Abstract
ProblemOver 290 million people worldwide suffer from chronic hepatitis B (CHB), with the highest prevalence in the Pacific islands. Mortality attributable to this disease exceeds that from HIV, tuberculosis and malaria combined in this region.ContextCHB is a major health problem in the Pacific island nation of Kiribati. Medical care is complicated by vast expanses of ocean separating population centres in its constituent islands. Birth-dose hepatitis B immunization rates need improvement. High rates of obesity, metabolic syndrome, and co-infection with hepatitis B and hepatitis D in Kiribati make treatment less effective. Staff allocation, training and retention are difficult. Limited infrastructure creates challenges in training, communications, laboratory testing and record-keeping.ActionWe have established a CHB treatment programme in Kiribati based on World Health Organization (WHO) guidelines and local needs. It includes direct patient care; laboratory, radiology and pharmacy support; public education; training; and data management. Thousands of individuals have been screened, and 845 hepatitis B-positive patients have had blood sent to Australia for molecular testing. Patient education pamphlets, medical training programmes and treatment protocols have been developed. Seventy-nine patients have started treatment. Regular onsite visits by technical experts are scheduled throughout the year.Lessons learnt and discussionThis is the first national CHB treatment programme established in the Pacific islands region. Unique challenges exist in Kiribati, as they do in each nation affected by CHB. Close engagement with local partners, knowledge of the barriers involved, flexibility, advocacy, and support from WHO and volunteer technical experts are key attributes of a successful treatment programme.
Highlights
Action: We have established a Chronic hepatitis B (CHB) treatment programme in Kiribati based on World Health Organization (WHO) guidelines and local needs
An estimated 2 billion people globally have been infected with hepatitis B sometime during their lives, and almost 300 million people suffer from CHB.[1]
A strategy to eliminate viral hepatitis as a public health threat by 2030 was adopted by the World Health Assembly in 2016.3 Low- and middle-income countries (LMICs) face a daunting task and are unlikely to reach this goal without significant effort, support and funding
Summary
Problem: Over 290 million people worldwide suffer from chronic hepatitis B (CHB), with the highest prevalence in the Pacific islands Mortality attributable to this disease exceeds that from HIV, tuberculosis and malaria combined in this region. Action: We have established a CHB treatment programme in Kiribati based on World Health Organization (WHO) guidelines and local needs It includes direct patient care; laboratory, radiology and pharmacy support; public education; training; and data management. One of the first CHB treatment programmes in the Pacific islands was facilitated beginning in 2018 through a collaboration among the Kiribati Ministry of Health and Medical Services (MHMS), the World Health Organization (WHO), the Victorian Infectious Disease Reference Laboratory (VIDRL), and Hepatitis B Free We describe the progress made and the barriers encountered and addressed, and conclude that successful CHB treatment programmes in Pacific island countries, such as Kiribati, are challenging but achievable
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