of the burden of illness, strengthen nationwide planning, and broaden consciousness. At the moment, solely 0.4% of individuals dwelling with HBV and solely 4.69% of individuals dwelling with HCV have been recognized in Ghana, based mostly on 2022 estimates from the World Well being Group.
To assist the event of a nationwide testing coverage, in 2020, the Coalition supplied a grant to native researchers and community-based organizations to implement the Hepatitis Evaluations to Amplify Testing and Therapy (HEAT) challenge. The HEAT challenge concerned assessments of the epidemiological burden of HBV and HCV and a laboratory testing capability evaluation. Beneath the steering of the Principal Investigator, Dr. Yvonne Nartey, a staff of area epidemiologists consulted public well being laboratories, nationwide well being data administration programs, and greater than 134,676 information of HBV and HCV checks for these analyses.
Alongside the way in which, CGHE supplied technical assist and coaching to epidemiologists and trainees. The HEAT Mission revealed stark variations within the prevalence of hepatitis throughout the nation and main gaps in entry to testing the place the very best burden of illness was estimated. The HEAT Mission was carried out in coordination with the Ghana Well being Service, and the Ghana Hepatitis Basis organized a dissemination assembly to temporary stakeholders on the outcomes and plan for the following steps.
With the knowledge and momentum from the HEAT challenge, Egypt pledged to donate HCV medicines to deal with 50,000 Ghanaians. The STOP-HEPC Ghana Mission was launched in March of 2023 to boost hepatitis consciousness and inform Ghanaians on the way to get examined and handled for Hepatitis.
Dr. Nartey stayed on with the Coalition staff as a Hepatitis Analysis, Analysis, and Outreach (HERO) Fellow to assist the event of STOP-HEPC, following the HEAT challenge. The STOP-HEPC program goals to implement a basic inhabitants screening marketing campaign, with a give attention to the Northern Ghana base the place the very best burden of illness is, as proven by the HEAT challenge; enroll sufferers in a nationwide registry; and hyperlink individuals dwelling with HCV to care in regional hospitals. STOP-HEPC additionally plans to strengthen knowledge reporting programs and practice reporting personnel.
As well as, in 2022, as a part of an initiative funded by US CDC to enhance protection of hepatitis B delivery dose in African nations, CGHE collaborated with the Ghana Hepatitis Alliance to develop data supplies, implement instructional coaching for midwives, and organize conferences with Ministry of Well being officers and different policymakers to advocate for delivery dose introduction.
The Coalition has developed a Nationwide Hepatitis Elimination Profile for Ghana in collaboration with the companions talked about above, accessible right here: https://www.globalhep.org/tools-resources/view-national-hepatitis-elimination-profiles.
Be a part of the Battle: A UN Group of Buddies to Get rid of Hepatitis
What particular tasks or initiatives have you ever been concerned in inside northern Ghana to fight Hepatitis? Might you share successful story or a notable expertise from these efforts?
James Amugsi: I’ve been concerned within the following tasks:
- STOP HEP C challenge, the place I served because the staff lead for the Sandema Hospital case administration staff.
- Initiation of the ‘no vaccination, no discharge’ coverage on the Sandema Hospital for infants born to hepatitis B-positive moms. These infants are given no less than the hepatitis B monovalent delivery dose vaccine earlier than discharge
- Consciousness creation and screening checks for hepatitius C virus
- Viral hepatitis analysis (Group-based hepatitis C prevalence), which is about 8%
We have now achieved about 80-90% hepatitis C Sustained Virological Response (SVR) charge on the Sandema Hospital case administration heart. Free hepatitis C viral load/RNA for about 100 group members accomplished in partnership with Dr. Yvonne Nartey and Mpharma Ghana. Sandema Hospital is getting used as a case research for the decentralization of viral hepatitis remedy in Ghana.
How does the Coalition monitor and assess progress in hepatitis elimination efforts in low- to low-middle revenue nations, and what are the first metrics or indicators used?
Lindsey Hiebert: In 2021, the Coalition launched an initiative to develop Nationwide Hepatitis Elimination Profiles. These assets comprehensively assess the standing of hepatitis B and C elimination throughout nations. The profiles convey collectively knowledge on the burden of hepatitis, protection of key interventions, and the event of important insurance policies. The profiles assess progress towards program targets and well being outcomes and spotlight achievements, challenges, and possible subsequent steps to advance hepatitis elimination.
