A Hundred Times More Infectious Than HIV

People carry some ailments for decades before symptoms manifest and it’s too late for treatment. Those who do get diagnosed must grapple with expensive medical costs. What then is the solution?

How do you test for a virus when you don’t know you have it?

Hepatitis B is one such. Often times, it remains undetected until it is viral, at which stage, it is often too late.

It leads to an infection of the liver that can cause both acute and chronic disease. When chronic, it attacks the liver, eventually causing scarring (cirrhosis) of the organ, liver failure, and cancer.

There are various types of hepatitis viruses including types A, B, C, D and E. Types A, B, and C are the most common. All five hepatitis viruses can cause acute disease, but the highest numbers of deaths result from liver cancer and cirrhosis that occur after decades of chronic hepatitis B or C infection.

According to the World Health Organization (WHO), an estimated 257 million people are living with the hepatitis B virus (HBV) infection, however, the rate of diagnosis is extremely low, at approximately 9% of all HBV-infected persons.

In February, Abbott Laboratories announced, “the world’s most sensitive rapid diagnostic test for the detection of hepatitis B surface antigen… This highly-sensitive, easy-to-use, rapid lateral flow test enables identification of those with the virus and facilitates linkage to care in every healthcare setting”.

This is a monumental victory for healthcare practitioners, who are working on the ground to eradicate the virus, says Dr Andrew Scheibe, a medical doctor who focuses on HIV, viral hepatitis and infectious diseases among key populations, specifically people who use narcotics.

“What’s useful about it is that it’s very easy to use and you get results in 15 minutes. Compared to the previous test, you’re able to detect more people who are infected… [as] it detects more hepatitis B surface antigen (HBsAg) in the blood… this is very useful in the field as it is a rapid test,” he says.

Scheibe is a senior technical advisor for TB and HIV Care and has research affiliations with the University of Pretoria’s Department of Family Medicine and the Urban Futures Centre at the Durban University of Technology.

The rapid diagnostic test by Abbott Laboratories is likely to empower health practitioners to fight a battle that has seemed insurmountable on the continent.  

A report released by WHO states that the organization “has set baseline targets to diagnose 30% of HBV-infected individuals by 2020 and 90% by 2030. In order to reach these targets, rapid testing is imperative. Testing and diagnosis of HBV is the gateway for access to both prevention and treatment services and is a critical component of an effective response to the hepatitis epidemic”.

From an economic perspective, it is imperative that hepatitis B mortality rates be reduced because a significant number of the people who become symptomatic manifest from middle to late life.

“Those are people who should be economically active, so that has a huge economic consequence. And the treatment of people who have liver failure is very expensive,” Scheibe says. 

In sub-Saharan Africa, the overall hepatitis B carrier rate in the general population is 5%-20%, which is amongst the highest in the world. Viral hepatitis is also a growing cause of mortality among people living with HIV.

“About 2.3 million people living with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus,” according to WHO.

There are other socio-economic factors that make the virus endemic in sub-Saharan Africa, these are dictated by lack of basic resources, as well as population density. 

“A lot of the factors are linked to socio-economic and environmental factors. With hepatitis B in particular, it’s transmitted through bodily fluids, so if there aren’t good personal and public hygiene practices, that can foster an environment where these infections are spread,” Scheibe says.

“If you are in an area where there’s a high population living with an infection, it means that the likelihood of people contracting it is higher… This is a concept we call the community viral load. If, in sub-Saharan Africa, there already is a lot of hepatitis B, people will automatically be at a higher risk of contracting it, because they are more likely to come into contact with people who have the infection.”

The virus is transmitted through contact with the blood or other body fluids of an infected person.

“The virus is a hundred times more infectious than HIV. It’s one of those conditions that people can live with without knowing they are infected… a proportion of those people will go on to develop live cancer, which we have few treatments for,” Scheibe says.

In South Africa, the lack of political will to meet the goals set out by WHO has been criticized by medical practitioners who feel dealing with the virus decisively would be beneficial for all.  

“I think a lot of work needs to be done to get government to put it on their political agenda, particularly, if it’s affecting people who are at high-risk, that government may not want to deal with.

“For example, [these are] men who have sex with men, sex-workers and people who take drugs. In many contexts, those are politically sensitive topics, but it would be very important for government to embrace,” Scheibe says.

Happy Phaleng, the MSM (men who have sex with men) Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa, says the rapid diagnostic test serves as a much-needed form of assistance for a queer community that, at times, is not prioritized because of stigma.

Phaleng, who was vaccinated as a result of a study that was taking place at work, says his hepatitis B awareness was scant prior to the vaccination. He says in some cases, people resist getting vaccinated.

