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