ASHM International, under a contract with the WHO Division of Pacific Technical Support has over the past 6 months provided technical assistance to the Ministries of Health of Fiji, Vanuatu, Solomon Islands and Kiribati to strengthen the viral hepatitis response - viral hepatitis is an emerging threat in the Pacific region. ASHM has worked in close collaboration with The WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute, ASHM members and viral hepatitis specialists from the Kirby Institute and the University of Melbourne to fulfill requirements.

 

Viral hepatitis is a high burden disease in the Pacific countries with rates of hepatitis B with 20% of adults in the Solomon Islands living with related liver disease and chronic infection. In Vanuatu 10% of blood donors and antenatal women tested have hepatitis B, whilst in Fiji the estimate of hepatitis B in the population is between 2-4% following a successful child immunization program. It is estimated that 15% of health care workers in Kiribati are infected with Hepatitis B Hepatitis D co-infection is also considered high.

 

Obstetrician Dr Errolyn Tungu in Vanuatu noted '"it is currently so frustrating, we test the women in pregnancy (one of the few situations where testing is performed) but all we can do if the test comes back positive is give her some general lifestyle advice"

 

ASHM with collaborating partners carried out scoping missions in the four pacific countries between May and September this year. The purpose being to understand the viral hepatitis situation and response in each county and identify ways to strengthen the response. Technical assistance was also provided by ASHM and the Doherty Institute to review and revise national strategic plans for Vanuatu, Solomon Islands and Fiji. Hepatitis B treatment is currently unavailable or there is limited availability to access treatment in all four countries. Vanuatu and Kiribati were supported to include viral hepatitis treatment on national essential medicine lists. Professor Gail Matthews recently undertook country visits to Solomon Island and Vanuatu to assist the Ministries of Health and key stakeholders to develop their first Hepatitis B and C Testing and Treatment Guidelines. Professor Matthews is also working with the Ministry of Health in Fiji to update their Hepatitis B testing and treatment guidelines.

 

“There is widespread engagement and support for the development of some national guidelines, and the need for these to be as simple and pragmatic as possible. It is recognised that these will need to be followed by national policies and training programs’’, said Professor Matthews.

 

There are some substantial strengths to build on in each country, for example Solomon Islands has a National Strategy for Viral Hepatitis, some testing and treatment is taking place in Kiribati with support from the Australian organization Hepatitis B Free, and Fiji plans to introduce hepatitis B treatment later this year. However, much is required to provide an effective prevention and treatment response to viral hepatitis in the four countries. This includes national integration of testing and treatment into primary health care services, training of health care workers in diagnostics, treatment and management, developing therapeutic protocols, increased awareness of viral hepatitis within the general population and strengthened surveillance. Professor Gail Matthews states ‘making space for HBV is critical’.

 

Hepatitis B testing specimens in Solomon Islands. Photo courtesy of The Doherty Institute.

 

ASHM International has recently developed a 3 day Hepatitis B (HBV) in Health Settings Training for Asia and the Pacific Regions which aims to increase health care workers confidence and competence in clinical management of Hepatitis B and in turn increased testing, linkage to care, clinical management and treatment of hepatitis B. ASHM International will be adapting the training with Fiji partners to suit the Fiji context and will roll out the training in Fiji within the coming months.