Can Hepatitis B be Treated in Africa?

A recent Norwegian-Ethiopian study led by Dr. Asgeir Johannessen, Deputy Director at the Centre for Global Health, demonstrates how this disease can be treated effectively in a poor country.

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The local team in Jimma Photo: Asgeir Johannessen

Hepatitis B virus infection kills nearly one million people worldwide each year. An easy pill treatment exists but is unavailable to most people living in Africa. A recent Norwegian-Ethiopian study led by Dr. Asgeir Johannessen, Deputy Director at the Centre for Global Health, demonstrates how this disease can be treated effectively in a poor country.

An estimated 296 million people live with chronic hepatitis B worldwide. Most were infected in early childhood. Every year, close to one million people die from the disease, either because they develop cirrhosis and liver failure, or due to liver cancer caused by the virus. Simple and inexpensive pill treatment can halt the virus from multiplying and effectively prevent these complications. Nevertheless, less than 1% of those living with chronic hepatitis B worldwide receive treatment.

Image may contain: Clothing, Forehead, Nose, Hair, Face.In 2015, a Norwegian-Ethiopian study led by Asgeir Johannessen, Deputy Director at the Centre for Global Health established a screening and treatment program for 1300 patients living with chronic hepatitis B in Addis Ababa, Ethiopia. Over the coming 3 years, the study team aims to include an additional 6,000 patients at three new hospitals (listed below) in the country and advance the program.

Why do patients in Africa not receive treatment?

The lack of funding and political will, limited access to laboratory tests, regulatory obstacles on antiviral drugs, and complex treatment guidelines are a few reasons to why chronic hepatitis B patients have been left behind. Approximately 20% of those with chronic hepatitis B will die from the disease. The challenge is developing a screening model that is adaptable to the sub-Saharan setting with adequate sensitivity to predict - who will become ill and thus, who will need treatment and who will never need medication.

In Norway as in other rich countries, complicated and expensive analyses are used to select those in need of treatment. Examples of this include liver tissue testing and measurements of the amount of virus in the blood, both unavailable in most African countries.

Day 1 at the Hepatitis B clinic in Jimma Photo: Asgeir Johannessen

How can hepatitis B be controlled in Africa?

The way the HIV epidemic has been handled in Africa is an example of inspiration. Many thought it was impossible; however, simplified guidelines, cheap generic drugs and international investments have made it possible to offer treatment to most people who need it. This is reflected in a drastic drop in HIV mortality over the past decade.

In the same way, Dr. Asgeir Johannessen and his team has worked towards simplifying the hepatitis B treatment. In 2018, a simplified device for measuring the amount of hepatitis B virus came on the market (Xpert HBV viral load kit). In the next phase the team will also use a simple score (APRI; AST-to-platelet ratio index) which is based on cheap and widely available laboratory tests. By simplifying and hopefully streamlining the guidelines for treatment, the hope is that hepatitis B can be brought under control in Africa - in the same way as HIV/AIDS.

How does the World Health Organization (WHO) contribute?

When the WHO launched its guidelines for the treatment of hepatitis B in 2015, it was largely based on data from Asian patients. The research team has assessed how the WHO's treatment criteria perform in Ethiopia. The conclusion is that the WHO guidelines are inappropriate in this part of the world. The consequence of using WHO's criteria is that treatment will be given to patients with very advanced liver damage. To make a difference, treatment needs to start at an early stage - before patients develop serious complications. The team’s evaluation of WHO's guidelines were published in the acclaimed Journal of Hepatology in 2019 (1), and is a major contribution to the next revision of WHO's guidelines. 

Postdoc fellow Hailemichael Desalegn training the local team in Jimma Photo: Asgeir Johannessen

Facts about the study

  • Established in 2015 at St. Paul’s Hospital in Addis Ababa, Ethiopia
  • 1303 patients with chronic hepatitis B were enrolled in 2015 and have been followed since, nearly 300 qualified to antiviral treatment
  • Data from this cohort have provided unique insight into the effect of treatment and disease development in African patients
  • In the next phase, the team plans to further simplify the screening and treatment indications and roll out a scale-up program to 6000 new patients at three hospitals in Ethiopia (1. Jimma University Specialized Hospital (Jimma region) 2. Dubti General Hospital (Afar region) 3. Location is still pending)
  • The study is led by Dr. Asgeir Johannessen, Senior Consultant at Vestfold Hospital and Deputy Director at the Centre for Global Health, University of Oslo
  • Dr. Hailemichael Desalegn is postdoc fellow in the project and local study coordinator in Ethiopia
  • The study is funded by the Research Council of Norway, the South-Eastern Norway Regional Health Authority, and John C. Martin Foundation 
  • Results from the study has been published in high-ranking international journals such as the Journal of Hepatology, BMC Medicine, and Liver International

Nordic Global Health Talk

Earlier this month, Asgeir Johannessen (on behalf of the University of Oslo) presented at the Nordic Global Health Talk - a monthly webinar series about global health research at Nordic universities, hosted by the Nordic Network on Global Health. During his presentation, he provided insight into his work in Ethiopia along with the current and future challenges in managing HBV infection in Sub-Saharan Africa.

Watch the full presentation here


(1) https://www.journal-of-hepatology.eu/article/S0168-8278(19)30116-3/fulltext

By Asgeir Johannessen, Brenda Jimris-Rekve, Gabriella Rodriguez
Published Jan. 7, 2022 11:24 AM - Last modified Jan. 10, 2022 12:39 PM