Africa CDC releases new toolkit to combat hepatitis B burden

ETHIOPIA—The Africa Centres for Disease Control and Prevention (Africa CDC) has released an operational toolkit to support the prevention, diagnosis and management of hepatitis B across the continent.

In a statement issued on World Hepatitis Day, Dr Jean Kaseya, Director General of Africa CDC, said the Operational Toolkit for the Prevention, Diagnosis and Management of Hepatitis B was designed as a practical resource for healthcare workers, particularly those working in facilities with limited access to specialist services.

The toolkit includes treatment algorithms, liver fibrosis assessment guidance, and clinical decision-support tools to help health workers manage patients at the primary care level.

Africa CDC developed the resource through its Hepatitis B Group of Experts, in collaboration with the Centre for Operational Research on Hepatitis B, HEPSANET and the Society for the Study of Liver Disease in Africa.

According to Kaseya, the toolkit aims to bridge the gap between existing knowledge and the delivery of hepatitis services in routine healthcare settings by translating World Health Organization recommendations into practical guidance.

Africa faces a major hepatitis burden

An estimated 64 million people in Africa live with chronic hepatitis B, while the continent accounts for 63% of new hepatitis B infections globally. The disease was estimated to have caused 272,000 deaths in Africa in 2022.

However, access to testing and treatment remains limited. Fewer than 5% of people living with hepatitis B in Africa have been screened, while fewer than 1% receive treatment.

Kaseya also highlighted the low coverage of the hepatitis B birth dose vaccine, which can prevent almost all mother-to-child transmission when administered within 24 hours of birth. Only 18% of African newborns currently receive the vaccine within this critical window.

Meanwhile, hepatitis C can be cured in more than 95% of cases with a short course of treatment, yet many people across the continent remain undiagnosed and untreated.

Kaseya said Africa’s continuing hepatitis burden reflects a failure to implement affordable and effective interventions that have been available for decades.

Health sovereignty and domestic financing

The Africa CDC Director General said declining development assistance, more frequent disease outbreaks and an increasingly unpredictable geopolitical environment have reinforced the need for African countries to strengthen domestic health financing and reduce dependence on external funding.

He said Africa’s Health Security and Sovereignty agenda should not be viewed as a move towards isolation but as a framework through which African countries can take greater ownership of their health priorities, finance interventions they can afford, and strengthen local production.

Viral hepatitis, he added, provides a clear test of the continent’s ability to translate political commitments into action.

Hepatitis B vaccines are inexpensive, many medicines are off patent and diagnostic tools are relatively simple. In addition, existing maternal health, HIV and tuberculosis programmes can provide platforms for delivering hepatitis services.

African countries demonstrate progress

In February 2020, African Union Heads of State and Government adopted the Cairo Declaration on Viral Hepatitis in Africa, committing member states to expand prevention, testing and treatment.

Since then, several countries have demonstrated the impact of sustained political commitment and domestic investment.

Egypt screened more than 50 million people through its 100 Million Healthy Lives campaign and became the first country globally to achieve World Health Organization gold tier status on the path towards hepatitis C elimination.

The country is also supporting hepatitis C treatment in Ghana, with the programme targeting 50,000 patients.

Rwanda, meanwhile, has screened more than seven million people, made hepatitis C treatment available free of charge nationwide, decentralized services, and authorised trained nurses to manage uncomplicated cases at primary healthcare facilities.

Uganda allocates approximately US$3 million annually in domestic resources to provide free hepatitis B testing, treatment and viral load monitoring.

Other initiatives include Nigeria’s Project 365, Senegal’s national hepatitis elimination strategy, Ghana’s expansion of free treatment and innovative financing mechanisms in Cameroon.

According to Kaseya, these initiatives demonstrate the importance of political leadership, domestic financing and strategic partnerships in advancing hepatitis elimination.

Expanding vaccination and prevention

Nearly all African Union Member States have incorporated hepatitis B vaccination into routine childhood immunisation programmes.

The African Union has also adopted the Africa Plan Towards the Elimination of Vertical Transmission of HIV, Syphilis and Hepatitis B by 2030. The strategy promotes an integrated approach to addressing the three infections through antenatal care services.

Since 2022, with support from the Korea International Cooperation Agency (KOICA), Africa CDC’s Continental Viral Hepatitis Prevention and Control Programme has established a continental expert group, conducted the first assessment of national hepatitis programmes and supported 32 Member States in learning from Egypt’s experience.

Kaseya called on Member States to ensure that hepatitis B birth-dose vaccination is available in every delivery facility and that hepatitis screening forms part of routine antenatal care.

He said administering the vaccine within the first 24 hours of life represents one of the highest-impact opportunities for preventing hepatitis B transmission.

Achieving wider coverage, however, will require clear national targets, reliable supply chains, accurate birth notification systems and trained health workers who can administer the vaccine at the point of delivery.

Countries must also reach children born outside formal healthcare facilities by expanding vaccination through community health workers, midwives and outreach teams.

Mobilising sustainable financing

Kaseya urged African finance ministers to establish sustainable health financing mechanisms before the next major health crisis occurs.

He pointed to solidarity levies, health security bonds, diaspora bonds, taxes on tobacco and alcohol and catalytic private investment as potential sources of additional funding.

He also cited UNITAID’s long-standing financing model, which relies largely on a levy on airline tickets, as an example that African governments could adapt to their own needs.

According to Kaseya, predictable domestic financing can help countries retain health workers, maintain essential medical supplies and plan healthcare programmes beyond a single fiscal year.

Strengthening local manufacturing

Africa CDC also called on regulators, procurement agencies and development partners to prioritise African manufacturers when they meet required quality standards.

South Africa produces generic tenofovir, while Biovac is producing millions of doses of hexavalent vaccines containing hepatitis B components.

Aspen is also completing a technology transfer arrangement with the Serum Institute of India.

Egypt is expanding regional production of hepatitis therapeutics, while Egypt, Kenya and Nigeria are strengthening domestic production of rapid diagnostic tests.

Kaseya said African manufacturers need reliable demand to sustain and expand this capacity.

He noted that the African Medicines Agency and the African Pooled Procurement Mechanism could help consolidate fragmented national markets and create a larger, more predictable market for manufacturers.

Digital systems to strengthen accountability

Digital health systems could also help countries improve hepatitis prevention, diagnosis and treatment.

Digital birth notification systems can identify newborns who miss the hepatitis B birth dose while vaccination can still provide effective protection. Similarly, digital health records can help healthcare providers track patients diagnosed with hepatitis and ensure they remain in care.

Africa CDC is supporting Member States to align partner investments with country-led digital health roadmaps to strengthen coordination and national ownership.

Kaseya said the impact of these efforts should ultimately be reflected in routine healthcare delivery, from newborns receiving hepatitis B vaccination before leaving maternity wards to pregnant women learning their hepatitis status during their first antenatal visits.

He also highlighted the importance of ensuring that nurses in rural facilities can identify which patients require treatment and which need monitoring, while people diagnosed with hepatitis receive timely care before developing cirrhosis or liver cancer.

Kaseya further called for greater investment in African diagnostic manufacturing, domestic procurement and health workforce financing.

He said Africa’s hepatitis response will continue to depend on collaboration among African governments, KOICA, the World Health Organization, UNICEF, professional societies, civil society organisations and affected communities.

According to Kaseya, such partnerships can strengthen African leadership while ensuring that external support complements, rather than replaces, national and continental efforts.

He cited the progress made by Egypt, Rwanda, and Uganda as examples of what sustained commitment can achieve and called for similar action across the continent.