Browsing by Author "Davwar PM"

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    A new approach to prevent, diagnose, and treat hepatitis B in Africa.
    (2023) Spearman CW; Andersson MI; Bright B; Davwar PM; Desalegn H; Guingane AN; Johannessen A; Kabagambe K; Lemoine M; Matthews PC; Ndow G; Riches N; Shimakawa Y; Sombié R; Stockdale AJ; Taljaard JJ; Vinikoor MJ; Wandeler G; Okeke E; Sonderup M; School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA.; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; LiveWell Initiative, Yesuf Abiodun Street, Victoria Island, Lagos, Nigeria.; Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK.; Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia.; Department of Internal Medicine, Jos Univeristy Teaching Hospital, Jos, Nigeria.; Radcliffe Department of Medicine, University of Oxford, Oxford, UK.; Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa.; Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, Paris, France.; The National Organisation for People Living With Hepatitis B, Kampala, Uganda.; Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway.; School of Medicine, University of Zambia, Lusaka, Zambia.; Division of Infection and Immunity, University College London, Gower Street, London, WC1E 6BT UK.; Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Service d'hépato-Gastroentérologie, CHU Yalgado OUÉDRAOGO, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK.; Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.; Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.; Department of Infectious Diseases, University College London Hospital, Euston Road, London, NW1 2BU UK.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.; Women in Hepatitis Africa, Womens Wellness Center for Hepatitis, Isale Ajoke, Iwaya-Makoko, Lagos State, Nigeria.; Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso.; Department of Clinical Infection, Microbiology and Immunity, University of Liverpool, Liverpool, UK.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    There are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB.