Authorities urged to provide free WHO-approved self-test kits

As the incidence of hepatitis B and C continues to rise in Pakistan, leading gastroenterologists and hepatologists have urged the federal and provincial health authorities to ensure the availability of free World Health Organisation (WHO) pre-qualified hepatitis C virus (HCV) self-test kits for the diagnosis and treatment of viral hepatitis.

Speaking at a press conference in connection with World Hepatitis Day 2024, health experts from the Pak GI & Liver Disease Society (PGLDS) emphasised the importance of these self-test kits in controlling the spread of the disease.

They reiterated their demand to link the issuance of computerised national identity cards (CNICs) with hepatitis B and C screening, asserting that this measure is crucial for accurately determining the prevalence of viral hepatitis in Pakistan.

“The incidence of hepatitis B and C has been increasing at an alarming rate in Pakistan, leading to significant public health concerns,” said PGLDS President Dr Lubna Kamani at the press conference at the Karachi Press Club on Saturday.

“Accurate and widespread screening is essential for early diagnosis and treatment, which can prevent the spread of these infections and reduce the burden on the healthcare system.”

Dr Lubna was flanked by PGLDS Patron Prof Dr Shahid Ahmed, General Secretary Dr Sajjad Jamil, Dr Nazish Butt, Dr Amanullah Abbasi, Dr Nasir Luck, Dr Kanwal Botani and Dr Masood Khoso.

She said WHO pre-qualified HCV self-test kits are considered reliable and user-friendly, allowing individuals to conduct the test themselves and receive quick results. “Making these kits available free of charge will encourage more people to get tested, particularly in remote and underserved areas where access to healthcare facilities is limited.”

She argued that linking the issuance of CNICs with mandatory hepatitis B and C screening can significantly improve the rates of detection of these infections.

She pointed out that this strategy would ensure that a larger portion of the population is tested, thereby providing a clearer picture of the disease’s prevalence and enabling more targeted public health interventions.

She attributed the spread of these viruses to unnecessary injections, contaminated medical tools and unsafe practices, pointing out that intravenous drug users face a significantly higher risk.

Highlighting the mortality associated with HBV and HCV infections, she underscored the need for comprehensive national data, improved access to testing and treatment facilities, and enhanced public awareness to combat these public health challenges effectively.

Dr Ahmed advocated learning from Egypt’s successful efforts in eliminating viral hepatitis, especially hepatitis C. He cited Egypt’s 100 Million Healthy Lives campaign, which utilised extensive testing and treatment infrastructure to screen the entire adult population for HCV and make treatment widely accessible.

Dr Jamil highlighted the effective treatment options available for hepatitis B and C. “While there’s no cure for hepatitis B, antiviral medications can suppress the virus and prevent complications. In contrast, hepatitis C is curable with direct-acting antivirals, which offer high cure rates, exceeding 95 per cent in most cases.”

Dr Nazish, a prominent hepatologist from the Jinnah Postgraduate Medical Centre, emphasised the critical need for early detection and treatment of hepatitis B and C in Pakistan.

She highlighted that these viruses often remain undetected for years, causing severe liver damage before symptoms become apparent. She pointed out that late diagnosis often leads to expensive treatments and potential liver transplants, placing a heavy financial burden on families and the healthcare system. In many cases, patients might die between one and three years after a late diagnosis due to limited access to timely testing and treatment, she remarked.

Other gastroenterologists, including Dr Abbasi, Dr Luck and Dr Kanwal, also urged people to get themselves screened for hepatitis B and C, saying that if they are infected with these viruses, they should immediately seek treatment.

Earlier this year, leading gastroenterologists had demanded that in a country where around 15 million people are affected by hepatitis B and C, the National Database & Registration Authority (Nadra) should make hepatitis B and C screening mandatory for the registration and renewal of CNICs.

They also demanded that all the union committees and Nadra link the issuance of birth certificates and B Forms with mandatory administration of hepatitis B vaccine within 24 hours of a child’s birth, deploring that hardly three per cent are administered the vaccine at birth in Pakistan.

“Around 10 million people are living with the hepatitis C virus [HCV] while around five million are affected by the hepatitis B virus [HBV] in Pakistan,” Dr Lubna said during the concluding session of a conference on stomach and liver diseases.

“Unfortunately, most of these people are undiagnosed and spreading the deadly disease unknowingly to others. Nadra should not issue or renew CNICs without checking the hepatitis B and C screening status of people.”

The two-day sixth annual conference of the PGLDS had been attended by leading gastroenterologists and hepatologists from Middle Eastern, Far Eastern and European countries as well as from the US and different Pakistani cities. The experts who spoke at the conference discussed the challenges and the advancements made in the field of gastroenterology and hepatology around the world and in the country.

Dr Lubna deplored that unnecessary injections, the use of contaminated razors and needles, and unsafe medical practices are major contributors to the spread of hepatitis B and C in Pakistan.

She said that intravenous drug users are also at a significantly higher risk of contracting hepatitis B and C. “The annual death toll due to complications from HBV and HCV infections is substantial. Estimates suggest around 12,100 people die from HBV and 19,000 from HCV every year.”

She also said that achieving elimination requires overcoming obstacles like a lack of comprehensive national data on the issue, limited access to testing and treatment facilities, and inadequate public awareness.

“Hepatitis B and C are major public health concerns in Pakistan. While the government has committed to eliminating these diseases, significant challenges remain. Increased access to testing, treatment and public education campaigns are crucial for achieving this goal.”

Dr Ahmed said that Egypt’s ambitious 100 Million Healthy Lives project utilised a massive network of over 6,000 fixed testing sites and 8,000 mobile teams, reaching even the remote areas.

“Testing and treatment were made widely accessible and free of charge. This eliminated financial barriers and encouraged participation in the programme. Egypt negotiated lower prices for direct-acting antiviral [DAA] treatments, the most effective drugs for HCV. This not only improved affordability but also drove down global DAA prices, benefiting other countries.”

He said hepatitis C is curable, as new and highly effective medications called DAAs have revolutionised treatment. DAAs offer short treatment courses, typically eight to 12 weeks, with cure rates exceeding 95 per cent in most cases, he added.

On the other hand, he pointed out, although there is currently no cure for hepatitis B, there are very effective antiviral medications that can suppress the virus, prevent liver damage, and reduce the risk of complications like cirrhosis and liver cancer.

“These medications can be highly effective in controlling the virus, with some people achieving undetectable viral loads for years, significantly reducing the risk of transmission.”

Dr Jamil said that both hepatitis B and C have effective treatment options available. He said hepatitis B treatment focuses on suppressing viral replication and preventing liver damage, while hepatitis C treatment with DAAs offers high cure rates and improved outcomes for patients with chronic HCV infection.

Treatment decisions should be made in consultation with healthcare providers, based on individual factors such as viral genotype, liver health and presence of other medical conditions, he added.

At another session on ‘Women in GI’, Dr Nazish and Dr Lubna said that half of the patients suffering from gastrointestinal and liver diseases in Pakistan are women, but the number of trained and qualified female gastroenterologists is very small.

They said that these days a large number of female physicians are training in the field of gastroenterology. They hoped that soon female patients would be approaching female physicians more freely to seek treatments like endoscopy and colonoscopy.