AFRICA – Researchers have recommended the revising of the current World Health Organization (WHO) guidelines on managing the chronic hepatitis B condition in Africa.

They have found that cheaper and more accessible blood testing methods can improve the care of patients with hepatitis B.

“Our data are important for informing clinical practice in [Sub-Saharan Africa] and should be considered in the next revision of the WHO hepatitis B guidelines,” say the researchers who make up the Hepatitis B in Africa Collaborative Network (HEPSANET).

According to the study, Africa represents one of the high-burden regions for chronic hepatitis B virus. Of the estimated 316 million people that live with chronic hepatitis B virus infection worldwide, 82 million are in Africa.

The research further says that antiviral therapy effectively reduces the risk of complications resulting from hepatitis B virus infection.

But with current WHO-recommended guidelines, early diagnosis and treatment are impacted because often only picked up when there is advanced liver damage.

The challenge in clinical practice in Africa has been to identify patients at risk of progressive liver disease who should start antiviral therapy in good time.

Findings from different parts of Africa

In the study, the 23 researchers reviewed data for 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries, namely Burkina Faso, Ethiopia, The Gambia, Malawi, Nigeria, Senegal, South Africa, and Zambia.

They evaluated the existing WHO treatment guidelines and a simple liver damage biomarker developed in West Africa.

They established that the conventional hepatitis B care standards are unsuitable for patient management in Africa.

They found that the diagnosis level as set by the WHO “is inappropriately high in sub-Saharan Africa,” which is often constrained by a lack of resources.

The problem, the researchers say, is that the existing WHO guidelines are not adapted for the African population.

The study that informed these guidelines was performed among active chronic hepatitis C patients in the USA, much older than Africa’s hepatitis B virus population and on a very different patient population compared to African chronic hepatitis B patients.

Under the hands of WHO and CDC

Johannessen said that they have shared their findings with the WHO and the Centre for Disease Control (CDC) in Africa.

“We believe our findings will inspire the first ever African hepatitis B treatment guidelines, and even the WHO is now changing their guidelines because of our work,” Johannessen said.

Initially, the researchers thought their main challenge would be to get people to share data.

The study is the largest, most comprehensive, and geographically representative analysis ever conducted in Africa.

Limitations of the study

However, they admit some limitations of their study. For example, the method used to assess liver damage has been associated with technical limitations, including unsuccessful measurements reported in patients with certain health conditions such as obesity.

The researchers did not ascertain the rates of failure of these tests.

“This may affect the overall applicability of our findings to the entire population with HBV,” they say.

But Adamson Muula, Professor and Head of Community and Environmental Health at the Kamuzu University of Health Sciences (KUHES) in Malawi, says in terms of the methodology used in this study, the systematic review of data was relevant in answering the question at hand.

“In the hierarchy of evidence, systematic reviews and meta-analyses are high up with respect to the rigor of the findings,” says Muula, who was not part of the research.

He noted, however, that there are downsides to this approach, including the fact that in the interpretation of the findings, there is an implicit sense that Africa is one place. Muula argues that African health systems can be different even within the same country.

Regardless, the study is vital, he acknowledges.

Hepatitis B diagnosis on the continent has been a luxury. In Malawi, for example, where 5 percent of the adults are estimated to be infected, virtually no screening or diagnostic system exists.

Individual patients may interact with the health system, but more so when things are already out of hand when irreversible liver damage has already happened.

The WHO’s goal is to have hepatitis eliminated by 2030.

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