Aims of the profiles embody:
1. Carry collectively key knowledge to evaluate the standing of hepatitis elimination efforts, with a particular emphasis on the coverage setting to construct a sustainable elimination program:
- Hepatitis burden
- Implementation of hepatitis prevention, testing, and remedy companies
- Coverage improvement
- Well being fairness for key populations
2. Assess progress towards program targets and well being end result targets
3. Spotlight achievements, challenges, and possible subsequent steps
Assessing progress throughout WHO’s goal interventions is important, together with protection of prevention, testing, and remedy entry. Globally, two of three new infections are within the African area, and a rising proportion of them are mother-to-child transmissions. The delivery dose of the hepatitis B vaccine, given inside 24 hours, is a crucial intervention to stop transmission. Solely about 15 African nations have insurance policies for hepatitis B delivery doses. The Coalition intently tracks hepatitis B delivery dose coverage improvement and protection. The Coalition additionally has developed a toolkit to assist nations in growing insurance policies for the primary time.
Throughout all nations, step one to growing a nationwide program is to determine nationwide elimination targets and develop nationwide methods. The Coalition additionally tracks which nations have adopted these practices.
The total set of indicators the Coalition displays by way of the Nationwide Hepatitis Elimination Profiles is obtainable right here: https://www.globalhep.org/approach-national-hepatitis-elimination-profiles
How do you have interaction and educate the native communities in northern Ghana about hepatitis prevention and remedy?
James Amugsi: For face-to-face interplay, I attempt to establish key stakeholders in the neighborhood, such because the chief or meeting member. After I safe permission to interact group members, phrase will likely be despatched round via the group well being volunteers or the ‘Rooftop announcement’ ranging from the chief/subchief home. The venue, date, and time of the assembly are sometimes communicated throughout these bulletins. This mode of communication has confirmed to be very efficient.
I additionally attain group members by way of native radio stations, the place they will cellphone in and ask questions. Locations of worship, akin to church buildings and mosques, are additionally used to offer well being schooling. Social media, akin to Fb and WhatsApp, is probably the most cost-effective technique of making viral hepatitis consciousness. Nonetheless, data despatched via this medium often targets the literate/youth.
What are the primary obstacles you encounter within the combat towards Hepatitis, and the way do you tackle these challenges?
Lindsey Hiebert: Two of the best obstacles are political dedication and financing. The general public well being instruments can be found—vaccination for hepatitis B, dependable checks for hepatitis B and C, efficient remedy for hepatitis B, and cures for hepatitis C. Nonetheless, these present instruments are usually not accessible to most individuals dwelling with Hepatitis.
All governments should decide to hepatitis elimination. To encourage diplomatic commitments to hepatitis elimination, the Coalition is the Secretariat for the UN Group of Buddies to Get rid of Hepatitis. The UN Group of Buddies creates a discussion board for Member States to trade data on progress, improvements, and classes realized with different Member States, organizations inside the UN system, technical specialists, civil society organizations, and different stakeholders. By elevating consciousness on the diplomatic degree, the UN Group of Buddies brings high-level consideration to donor businesses, improvement banks, philanthropic organizations, and nationwide governments, serving to low- middle-income nations (LMICs) get rid of Hepatitis.
The ethical and financial case for hepatitis elimination is evident; hepatitis elimination saves lives, prevents morbidity, and is cost-effective whereas saving well being programs cash in the long term. The Coalition lately printed coverage briefs to summarize the proof on the financial and well being advantages of why nations ought to spend money on hepatitis elimination now. These briefs can be found right here: https://www.globalhep.org/projects-research/new-policy-briefs-consequences-inaction.
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James Amugsi: A number of the obstacles embody misinformation about viral hepatitis from natural drugs practitioners and a few well being staff who lack enough information on the illness, stigma, insufficient funds for screening and consciousness creation campaigns, excessive value of hepatitis B and C viral load, insufficient authorities assist, lack of robust motor bikes or a automotive to convey volunteers and logistics, and so on. I tackle a few of these via steady well being schooling, partaking a number of donors, together with people and native and worldwide organizations, partnerships with different native CSOs, steady lobbying, and so on.