“I remember when they started the study, it was quite a struggle to get people vaccinated… You look at things like PrEP (Pre-Exposure Prophylaxis), you still find people who say, ‘let me go think about it,’ even though it’s free and on-the-go.”

However, on the day he meets FORBES AFRICA, he is armed and ready with the hepatitis B and C pamphlets that are laid out in front him as he has a frank conversation about risky lifestyles.

He says there’s a certain demographic of people who are privy to information as a result of being privileged to access, he also says there are cost implications to purchasing certain news items and money is not easy to come by.      

“Class plays a role. There’s a certain class of people, in this case, the medical space, who would know about medical developments. Some people don’t read, and those who do, won’t take it in because it doesn’t affect them directly,” he says.

Phaleng also frankly states that people tend to be their own worst enemies as a result of unfounded fears that prevent them from accepting help. 

“We are too resistant to new things and we also have the notion that, ‘I’ve lived before without this vaccine. Why am I complicating my life with medications and vaccination?’ This ties in with the concept that, ‘what you don’t know, won’t kill you’.”

Innovations are good and well, however, studies and pilots defeat the purpose of what they are intended for as they are, at times, exploitative and not reciprocal. He alludes to the idea that citizens tend to be treated like guinea pigs by those who work on the ground on fact-gathering missions.

“In South Africa, we have had so many piloted studies and, as people, we get tired… I’ve worked with people who conduct studies can’t enter our communities and urge us to try new things and, the next thing you know, the medication no longer exists because of the outcomes of the study.”

“They just want to use our bodies to get their PhDs and launch their products.”

Scheibe, who has been working in the field of harm reduction and substance use for the past eight years, says that more people in high-risk groups may acquire the infection and they should also be vaccinated.

According to NCBI, these include, but are not limited to, people who frequently require blood or blood products; people interned in prisons; persons who inject drugs; and people with multiple sexual partners.

Duncan Tsegula, who is a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being, is a recovering drug user who used to share needles while homeless in the streets of Pretoria.

The Project, which has been running for four years, focusses on reducing the risk of harm, with particular focus on homeless (needle) drug users. Tsegula has been a leader for two years.

“Before I became a member, I was a client of the same project. They were giving out needles, to us, guys using on the street. It got to a point where people were discarding them on the street. We came up with a solution which was a needle exchange,” Tsegula says.

“If we give you 10 needles this week, we come back next week to give you more, and you return the old ones. That’s when we are sure that you are not discarding them on the streets. So far, for the past year-and-a-half, it has been working and the city council has stopped complaining.”

He confirms that he’s witnessed people sharing and repurposing needles. Some of the sharing of needles was due to desperation because homeless people are profiled and turned away from many businesses even when they are purchasing products.   

“I was one of the people sharing needles. It was not easy to access a needle even if you had money because of the way you look. 

“About 12 years ago, when my boss needed a needle to inject, the pharmacy refused him and he eventually broke a window. He was withdrawing and because of anger, he broke a window and was arrested.

“Our project is peer-driven and people who were there and used drugs have links with the clients, so it’s easier for them to communicate with us, but it’s not easy.

Along with the clean needles, the project provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.

They also provide alcohol swabs to prevent infection when users inject. “Some of the guys go through bins while they collect litter for recycling, they might cut themselves while doing that. The swabs are used to clean the surface area where they are going to inject,” Tsegula says.

Along with drug users, sex-workers are also profiled and are not afforded equal rights.

Phaleng says, “there are many people who take drugs for their own reasons but what we’re saying is, ‘even though you’re using for your own reasons, do it the safe way.’ Because, you can imagine if I’m injecting drugs and I still have that I’m going to – I might infect that person with a range of things.

“Sex-work is work. Everybody has the right to health. They also deserve to be treated fairly and access medication.

“A healthy society is a very productive society. If we get to a point where we succeed in preventing illness rather than treating them, will save large amounts of money,” Phaleng says.

Scheibe echoes his sentiments.

“We must understand that we need to move away from criminalization because that has very negative public health consequences which, in turn, have very negative financial implications.”

For his work with hepatitis, he’s the light at the end of the tunnel, but he is cautiously optimistic.

“It’s important to be optimistic that progress can happen, should happen and is already happening. It’s very clear that we have the tools, and we know what needs to be done.

Scheibe says very little will change, “unless there is a recognition that policies that criminalize sex work and drug use, or are discriminating on women, are re-evaluated. There needs to be a lot of focus in addressing those, or we will never be able to eliminate hepatitis or HIV.”