Early this month, the Ministry of Health proposed an ambitious plan that aimed at eliminating the hepatitis C virus (HCV) in the country, within five years. The initiative seeks to screen about four million people aged 15 years and above, carry out viral load tests for about 230,000 people and treat 112,000 chronically affected patients. Hepatitis C is prevalent among four to eight percent of Rwandan adults and it is believed to be the second-largest contributor to cancers in the country. According to available information, Rwanda is the first country in sub-Saharan Africa to propose an elimination plan of this size. According to officials, the plan aims at reducing the HCV prevalence from the current four percent to close to 1.2 percent and achieving 90 percent treatment coverage for people aged 15 years and above by 2024. UNDERSTANDING HCV Prosper Dusengeyezu, a public health officer at Rwanda Pharmaceutical Students’ Association (RPSA), says hepatitis refers to an inflammatory condition of the liver, commonly caused by a viral infection; but there are other possible causes of hepatitis. These, he says, include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. He explains that autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue. Hepatitis C, he says, comes from the hepatitis C virus (HCV). “Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact,” he says. Approximately 10 million of the 71 million individuals infected with HCV globally live in sub-Sahara Africa. The estimated prevalence of HCV viremia in sub-Saharan Africa varies by sub-region, ranging from 0.5 to 2.1 percent, with HCV infection contributing to high mortality due to cirrhosis and hepatocellular carcinoma. In Rwanda, a central African country of 12 million inhabitants has an anti-HCV antibody seroprevalence of approximately three percent, with a higher prevalence among key populations, including individuals who are co-infected with HIV and people above the age of 45. Dr Jean-Damascene Makuza, a senior officer at RBC, says being male, advanced age, marital status, (married and widows), comorbidities like high blood pressure and chronic renal failure, traditional operational practices, and scarification, as well as history of viral hepatitis in the family, can all put one at risk of being infected by HCV. Additionally, he says, people who have received medical or dental interventions in healthcare can as well be at risk of getting the virus. Patients who received blood products or organ transplants prior to the introduction of anti-HCV screening (which was introduced in the country in 1999), people who inject drugs (PWID), are all at risk as well. Children born to mothers infected with HCV, people with HIV infection, people who have used intranasal drugs, he says, are at high risk of getting HCV as well. PREVENTION OF HCV According to Dusengeyezu, there are many steps one can take to reduce the risk of viral hepatitis. For instance, he says, getting vaccinated against hepatitis A and B, especially if one wasn’t vaccinated before as a child. This, he says, is the number one way to prevent these illnesses. Another measure, according to him, is embracing the culture of washing hands with soap and water after using the bathroom or changing a baby’s diaper, and before handling food. When traveling to developing countries, he says one should avoid unpeeled or raw foods. Drink only bottled, boiled or chemically treated water, as it’s also one way of preventing the virus. Makuza says sharing syringes, shaving razors; toothbrushes or tattooing or piercing supplies should be avoided at all costs. Wearing gloves when performing first aid can help keep one-off from getting HCV, Makuza says. Disinfecting blood spills (including dried ones) with diluted bleach, and wearing gloves during clean-up, following all occupational safety precautions in your workplace, are all securities that should be taken as far as preventing HCV is concerned. If you are pregnant, Makuza says seeking early and regular prenatal care is vital. To reduce the risk of non-viral hepatitis, he says one should avoid excessive alcohol consumption and consult with a healthcare professional about medications and supplements. TREATMENT Antiviral medications are used to treat both acute and chronic forms of hepatitis C. Dusengeyezu says people who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies, they may also need further testing to determine the best form of treatment. He adds that people who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant. Currently, there is no vaccination for hepatitis C. “In Rwanda, we are treating HCV by using clinical trials of ledipasvir and sofosbuvir for chronic HCV infection genotype 1 or 4,” he says. COMPLICATIONS Chronic hepatitis B or C can often lead to more serious health problems. Here, experts say, the virus affects the liver; people with chronic hepatitis B or C are at risk for chronic liver disease, cirrhosis, and liver cancer. When your liver stops functioning normally, liver failure can occur. Complications of liver failure include; bleeding disorders and a build-up of fluid in the abdomen, known as ascites. With HCV, Makuza says one can as well develop complications such as increased blood pressure in portal veins that enter the liver, known as portal hypertension, and kidney failure. Hepatic encephalopathy, he says, is another complication that can involve fatigue, memory loss, and diminished mental abilities due to the build-up of toxins, like ammonia, that affects brain function. Dusengeyezu says people with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. “Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications,” he advises. MEASURES IN PLACE Rwanda has made remarkable gains in key global health priorities, such as the control of HIV and malaria and the reduction of maternal and child mortality. The country has now established ambitious goals for the elimination of HCV and made several important steps towards this goal. The goals include the establishment of strong national governance and planning systems, development of diagnostic capacity, regulatory approval and introduction of directing-acting antiviral and training of key health professionals. Other strategies include increased awareness in the population through media and other communication channels, systematic screening of all people over 15 and confirmation of positives, and also treating all patients tested positives. The steps have been facilitated by high-level leadership and the development of key strategic partnerships. editorial@newtimesrwanda.com
