National Hepatitis B viral load testing programme in Uganda

VIOLA KASONE

UGANDA NATIONAL HEALTH LABORATORY SERVICES

INTRODUCTION: Uganda the Peal of Africa

• East African country • Population 42m• Home to the source of the Nile• Home to over 1,000 birds species• Tourist destination

Prevalence of Hepatitis Viruses In Uganda by region

•UPHIA,2016 included HbV

•Prevalence ranged between 0.8 - 4.6%

•Historical studies estimated highest preference at 10% (2005)

• Blood bank data is the closest information about HCV prevalence

• ~1.5%

• Blood bank data is underestimation

• The is limited information about the other hepatitis viruses in Uganda

• High level of Political commitment• Prioritization of hepatitis B at presidential level

• Parliamentary mobilization of $ 3 million annually• Vaccine procurement

• laboratory reagents

• Antiviral drugs

Progress and Successes

• Several Epidemics mainly in Northern Uganda attracted political attention• Resulted into political commitment to attend to the problem• Parliamentary mobilization of $ 3 million annually

• Development of National Strategy for control of Hepatitis B (2015–2019) • Prevention – Vaccination• laboratory testing and monitoring• Treatment

• Establishment of the National Technical working groups• The clinical sub committee• The Laboratory sub committee• Advocacy group - NOPLHB

• National Plan for the Vaccination against HBV

• Testing and Treatment guidelines

Genesis of Hepatitis Program in 2014

• Training of health workers in target districts

• Screened 5.7M/16M (15-65years

• ~40% of the target population• HBsAg –ve vaccinated

• 93%, - 1st

• 74% - 2nd

• 38% - 3rd

• 250,000 HBsAg + identified

Testing Vaccination and Treatment

• Capacity for chemistry and hematology testing at the Regional and district hospitals.

• Establishment of centralized free Hepatitis B and C Viral load testing

• Enabling patients that test positive to get linked into care for proper treatment initiation and monitoring .

Follow up of HBV+ Patients

Progressive scale up of Hepatitis B viral load testing

• Facilities are from 62/120 Districts • North, East and Central

• 7 Eastern Districts contribute 50% of the total volume

• Monthly Volumes at increased to 4,000

• 31,000 tests tested in last one year

138

194

243272

299

Jan/19 Feb/19 Mar/19 Apr/19 May/19

Cumulative Number of Health facilitiesSe

p-18

Oct

-18

Nov

-18

Dec

-18

Jan-

19

Feb-

19

Mar

-19

Apr

-19

May

-19

Jun-

19

Jul-1

90

1000

2000

3000

4000

HBV VL Monthly Volumes

Month

Volu

me

HBV VL TAT from sample collection to results printing at the health facility

W01

w02

w03

w04

w05

w06

w07

w08

w09

w10

w11

w12

w13

w14

w15

w16

w17

w18

w19

w20

w21

w22

w23

w24

w25

w26

w27

w28

w29

w30

w31

4

8

12

16

20

24

28

weeks

tim

e (d

ays)

- TAT upset by backlog build up fromHIV due to long down time-Additional platforms placed and

- expanded testing capacity- Aimiing at TAT of 4 daya

Viral load suppression rates

• 16.4% - not suppressed (VL >20,000 IU/ml)

• 26.9% - with VL>2,000IU/ml

• 67.9% - detectable VL47%

53%

Testing by gender

Female Male

7%

47%

46%

Testing by Age Categories

0-17 Yrs 18-30 Yrs >30 Yrs

59%

41%

vl>20,000iu/ml by Sex

Male Female

11%

55%

34%

VL>20,000IU/ml by Age tat

0-17 Yrs 18-30 Yrs >30 Yrs

Challenges

•Limited funding has led to slow program roll out in the country

•Knowledge gaps among health workers

• trainings are limited

•Insufficient awareness in the Community

•Hepatitis B patients lost to follow up

•who qualify for treatment

•Enrolled on treatment

• Hepatitis C testing and treatment not funded

Summary

•Uganda has developed National Strategy for control of Hepatitis B

•Implementation is phased

•Leveraging on HIV programs and resources

•Mass screening is steadily rolling out

•Vaccination of all those who test Negative

•Positive patients are targeted for linkage into care

•Linkage gaps exist in the entire cascade

ACKNOWLEDGEMENT

•MOH-UGANDA

•UNHLS

•VIROLOGY EDUCATION – COLDA

•ROCHE

•ABBOTT

•NOPLHB