Standard of care: Hepatitis A diagnosis, treatment and risk factors in India

Updated: July 30, 2019 12:43:31 PM

Around 40 million people suffer from hepatitis B in India as per the latest estimates.

HepatitisInflammation of the liver is usually known as hepatitis. (Image: Thinkstock Images)

By Dr. V. Sam Prasad

Wondering how to cure Hepatitis A fast and how to figure out and understand Hepatitis A diagnosis? First, let’s understand what it means as a health condition. Inflammation of the liver is usually known as hepatitis. As you already know, viral hepatitis is widespread and is known to be an infectious disease. This condition is normally caused by hepatitis viruses A, B, C, D and E. The condition can be self-limiting or can progress to liver fibrosis (scarring), cirrhosis or liver cancer.

In India, as per latest estimates, 40 million people suffer from hepatitis B. Also, around six to 12 million people are chronically infected with hepatitis C. Hepatitis E virus is the most important cause of epidemic hepatitis, though Hepatitis A virus more common among children. Most acute liver failures diagnosed are attributable to HEV.

Till July 2018, India didn’t have any comprehensive Viral Hepatitis Action Plan. It was only limited to vaccination of infants and newborn babies under Universal Immunization Programme and screening of blood at the blood banks for hepatitis B & C since year 2002.

However, few Indian states had taken the initiative to address the issue of hepatitis C. Punjab was the pioneer state to start the hepatitis C care under the ‘Mukh Mantri Hepatitis C Relief Fund’. It was largely due to political pressure built on the state after the estimations of high prevalence of hepatitis C in the state largely to unsafe injection practice and injection drug use.

This was a landmark step because it brought thousands of people infected with hepatitis C under care and established a model for other states. Similarly, the neighbouring state of Haryana started its programme under the name ‘Jeevan Jyoti’ at PGI Rohtak. Both the programmes paved the way for National Hepatitis Programme and established that through government’s intervention, cost of diagnosis and treatment for hepatitis C can be reduced and more people can be benefitted.

Realising the burden of HCV and demand from vulnerable populations led the Delhi Government to respond. The Government of NCT of Delhi amended its essential drug list to include hepatitis drugs. Some of the Delhi government hospitals such as GB Pant Hospital and Maulana Azad Medical College did provide HCV treatment. But due to huge demand and shortage of drugs the patients often face difficulty in accessing treatment. Above all, diagnostics remain a major challenge due to long waiting and high prices in private sector.

READ: Hepatitis B virus: Prevention over cure should be the approach India needs

On the contrary, the north-eastern states of Manipur, Mizoram and Nagaland, estimated to have high prevalence of hepatitis C and HIV-Hepatitis C co-infection, saw lukewarm response from the state government despite having vibrant civil society groups and huge demands by activists. Still many infected and vulnerable populations do not have access to hepatitis C services within their reach.

India is committed to achieving the Sustainable Development Goals (SDGs). The SDGs are a collection of 17 global goals set by the United Nations. The broad goals are interrelated though each has its own targets to achieve. SDG 3.3 aims to achieve the elimination of viral hepatitis by 2030. India is also a signatory to this World Health Assembly resolutions and the country’s vision is to move towards elimination of Viral Hepatitis by 2030.

Towards this, the National Viral Hepatitis Control Program (NVHCP) was launched a year back, on 28th July 2018 under the National Health Mission with a budget outlay of Rs 517.35 crores over 3 years. The program is designed to address the following preventive measures:

  • Awareness generation & behaviour change communication
  • Immunization for hepatitis B including the birth dose, the high-risk groups as well as the health care workers
  • Provision of safe blood and blood products through 100% voluntary blood donations
  • Injection safety by use of re-use prevention/auto-disable syringes in all government health care facilities
  • Safe socio-cultural practices
  • Safe drinking water and sanitation

To ensure basic standards of hepatitis care, the NVHCP division need to liaise with existing government programs under various Ministries and Departments such as; Immunisation Division, National AIDS Control Organisation (blood safety and targeted intervention), Swacch Bharat Abhiyan, Ministry of Drinking Water and Sanitation for the above prevention activities.

The programme also has component of control (diagnosis and treatment). Under this component quality testing for all types of viral hepatitis shall be carried out for diagnosis of viral hepatitis upto Primary Health Care/Health and Wellness Centre level in a phased manner. Those who are eligible for hepatitis B and C treatment shall put on antiviral treatment by trained health care providers in designated treatment centres at Government Medical Colleges and District Hospitals. Under the NVHCP, the drugs are to be provided free of cost to the patients.

Though the Government of India has launched the NVHP but so far, patients haven’t started to receive the services. There is a long gestation period to physically make the services available on the ground and this had led to anxiety among those who are vulnerable to viral hepatitis or those who are waiting to receive the services.

Few years back, the hepatitis C treatment was very expensive, was ineffective with low rate of cure and moreover inconvenient to patients as it was based on injectable drugs. In the last few years, after the introduction of direct acting antiretroviral drugs (DAAs), the treatment was becoming more effective (95% cure), less expensive, convenient with oral drugs and shorter (12-24 weeks) with fewer side-effects.

However, still a large number of patients are not able to access the treatment. India manufacturers high quality lost cost generic HCV drugs for exports to other countries but its own people have limited access to these drugs.

In absence of HCV services in public health, most of the people are forced to seek healthcare services from the private sector. Through the price of treatment has reduced drastically relative to earlier treatment the diagnosis remains the major bottleneck. It becomes even more cumbersome due to ambiguity in diagnostics pathways and redundant tests prescribed by physicians. People are still paying out of pocket for diagnosis and treatment. Therefore, it is important to improve access, availability and affordability of quality diagnostics and treatment.

The vulnerable groups and key affected populations hope that on this World Hepatitis Day which was on 28th July, their dream to access quality HCV care will be realised with the on-ground roll-out and implementation of NVHCP.

(Dr. V Sam Prasad is Country Director, Aids Healthcare Foundation India Cares. Views expressed are the author’s own.)

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