Hepatitis continues to pose a serious threat to public health in many African nations. In Nigeria, an estimated 20 million people have chronic hepatitis B and C infections. Could you provide more details about the prevalence of hepatitis in the Anglo-West African region and the steps Roche Diagnostics is doing to address it?
Nigeria ranks in the top ten nations in the world for the number of cases with this illness. More than 80% of those who contract the condition are unaware that they have it, which is concerning. As a result, it is critical that Nigeria conduct increased testing and awareness campaigns to ensure that those who are afflicted are informed and receive treatment. Because we have the tests to undertake the hepatitis screening and diagnosis, Roche plays a significant role. We wish to contribute to the effort to end the vicious cycle of infection and undertreatment. By doing so, we can either halt the infections or perhaps cure the illness. Together with our other Nigerian partners, this might come to pass. We have an example where hepatitis C has virtually vanished in Egypt as a result of diagnosis and treatment. Therefore, while it is possible to fight for the disease’s eradication, we cannot achieve it alone. Collaboration between partners in the public and private sectors is vital. throughout the spectrum of diseases since, as I’ve already shown, awareness, testing, screening, and treatment are all necessary. Additionally, partnerships are necessary to make this work, particularly when it comes to finding funding for the disease’s diagnosis and treatment. Working together with the government, the World Bank, and other donors, we hope to ensure that, in accordance with WHO guidelines, we reach “gold-tier status” in our efforts to eradicate hepatitis C. The WHO has classified the nations that have been able to successfully control or lower this disease burden as having gold-tier status.
According to a 2021 NCBI study, subgenotype 4A is the most common hepatitis B genotype. Additionally, Nigeria and other nations are experiencing an evolution of HPV sub-genotype sequences. Additionally, a novel genotype of the amino acid AYW has been found and is spreading throughout the area. Additionally, genotype E is widely distributed throughout West Africa. Despite being relatively new, this genotype is becoming more prevalent in the area. In West Africa, genotype 1 hepatitis C is the most prevalent. Additionally, genotype two is more common in West Africa, but it responds better to ant iviral therapy and is easier to maintain. Once more, Roche is significant since our diagnostic instruments can identify the distinct genotypes of hepatitis B and hepatitis C. This implies that we can monitor viral loads more successfully and provide diagnoses with more accuracy. Viral load monitoring allows us to monitor the disease’s course and the efficacy of treatment. Knowing which genotypes are most common allows us at Roche to design and suggest treatment plans that are optimized for each of these genotypes, especially the most common ones, such as HPV, hepatitis B sub-genotype A4, and hepatitis C genotype 1.
Collaboration between the public and commercial sectors is essential to combating this illness, particularly between organizations like Roche that may offer hepatitis testing services. In order to facilitate integrated testing across various illness categories, we assist healthcare providers. For instance, the nation already has equipment that enables medical facilities to do simultaneous tests for HIV, TB, hepatitis, and other illnesses. When this method is used, a co-infection is found early on, allowing for the implementation of therapy and monitoring for the patients’ benefit. In order to maximize the work at the laboratory, we additionally support training and programs for laboratory quality management and improvement that are run in collaboration with the stakeholders. In order to improve access to various pathogen testing capabilities, we maintain an integrated diagnostics network. Additionally, we collaborate with the government to make sure that early diagnosis is given top priority because early detection leads to better illness management and better outcomes. Nigeria now follows HPV guidelines, which were issued by the government in 2023. According to these guidelines, testing is crucial to ensuring that hepatitis is appropriately controlled and treated in the nation.
In terms of Nigeria’s vaccination uptake, there is good news and bad news. The introduction of the HPV vaccine at birth has reduced the prevalence of chronic hepatitis B among children under five, and this is very good news. We are still not yet at the global level that has seen a decline from about 5 percent in the pre-existing area to less than 1 percent as of 2019, but Nigeria is well on its way. There are still a lot of differences between the various regions of Nigeria, even with this adoption. Some regions achieve much higher vaccination coverage than others, and this, of course, results in different impacts across the country, with some regions experiencing lower prevalence than others. Something else that needs to be improved is that the coverage rate of the hepatitis B birth dose vaccine is significantly low at 18 percent. This is across Africa, compared to 80 percent in the Western Pacific, 65 percent in the Americas, and 58 percent in Southeast Asia. So, across Africa, there is still a lot to be done to increase the coverage of the hepatitis B birth dose vaccine. Something needs to be improved. Only fifteen African member nations have embraced the immunization. And that is 15 out of more than 50 countries. So, there’s still a lot to be done across Africa to improve access to the hepatitis B vaccine. Fortunately, Nigeria is one of those 15 countries that have adopted the vaccine for Hepatitis B at birth. There has been a reduction in the incidence of transmission of a hepatitis B infection in children below five years old, including a significant reduction of this disease among children.
I will start by specifically mentioning blood screening, which is very important to stop the spread of this disease. So, we are currently working with the blood bank associations and blood bank authorities in Nigeria to build capacity in blood screening and safety. This includes training healthcare professionals, improving laboratory infrastructure, and ensuring that the facilities in Nigeria can effectively use brush diagnostic tools. Another way that we are working with health authorities in Nigeria is trying to educate and being able to implement centres that can detect different infections, including hepatitis, HIV, and TB. That way we can maximise the resources both in terms of personnel but also of the costs associated with screening. So, these are two specific ways in which Roche has been working to improve the diagnostics and screening of HPV and other diseases. We also want to work with different stakeholders to co-create innovative funding models with both the public and private sectors in coming up with solutions to testing more cost-effectively and build diagnostic platforms that are tailored for using resource-limited settings.
