Establishing a hepatitis care centre to promote integrated care and population-level liver cancer prevention in Nigeria: experiences and opportunities

The burden of hepatitis B and hepatitis C virus (HBV, HCV) infection is exceptionally high in sub-Saharan Africa (SSA). Many countries in the SSA region are classified as hyperendemic for HBV by the World Health Organization (WHO), with West Africa being most affected. Data from the WHO suggest that Africans infected with hepatitis virus are at a higher risk of dying than those infected with human immunodeficiency virus (HIV) or tuberculosis (TB), with 7 of 10 deaths from HBV occurring in SSA. 1 Despite the sub- stantial HBV and HCV disease burden in SSA, the implementation of WHO s global hepatitis strategy for eliminating viral hepatitis as a public health threat by 2030 in SSA has been patchy. If success- fully implemented, it is projected that the global hepatitis elim- ination strategy will save 7.5 million lives that would have been lost from chronic complications of hepatitis. With an estimated population of 213 million people, Nigeria has high hepatitis seroprevalence rates, with approximately 16 million (8.1%) HBV and 2.2 million (1.1%) HCV infections among Nigerian adults between the ages of 15 64 years. 2 Available data suggest that 95% of people with chronic HBV and/or HCV infection are unaware of their infection, thereby putting them at increased risk of developing end-stage disease complications such as cirrhosis and hepatocellular cancer. 1 These undiagnosed individuals constitute a substantial infectious risk and unknow- ingly transmit these serious infections to others. In addition, the cost of treatment for these conditions is not affordable, especially for underserved and vulnerable groups. For instance, while it costs about $2 to test for HBV or HCV, mean treatment costs for an 8- to 12-week course of antivirals for HCV is estimated to be US$1229 (without cirrhosis) and US$1971 (with cirrhosis) in Myanmar. 3 Thus the cumulative cost of treating HBV infection would ulti- mately be high given that treatment duration is infinite. Against this backdrop, early diagnosis and effective medical manage- ment remain vital prevention and control strategies, in addition to raising awareness in communities, vaccination against HBV and the adoption of safe blood transfusion strategies. Cross River State (CRS) is a coastal state in the Niger Delta region in southeastern Nigeria. Its capital is Calabar and it occu- pies 20 156 km 2 . The current seroprevalence of hepatitis B among adults in CRS is 8.8%. 2 , 4 With an average population of around 3.8 million, >300 000 individuals in the state are currently infected with HBV. 5 At present, there is no uniform viral hepatitis care pro- gramme in CRS. Activities such as viral hepatitis screening, vac- cination and treatment are undertaken by a handful of special- ist physicians in the public hospitals in Calabar. A cross-sectional study involving 1620 healthy adults from the three senatorial dis- tricts of CRS in 2015 revealed a low level of knowledge of viral hepatitis among this cohort and this correlated with poor atti- tudes and practices towards HBV.