July 28 was chosen as World Hepatitis Day in honor of the birthday of Baruch Samuel Blumberg, who discovered both the hepatitis B virus and the first vaccine against it. It has become a good tradition on this day to get tested annually for this infectious disease.International days dedicated to fighting various diseases are organized to raise awareness about the most dangerous diseases that pose the greatest threat to us and for which there is the greatest need for education and publicity. That is why this material, prepared in collaboration with the team behind the social project “Your Family Doctor,” is dedicated to this very goal—education.
According to a study conducted by the BCD NGO in collaboration with the “100% Life. Kyiv Region” Charitable Organization, with technical support from the Public Health Center of the Ministry of Health of Ukraine, family doctors are not testing patients on a large scale. The situations vary: in some places, there are no tests (even though they should be included in the National Health Service of Ukraine’s package); some hospitals are cutting costs and not purchasing tests; in other places, doctors do not know how to administer them. Or they do not realize the scale of the problem and the reasons why testing is simply essential, as this is a matter of life and health for tens and hundreds of thousands of people.
Since the government purchases the medication and orders are demand-driven, the biggest problem is that not many people reach the testing stage due to a shortage of tests. For example, in 2020, 43,000 people were tested in Kyiv. But according to the national strategy, 300,000 should have been tested. In general, if we follow the national strategy, by 2025, 50% of patients should know their diagnosis. That means half the population needs to be tested. But people aren’t getting tested, aren’t registering, so there’s no point in purchasing that many medications.
In particular, people are discouraged from getting tested by prejudices regarding treatment funded by the state. The belief that “state-funded means low-quality” is quite widespread, but it does not correspond to reality. Treatment is carried out using effective medications approved by the WHO.
Finally, people may be deterred from getting tested by fear of stigmatization from their doctor. Typically, the treating physician has not had hepatitis themselves and may not understand the specifics of the disease. Unfortunately, even among doctors, hepatitis is sometimes considered a marginal disease affecting people who use drugs or those with multiple sexual partners. However, it’s not that simple.
Let’s start with the basics. Essentially, hepatitis is a viral inflammatory disease of the liver. You may have even heard that there are five main types of hepatitis viruses: A, B, C, D, and E. The most dangerous of these are viral hepatitis B and C: they account for 96% of deaths from this disease.
And this is despite the fact that affordable and effective prevention for hepatitis B and D—which sometimes occurs as a co-infection—has long been available. This prevention is vaccination. There is no vaccine for hepatitis C yet, but it can be treated with modern medications in three months. The key here, as with many viral infections, is to detect it early.
Hepatitis remains a problem because, first, it usually progresses asymptomatically until serious liver damage occurs. And second, because many people do not consider it necessary to get tested for hepatitis regularly, as they are certain that this disease “will never happen to them.”
Because of these dangerous stereotypes about who can and cannot get hepatitis, the disease claims millions of lives every year. According to 2015 data from the World Health Organization, 1.34 million people worldwide died from viral hepatitis. That is more than the number of deaths from tuberculosis or HIV/AIDS. Unfortunately, 4 out of 5 people with chronic hepatitis C are unaware of their diagnosis, and 9 out of 10 people with chronic hepatitis B do not realize they have the disease. Of those who know their diagnosis, only 8% have access to treatment.
Despite the enormous problem of the spread and mortality from hepatitis, Ukraine still lacks a national registry of people with hepatitis C. This means it is impossible to accurately estimate the number of patients.
As of April 1, 2021, the estimated number of people infected with viral hepatitis C (hereinafter HCV), according to the Center for Public Health, stands at 2,122,400, while 1,528,128 people have chronic HCV.
Regarding hepatitis B, according to expert estimates, as of early 2019, 1.5% (632,298) of the population in Ukraine was infected, of whom only about 1 in 25 is under medical supervision.
Hepatitis has been with humanity since the Bronze Age, as evidenced by traces of the virus found in human remains dating back over 4,500 years. Officially, the hepatitis B virus was discovered in 1966 by Baruch Blumberg. This scientist also developed a method for diagnosing the disease and a vaccine against it, for which he received the Nobel Prize.
In 1987, the second generation of hepatitis B vaccines appeared, which were cheaper to produce and more accessible to people. After the introduction of mass immunization against hepatitis, the incidence of acute forms decreased tenfold worldwide.
If you do not get vaccinated, you may develop a lifelong disease that is rarely completely curable but can at least be managed with daily medication. In addition, the hepatitis B vaccine also protects against hepatitis D, which is a co-infection. There are no
vaccines for hepatitis C. However, this disease can be completely cured with modern medications.
Since the 1990s, patients with viral hepatitis C and B have been treated with pegylated interferons. These are weekly injections into the abdomen that stimulate the immune system to fight the virus. Treatment could last six months or even a year—depending on the genotype.
Interferons are highly toxic, much like chemotherapy for cancer: they come with a host of contraindications and side effects. Moreover, this wasn’t treatment administered in intermittent courses, as is the case with cancer. Treating hepatitis C could require 24 to 72 weeks of continuous injections. The course cost about $11,000, but the treatment was successful in only 50% of cases. On top of that, the tests alone before starting treatment cost between 5,000 and 8,000 hryvnias.
In 2018, the WHO released updated recommendations for the treatment of hepatitis C, and in January of this year, Ukrainian standards for providing medical care to patients with viral hepatitis B and C were revised. All essential medications are registered in Ukraine, and the treatment course lasts from 12 to 24 weeks.
Direct-acting antivirals (DAAs) have almost no side effects and are better tolerated by the body. In addition, there are generic drugs that are just as effective and safe as brand-name ones, but are cheaper. Currently, commercial treatment is available for approximately $500 (including tests).
The current treatment for chronic hepatitis C does not harm the body like interferons do, and does not prevent people from leading active social lives. Moreover, high-quality treatment for hepatitis is available free of charge from the government: it consists of a three-month course of pills.
Today, family doctors can treat viral hepatitis. To do so, they must complete relevant training courses and obtain certification (for example, through the National Health Service Academy, the Center for Public Health, etc.). Of course, no additional qualifications are required for testing.
Starting at age 18, everyone should get tested annually for viral hepatitis and HIV by their family doctor as a preventive measure. If the test results are positive, the person receives a referral to an infectious disease specialist, where they can be scheduled for additional tests. Then, the person receives a referral to a hospital, where they can receive treatment covered by the state.
While the culture of treating the disease is still developing in Ukraine, potential patients can turn to community projects and patient organizations. For example, the BCD NGO, which specializes in hepatitis, the Public Health Alliance, the “100% Life” Charitable Organization, and Doctors Without Borders. Finally, call specialized institutions, the National Health Service hotline, the National Hotline for Viral Hepatitis, etc.
Non-governmental projects can provide consultations, help find medications, and even assist with covering the cost of diagnostics. At such organizations, you can usually consult with someone who has personally faced this disease and knows where to go and whom to contact. When a representative of a patient organization speaks to a patient as an equal, sharing their own successful experience of recovery, it builds trust in the treatment process. And this is a very important psychological factor.
Original text of the publication in New Voice