“So, across Africa, there is still a lot to be done to increase the coverage of the hepatitis B birth dose vaccine. There has to be an improvement.”
Roche is currently working to expand its point of testing, which is crucial for blood safety in remote and underserved areas. We aim to provide these easy-to-use devices that can enable healthcare providers to conduct blood safety tests on site, provide immediate results, and reduce the need for complex laboratory infrastructure. Roche point-of-care solutions are designed to be both affordable and scalable, making them ideal for widespread use in low- and middle-income countries. So, Roche has a strategy of both having point-of-care solutions for remote areas and, at the same time, having tests in laboratory settings that allow for higher volume testing.
To achieve these goals, it is critical that we ensure investments in preventive care. For example, especially diagnostic, and this is aligned with a WHO resolution that calls for all countries to strengthen their diagnostic systems and invest more in testing capabilities. We believe that with more investments in preventive care and early testing and screening, we can reduce maternal and child mortality and reduce the burden of preventable diseases like hepatitis, HIV, and tuberculosis. We are also encouraging the government and working with them to increase access to health coverage or the universal health coverage that is being implemented in Nigeria. This is critical because without universal health coverage, those populations in poor areas will not be able to afford testing and treatment. So, we are working with different health authorities to try to increase the number of people that are covered under universal health coverage. Again, because we believe that enhanced diagnostic capacity contributes to a strong and resilient health system, we are working to improve policy decision-making that makes diagnosis an important part of the health investment in the country. We are also stimulating dialogue among stakeholders, improving and prioritising access to quality diagnostics and laboratory systems, strengthening them, and shaping the right policy environment to drive diagnostic investments, which, as I mentioned, are a critical part of a robust health system.
To reduce the disease burden and eliminate some of these diseases, there is definitely a need to improve the healthcare systems in Nigeria and Anglo-West Africa. A very important part is to achieve universal health coverage, and this is also a goal of the government. These will increase accessibility and affordability for all Nigerians. Currently, only about 5 percent of Nigerians are covered under universal health coverage, which is not enough. This means that there is an urgent call for healthcare organisations to consider how we have a cost of managing care addressed. So, one goal in which Roche plays a part is increasing accessibility for universal health coverage. Supported by the recent adoption of the WHO resolution on strength in diagnostic capacity, we are working with healthcare stakeholders to improve and prioritise access to quality diagnostics and laboratory systems because having a strong diagnostic infrastructure is key for a good healthcare system. This is very important, and this is something that Roche is working very hard Won. A strong diagnostic infrastructure will make the health system more resilient and will respond to population needs, especially when there are disease outbreaks, external shocks, or pandemics like the one that we recently experienced with monkeypox. The same as with COVID-19, enabled to manage pandemics like a monkeypox, the diagnostics and screening are essential. Again, as a summary, we need to work together with different stakeholders to improve access and affordability to the best quality diagnostics and, of course, treatment, and the universal health coverage that is one of the main projects of the Nigerian government is a very, very important part.
There is still a lot to do to have more cooperation from the public and private sectors. Specifically, in the case of hepatitis, to be able to have better control and management, there needs to be more awareness. As I mentioned earlier, 80 percent of people affected by hepatitis don’t know they carry the disease. So there has to be more awareness and more screening and testing. This can be done; as I mentioned, there is an example in Egypt in which they eliminated hepatitis C with a combination of screening and treatment. There are also other examples in other countries, both in Africa and worldwide, in which, with improved access to testing and more awareness, the disease burden has been reduced. In the media, it also plays an important part to increase public knowledge about hepatitis and also to tell the public about the diagnostics and treatments available to them. This is especially so in underserved communities. In summary, I think that there has to be a strong partnership between private sector healthcare providers and the government to take coordinated action against viral hepatitis. We need to work together to look for innovative ways for funding, improve diagnostic laboratory infrastructure, and prioritise access to testing and care for all Nigerian patients, even in the most remote communities.
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The developed countries have more robust systems in terms of health coverage for the population. So, there are more people that can either get their health needs subsidised or covered by the government. That is still not the case in most of Africa. In Nigeria, most healthcare expenses are out of pocket, and this hurts particularly the poor people that do not have enough money to pay for their healthcare needs. So, the government has to increase the coverage and the funding for healthcare access because it is not enough to be enrolled in a universal healthcare access program if there is no funding to effectively diagnose and treat the patients that are enrolled. So, one thing is the coverage or the amount of the number of people that are enrolled, but another thing that is even more important is that then the government has the funds for people to be diagnosed and treated, either subsidised or covered 100 percent of the cost for the population. That is a general point, but more developed countries also do a very good job in preventing disease or disease progression through vaccination and more robust diagnostic infrastructure. Diagnostics is very important, especially early diagnostics, because if you can’t, if you are able to diagnose early, then the treatments are cheaper and the outcomes are better.
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