Plan to Eliminate Hepatitis: Remarkable Progress in Rwanda
Updated: Jul 30, 2021
PIH/IMB is spearheading the national hepatitis elimination campaign in three rural districts.
Lab Technician Musafiri Tumusiime preparing a patient before conducting a Rapid Diagnostic Test for Hepatitis B and C at Mahama Refugee Camp.
In 2018, Rwanda announced its plan to eliminate Hepatitis C virus (HCV) as a public health threat by 2024, ahead of the World Health Organization’s 2030 global HCV elimination targets.
In Partnership with the Government of Rwanda, Partners In Health (PIH), locally known as Inshuti Mu Buzima (IMB) is proving that no dream is too big.
Using novel approaches like linking patients to hepatitis treatment at their local health centers through a mobile hepatitis clinic, integrating refugees into the national hepatitis elimination program, and providing combined hepatitis, HIV, and cervical cancer screening for female sex workers, PIH/IMB is spearheading the national hepatitis elimination campaign in three rural districts-Kirehe, Kayonza, and Burera.
“Our team has emphasized monitoring, evaluating, and publishing on our interventions because what we are doing here has important implications outside of Rwanda,” said Dr. Dale Barnhart, an epidemiologist and research fellow with PIH/IMB.
A serious health threat requires novel approaches
Elimination of any outbreak is never a straightforward undertaking. 325 million people globally are living with viral hepatitis, with low- and middle-income countries facing elevated risk.
PIH/IMB’s approach to hepatitis elimination relies on targeted micro-elimination campaigns, where PIH/IMB identifies and directs its efforts to serve a group that is either at elevated risk of hepatitis or that faces barriers accessing hepatitis-related care. The identified targeted population is tested for hepatitis and patients who test positive are then enrolled in a treatment program.
Among the populations that received care include Mahama Refugees Camp, which Is the largest refugee camp in Rwanda, located in Kirehe District, in Eastern Province. Thanks to good coordination across national, district, community-level stakeholders, and real-time data analysis, 78% of all refugees aged 15 and older were screened for both hepatitis B & C, and those with positive results were linked to care.
Integrating refugees into the national hepatitis screening and treatment campaigns enhances the health of refugee communities while also supporting national goals for hepatitis elimination and control.
Leaders from Save the Children, ALIGHT, UNHCR, Refugees representatives, alongside PIH/IMB team holding Rapid Diagnostic Test during the launch of the screening campaign against Hepatitis B and C at Mahama Refugee Camp in February 2020.
Another targeted population included female sex workers. Female sex workers are not only vulnerable to viral hepatitis infection, but they are also at risk of HIV and cervical cancer. PIH/IMB provided a customized screening and treatment program that integrated HIV and cervical cancer screening alongside hepatitis services.
PIH/IMB also provided hepatitis screening to 75% of all patients enrolled in an NCD program. NCD patients are often older and are therefore at higher risk of hepatitis C. Because these patients already have a relationship with the health center, targeting screening and treatment was a powerful way to provide more holistic healthcare.
Learn more about PIH’s NCD program in Rwanda.
A mobile clinic, ‘A low cost and effective intervention’
Perhaps one of the most awesome and effective approaches in the fight against hepatitis was a mobile clinic, a team of a clinician, a lab technician, and a driver who provided hepatitis treatment to patients at their local primary-level health center.
This low-cost intervention enabled eligible patients, who would have otherwise struggled to reach a hospital, to receive same-day clinical consultations, counseling, laboratory tests, and treatment initiation.
A report by Kamali et al., PIH/IMB’s Director of Non-Communicable Diseases (NCD) Program, showed remarkable impacts of the mobile clinic. Before the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over 25 months. But during the 3-month mobile clinic, an additional 429 were linked to care through the mobile clinic.
Read more about the mobile clinic approach
‘90% of patients who complete treatment have been cured’
“We are consistently seeing that over 90% of patients who complete treatment for HCV and come in for their follow-up viral load test have been cured of HCV. It really highlights the fact that modern treatment options for HCV are extremely effective and that HCV treatment can be provided effectively even in rural, low-resource settings,” Dr. Barnhart said.
PIH Lab technicians Musafiri Tumusime and Francoise Nyirahabihirwe preparing samples for viral load testing using a new viral load testing machine in Kirehe. Having access to this machine reduced turn-around time for test results from 15 days to 2 days, allowing PIH to quickly identify which patients are eligible for treatment and link them to care.
In Africa, chronic viral hepatitis affects over 70 million people and continues to take the lives of many, especially those who can’t afford to access quality health care. Hepatitis can be prevented, screened, treated, and eliminated, but it requires united efforts across all spectrums; political, private, and the public.
Over the years, PIH/IMB has worked with the Government of Rwanda to strengthen health systems in Rwanda, many projects PIH/IMB piloted in three districts it supports served as models for related projects and were adopted nationwide.
“By piloting these programs in our districts, we hope to demonstrate that these approaches are feasible ways to promote access to hepatitis care, and other diseases, around the world. I’m really proud of our team’s commitment to the research process, and I think that it shows one of the most valuable ways PIH can promote global health,” Dr. Barnhart added.
“Smart investments in accurate diagnosis and in effective therapy for hepatitis C could save millions of lives in the coming years, radically cut transmission and pave the way toward the eradication of the virus.” – Dr. Paul Farmer