Viral hepatitis elimination challenges in low‐ and middle‐income countries—Uzbekistan Hepatitis Elimination Program (UHEP)

Author:

Musabaev Erkin1,Estes Chris2ORCID,Sadirova Shakhlo12,Bakieva Shokhista1ORCID,Brigida Krestina1,Dunn Rick1,Kottilil Shyamasundaran3,Mathur Poonam3,Abutaleb Ameer3,Razavi‐Shearer Kathryn2ORCID,Anstiss Tim4ORCID,Yusupaliev Bakhodir5,Razavi Homie2ORCID

Affiliation:

1. Research Institute of Virology Tashkent Uzbekistan

2. Center for Disease Analysis Foundation Lafayette Colorado USA

3. University of Maryland School of Medicine Baltimore Maryland USA

4. University of Southampton Southampton UK

5. Ministry of Health of the Republic of Uzbekistan Tashkent Uzbekistan

Abstract

AbstractBackground & AimsChronic infection with hepatitis B and C viruses (HBV & HCV) is a major contributor to liver disease and liver‐related mortality in Uzbekistan. There is a need to demonstrate the feasibility of large‐scale simplified testing and treatment to implement a national viral hepatitis elimination program.MethodsThirteen polyclinics were utilized to screen, conduct follow‐up biochemical measures and treat chronic HBV and HCV infection in the general adult population. Task shifting and motivational interviewing training allowed nurses to provide rapid screening and general practitioners (GPs) to treat individuals on‐site. An electronic medical system tracked individuals through the cascade of care.ResultsThe use of rapid tests allowed for screening of 60 769 people for HCV and HBV over 6 months and permitted outdoor testing during the COVID‐19 pandemic along with COVID testing. 13%–14% of individuals were lost to follow‐up after the rapid test, and another 62%–66% failed to come in for their consultation. One stop testing and treatment did not result in a statistically increase in retention and lack of patient awareness of viral hepatitis was identified as a key factor. Despite training, there were large differences between GPs and patients initiating treatment.ConclusionsThe current study demonstrated the feasibility of large‐scale general population screening and task shifting in low‐ and middle‐income countries. However, such programs need to be proceeded by awareness campaign to minimize loss to follow up. In addition, multiple trainings are needed for GPs to bolster their skills to talk to patients about treatment.

Funder

California Dental Association Foundation

Gilead Sciences

Publisher

Wiley

Subject

Hepatology

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