LAHORE: A report on the Prevention & Control of Hepatitis Programme in Punjab has made revelations about failure of the strategies/steps to save the largest province from the life-threatening virus epidemic.

Prepared by the Planning and Development Board of the Punjab government, the report has covered last four year’s (2017-2021) performance of the programme and dispatched it on March 10 to the provincial authorities.

It clearly warned that high percentage of patient-dropout in Punjab has increased the likelihood of massive transmission of Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV), putting millions of healthy people at grave risk to contract the dangerous viruses.

The report has appeared at a time when the World Health Organization declared that Pakistan has the second largest Hepatitis C Virus (HCV) burden in the world, with transmission being driven by multiple risk factors including community (barbering, ear/nose piercing etc.) and health care practices (blood transfusion, medical injections) and injecting drug use. This emphasises the crucial importance of tackling the HCV epidemic in Pakistan.

WHO declares Pakistan has second largest hepatitis C virus burden

It revealed that the programme had treated a few thousand patients while spending over Rs4 billion funds in Punjab during the last four-year period.

It said Pakistan and Egypt bear 80pc of the viral hepatitis disease burden in the Eastern Mediterranean region. In Pakistan, around 12 million people are suffering from hepatitis B or C, and every year around 150,000 new cases are added to this number.

According to the report, with an annual average of 408,653 individuals, a total of 1,634,614 individuals were registered at various hepatitis clinics established under the project across Punjab during the past four years (2017-2021) for the treatment of Hepatitis B & C, family screening and Hepatitis-B vaccination.

Of them, it said, with an annual average of 63,870 (HCV) and 5,706 (HBV) respectively, a total of 255,482 patients were treated for HCV and 22,826 patients for HBV across Punjab, showing a desperately low number across the province.

After the introduction of new highly effective treatments for HCV/HBV, the report said, the WHO had developed a global health strategy to eliminate viral hepatitis that aims to reduce HCV incidence by 80 per cent and mortality by 65pc by 2030 in Pakistan.

To achieve this target by 2030, as per Bristol modelling study, Pakistan has to treat around 1.1 million HCV cases annually that makes around 812,900 HCV cases/year in Punjab.

“However, currently, as per the project data, annual average of treatment of HCV cases is around 64,000 HCV cases /year that makes only around 8pc of the actual target i.e. 812,900 HCV cases/year”, the report unveiled.

For the treatment of Hepatitis B and C, the highest number of individuals/patients were registered in Attock (102,915), followed by Vehari (91,932) and Bahawalnagar (87,587) districts.

Of the registered individuals/patients, the highest number of HCV patients were diagnosed in Rajanpur (42,797) followed by Bhakkar (42,533) and DG Khan (41,623).

While in terms of the proportion of patients who received treatment after initial diagnosis, the highest percentage of HCV patients were treated in Hafizabad (12,173 out of total 15,303 HCV patients or 80pc), Sialkot (7,102 out of total 10,376 HCV patients or 68pc) and Jhelum (10,615 out of total 15,887 HCV patients or 67pc), respectively.

Overall, the report said, about 50pc of HCV patients (31,4760 out of total 629,665 HCV patients) received treatment after initial diagnosis at various hepatitis clinics operating across 36 districts of Punjab.

While in case of HBV treatment, only about 24pc of HBV patients (28,210 out of total 117,800 HBV patients) received treatment after initial diagnosis.

“These figures show high patient-dropout rates after an initial diagnosis of HCV/HBV patients that increases the likelihood of transmission of HCV/HBV infection to index patients’ families/other individuals who are in close contact with the patients”, the report warns.

It said the HCP started the data collection on the contact tracing/family screening of index hepatitis-C patients in October 2020, after the activation of contact tracing module in the EMR (Electronic Medical Record).

Overall, a total of 2,81,578 individuals were screened for Hepatitis-C/B, of them, 1788 (0.63pc) were diagnosed HCV positive. Of these, aunts (6.55pc), mother-in-law (2.31pc) and grandmothers (2.06pc) were the most affected groups among the families/blood relations of the index hepatitis-C patients.

Similarly, for Hepatitis-B, a total of 154 (0.5pc) were diagnosed HBV positive. Of these, brother-in-law (0.33pc), sister-in-law (0.21pc) and mother (0.20pc) were the most affected groups among the families/blood relations of the index hepatitis-B patients.

In total, 278,308 HCV/HBV patients (255,482 HCV and 22,826 HBV patients) were treated at various hepatitis clinics across the province during the past four years (2017-2021).

As per the project PC-I and prevention protocols, families and close contacts of these patients should had been screened and treated for HBV/HCV.

Published in Dawn, March 14th, 2022