Improving communication about viral hepatitis in Africa

Shimakawa, Yusuke; Pourette, Dolorès; Bainilago, Louis; Enel, Catherine; Sombié, Roger; Rado, Ramanampamonjy; Lemoine, Maud; Giles‐Vernick, Tamara

doi:10.1016/s1473-3099(17)30339-0

Cited by 10 publications

(12 citation statements)

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“…This review also found only limited information regarding patient‐reported barriers to adherence, and there is a need for a better understanding of causes of nonadherence. More fundamentally, there is a need to improve awareness of the disease; in many low‐income settings, knowledge of HBV in the general population is very limited, with less than 1% of people in The Gambia reporting to have heard of hepatitis B, although most are familiar with HIV and malaria . Future research should focus both on identification of potential risk factors (including age, sex, coinfection status, and stage of disease) and patient‐reported barriers to help identify patients at higher risk of nonadherence and supportive interventions.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Ford

Scourse

Lemoine

et al. 2018

Hepatology Communications

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Successful treatment outcomes for chronic hepatitis B virus (HBV) infection requires high levels of adherence to treatment. We searched three databases and abstracts from two conferences up to January 2018 for studies reporting the proportion of patients who were adherent to HBV antiviral therapy and pooled data using random effects meta‐analysis. We included 30 studies, providing data for 23,823 patients. Overall, adherence to treatment was 74.6% (95% confidence interval [CI] 67.1%‐82.1%). Adherence was similar in high‐income settings (75.1%; 95% CI, 65.4%‐85.0%) and in low‐income and middle‐income settings (72.9%; 95% CI, 57.8%‐88.0%). Reported barriers to adherence included forgetting, limited understanding of the importance of adherence, and change to routine. Conclusion: There is a need to reinforce assessment and reporting of adherence as a routine part of HBV care and to assess the extent to which evidence‐based interventions to improve adherence to medication for human immunodeficiency virus [HIV] and other chronic diseases are effective for HBV infection.

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Section: Discussionmentioning

confidence: 99%

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Ford

Scourse

Lemoine

et al. 2018

Hepatology Communications

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“…Undiagnosed cases in low‐ to middle‐income countries (LMIC) are also found in these key populations, but the greater problem lies in limited centralized diagnostic facilities, cost of testing, lacking public education and awareness, and need for skilled health professionals . Improving general understanding of viral hepatitis and its health consequences are also central to increasing disease awareness and could be addressed via public health campaigns .…”

Section: Discussionmentioning

confidence: 99%

Research gaps in viral hepatitis

2018

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IntroductionThe World Health Organization has aimed for global elimination of both hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030. Treatments available to cure HCV and control HBV, as well as vaccination to prevent HBV infection, have certainly allowed for such bold goals, yet the final steps to usher in elimination require further evidence.DiscussionWe broadly discuss the needs for three major public health approaches. First, an effective vaccine exists for HBV and mass‐vaccination campaigns have resulted in decreases in hepatitis B surface antigen seroprevalence and overall rates of liver‐related morality. Still, HBV vaccination coverage is poor in certain regions of the world, while the reasons for such low coverage require further study. A prophylactic vaccine is probably needed to eliminate HCV, but is not being readily developed. Second, identifying HBV/HCV infected individuals remains a priority to increase awareness of disease status, particularly for key populations. Research evaluating large‐scale implementation of novel, rapid and mobile point‐of‐care tests would be helpful to determine whether increased awareness is achievable in these settings. Third, antiviral therapy allows for strong HBV suppression and HCV cure, while its access depends on financial factors among many others. Although there is strong evidence to treat key populations and specific groups with progressed disease, as stated in current guidelines, the advantages of extending treatment eligibility to decrease onward spread of HBV/HCV infection and prevent further burden of disease are lacking “real world” evidence. Novel anti‐HBV treatments are being developed to target intrahepatocellular HBV replication, but are still in the early phases of clinical development. Each of the strategies mentioned above has specific implications for HIV infection.ConclusionsThere are certainly effective tools to combat the spread of viral hepatitis and treat infected individuals – yet how they are able to reach key populations, and the infrastructure required to do so, continue to represent the largest research gap when evaluating the progress towards elimination. Continuously adapted and informed research is required to establish the priorities in achieving elimination goals.

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“…Previous sub-Saharan African studies have found a lack of recognition of the term "hepatitis B" among lay publics and limited knowledge among health-care workers, for which there are numerous reasons. [9][10][11][12][13][14][15][16][17] The natural history of chronic HBV infection is complex: following exposure to HBV at birth or during early childhood, a lengthy period ensues during which chronic HBV infection is asymptomatic until the development of end-stage liver disease (jaundice, ascites, hematemesis, and weight loss). 18,19 Nonetheless, because signs and symptoms of end-stage liver disease are visible, understanding how African lay populations explain these physical symptoms would be useful.…”

Section: Introductionmentioning

confidence: 99%

“…We conducted this investigation to provide the foundations for strengthening communications strategies to enhance scale-up of screening and treatment services in Senegal and other African countries. 14…”

Section: Introductionmentioning

confidence: 99%

Limited Awareness of Hepatitis B but Widespread Recognition of Its Sequelae in Rural Senegal: A Qualitative Study

Boye

Shimakawa

Vray

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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To achieve the WHO's global strategy of eliminating hepatitis B virus (HBV) infection, it is essential to ensure adequate understanding of hepatitis B disease to facilitate uptake of screening, linkage to care, and adherence to antiviral therapy. Sub-Saharan Africa has the world's highest prevalence of HBV infection, yet less than 1% of HBV-infected people have been diagnosed. Lay populations do not widely recognize "hepatitis B." Hypothesizing that visible signs and symptoms of chronic HBV infection sequelae (jaundice, ascites, or cachexia) might be more easily recognizable, we conducted a qualitative study to determine how rural populations in Senegal understood these sequelae. We led six focus groups and 149 individual interviews with lay populations and formal and informal health workers in three rural study sites in Senegal. Only a third of lay populations (30/105) had ever heard of "hepatitis B," nor did they evoke local language diagnostic terms resembling this illness. Nevertheless, more than two-thirds (71/105) recognized signs and symptoms of end-stage liver disease but considered these physical manifestations to be a consequence of the manipulation of occult forces. Lay populations also contended that traditional healers, not formal medical structures, should treat such illnesses. Formal and informal health workers had limited knowledge about hepatitis B and difficulties identifying terms in local languages to explain the disease. Communication strategies based on the population's widespread recognition of the hepatitis sequelae may enhance awareness of hepatitis, which is a crucial element to increase screening uptake, linkage to care, and commitment to lifelong treatment in African communities.

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Improving communication about viral hepatitis in Africa

Cited by 10 publications

References 9 publications

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Research gaps in viral hepatitis

Limited Awareness of Hepatitis B but Widespread Recognition of Its Sequelae in Rural Senegal: A Qualitative Study

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