WHO highlight the true burden of hepatitis B virus (HBV) prevalence in Africa with the pioneering work of the MRC Unit The Gambia

WHO Global Hepatitis report describes, for the first time, the global and regional estimates on viral hepatitis in 2015, setting the baseline for tracking progress in implementing the new global strategy.

Community HBV survey

Community HBV survey

To set up the 2017 global hepatitis report, research data from MRC Unit The Gambia’s Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) indicated the true burden of hepatitis B virus (HBV) prevalence in Africa.

Research into Hepatitis B infection has been ongoing in The Gambia for over three decades, thanks to the collaborative partnership between the International Agency for Research on Cancer Lyon, the Imperial College London, MRCG and the Gambia Government through Ministry of Health and Social Welfare, and the National Public Health Laboratories.

The PROLIFICA team talk with a local community

The PROLIFICA team talk with a local community

As reported, statistics reveal viral hepatitis as a major public health challenge requiring an urgent response. The report focuses on hepatitis B and C, which are responsible for 96% of all hepatitis mortality. It presents data along the five strategic directions (strategic information, interventions, equity, financing and innovation) – key pillars of the World Health Assembly-endorsed Global Health Sector Strategy (GHSS) to facilitate monitoring of progress in countries, regions and globally, and to measure the impact of interventions on reducing new infections and saving lives.

The report called on the international community to combat viral hepatitis by focusing on achieving the 2030 Agenda for Sustainable Development as the disease was responsible for 1.34 million deaths in 2015, a number comparable to annual deaths caused by tuberculosis and higher than those caused by HIV or malaria. The report made reference to several studies from our PROLIFICA project conducted in The Gambia, including:

Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) Study (Lemoine et al. Lancet Global Health 2016)

This study provided data on the feasibility of population-level screening and treatment for HBV infection in Africa. As part of the PROLIFICA project, people have been tested and referred to care using two approaches. First, during community-based testing activities, 69% of 8170 individuals who were approached accepted to be tested. Of those tested, 8.8% were infected with HBV and 81% visiting the liver clinic at least once. Second, 5,559 potential blood donors were screened at the local blood bank (EFSTH, Banjul) and found a prevalence of 13% but lower attendance to the liver clinic (42%).

Cost-effectiveness of community-based screening and treatment for chronic hepatitis B in The Gambia: an economic modelling analysis (Nayagam et al. Lancet Global Health 2016) Results show that adult community-based screening and treatment for hepatitis B in The Gambia is likely to be a cost-effective intervention. Higher cost-effectiveness might be achievable with targeted facility-based screening, price reductions of drugs and diagnostics, and integration of HBV screening with other public health interventions.

The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa (Lemoine et al. Gut 2016)-Research team developed a new simple biomarker of fibrosis, the gamma-glutamyl transpeptidase to platelet ratio (GPR) which is a more accurate routine laboratory marker than aspartate transaminase-to-platelet ratio index (APRI) and Liver Fibrosis (Fib-4) to stage liver fibrosis in patients with chronic hepatitis B in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia (Shimakawa et al. Gut 2016)

Between 1974 and 2008, sero-surveys were repeated in two Gambian villages (Manduar and Keneba), and an open cohort of treatment-naive chronic HBV carriers was recruited. 405 chronic carriers (95% genotype E) recruited at a median age of 10.8 years, were followed for a median length of 28.4 years. Annually, 7.4% (95% CI 6.3% to 8.8%) cleared HBeAg and 1.0% (0.8% to 1.2%) cleared HBsAg. The incidence of HCC was 55.5/ 100 000 carrier-years (95% CI 24.9 to 123.5). This is the first and unique data on natural history of chronic hepatitis B in Africa.

Commenting on the 2017 Global hepatitis report, Dr Maud Lemoine, Imperial College, London said, “The integration of the PROLIFICA data in the recent WHO global report on viral hepatitis is an important achievement. The project is now recognised as a unique project in Africa, which has provided key data on hepatitis B in Africa. This will hopefully contribute to scale up additional screening and treatment interventions in The Gambia and develop national strategies to comply with the 2030 HBV elimination goal.”

Commenting on the report Professor Umberto D’Alessandro, Unit Director said, “The inclusion of results from The Gambia into the WHO Global Hepatitis Report recognises the high-quality work carried out by the MRC Unit The Gambia on liver diseases. The Unit’s commitment to hepatitis B research is long-standing; The Gambia Hepatitis Intervention Study (GHIS) was implemented more than 30 years ago and produced critical data for the introduction of the Hepatitis B vaccine in the Gambian Expanded Program on Immunization. Similarly, the PROLIFICA study has investigated the management of patients with chronic liver disease. Results from these studies are essential for the formulation and implementation of national strategies for the control of viral hepatitis.”

 

Access the 2017 global hepatitis report on file:///C:/Users/cpotin/Pictures/Prolifica.pdf