Are you able to share a narrative of a affected person whose life was considerably impacted by the Coalition’s efforts or your advocacy work?
James Amugsi: Affected person Alie (not actual identify) – A 25-year-old girl from Builsa North Municipal: “Earlier than the STOP HEP C challenge, I requested for hepatitis C remedy and was advised it was GHS 7,500.00. So I left my life to destiny as a result of I couldn’t afford that quantity, however via the challenge, I used to be given a three-month dose of hepatitis C medication free of charge. I used to get drained simply, however after remedy, I’m now doing effectively. I’ve additionally been cured of hepatitis C! I’m very grateful to the STOP HEP C challenge staff.”
This 12 months’s theme for World Hepatitis Day is “Take motion, Check, Deal with, Vaccinate.” How does this theme resonate with the Coalition’s mission, and what particular actions are being taken in Ghana to align with this name to motion?
Lindsey Hiebert: Hepatitis elimination requires a world dedication to making sure everybody has entry to hepatitis B and C prevention, testing, and remedy. The Coalition is dedicated to constructing partnerships to make sure all individuals, all over the place, can profit from hepatitis B and C elimination. In Ghana, the Coalition will proceed to assist STOP-HEPC and efforts to broaden entry to hepatitis B testing and remedy. Thus far, there’s restricted entry to hepatitis B testing and remedy in Ghana, and accessible checks and remedy might be prohibitively costly. Classes realized from the hepatitis C program should quickly be tailored to broaden entry to hepatitis B care, as effectively.
James Amugsi: The “STOP HEP C” Ghana challenge, launched in 2023 by the Ghana Well being Service (GHS) and its companions, sought to display 50% of the eligible inhabitants, hyperlink 90% of recognized hepatitis C sufferers to care, and provoke 95% of sufferers’ remedy.
To date, about 300 hepatitis C sufferers have obtained remedy nationwide. Additionally, via a partnership with Hepatitis Alliance Ghana, SynLab, and MDS Lancert, there’s a subsidy for hepatitis C viral load testing to allow sufferers to profit from the free remedy. The problem, nevertheless, is that there’s nonetheless low hepatitis C testing and publicity. Many individuals from Northern Ghana can’t additionally afford the hepatitis C RNA/viral load check, which is about GHS 800.00
On my half, about 5,000 group members have been screened for hepatitis C free of charge, and 400 are being linked for additional analysis and care.
To me, a name for motion in viral hepatitis elimination in Ghana will imply extra publicity on viral hepatitis, extra testing, reasonably priced hepatitis B and C DNA/RNA checks, and the implementation of the hepatitis B delivery dose vaccine now!
The place can readers discover extra data?
About Lindsey Hiebert
Lindsey Hiebert serves because the Deputy Director of the Coalition for World Hepatitis Elimination.
The Coalition relies on the Activity Power for World Well being, a world NGO in Atlanta, United States. On the Coalition, Lindsey manages initiatives associated to technical help, operational analysis, advocacy, and coverage to advance hepatitis B and C elimination globally, together with the event of Nationwide Hepatitis Elimination Profiles for greater than 30 nations. Earlier than becoming a member of the Coalition, she was a Program Officer at Pharos World Well being. At Pharos, she managed collaborative tasks in South Africa, Indonesia, Senegal, Malaysia, and Morocco on viral hepatitis program strategic planning, funding case improvement, and epidemiological, program, and financial modeling. Lindsey has additionally labored as a analysis challenge coordinator and knowledge analyst at Yale College and BRAC in Dhaka, Bangladesh. She obtained a MPH in Epidemiology and World Well being and BS in World Affairs from Yale College.
About James Amugsi
James Amugsi is a Doctor Assistant (Medical) on the Sandema hospital within the Higher East Area of Ghana and is the medical lead for the hepatitis C case administration staff on the hospital.
James is actively concerned in viral hepatitis advocacy and analysis in Northern Ghana. Pushed by servant management, James has been giving again to his group after his Mandela Washington Fellowship expertise in 2018 at Howard College, USA.