Hepatitis is a silent epidemic in Nigeria and other West African countries, affecting millions without their knowledge. The disease could cause more deaths than malaria, tuberculosis, and HIV by 2040, according to the World Health Organisation, if current infection trends continue. Roberto Taboada, Roche Diagnostics’ head of Anglo West African Network, tells Temitayo Ayetoto-Oladehinde, a senior health journalist, about the organisation’s effort to stop the infection and lack of treatment in their tracks. By providing crucial diagnostics and working collaboratively with public and private sector partners, Roche aims to eliminate hepatitis C in Nigeria, mirroring the success of Egypt’s eradication efforts. Excerpt…
Hepatitis remains a significant public health challenge in many parts of Africa. About 20 million people are chronically infected with hepatitis B and C in Nigeria. Could you elaborate on the specific burden of hepatitis in the Anglo-West African region and how Roche Diagnostics is addressing this issue?
Nigeria is one of the top 10 countries in terms of people affected by this disease. It is also very worrisome that more than 80 percent of the people who got the disease do not even know that they have it, which makes it very important that we have in Nigeria our awareness campaigns and more testing so people that have the disease know about it and get treated. Roche plays an important part because we have the tests to do the screening and the diagnostics for hepatitis. We want to be part of the solution to break this cycle of infection and lack of treatment. This way we can stop the infections or even reverse the disease. Together with other partners we have in Nigeria, this could happen. We have an example in Egypt in which, through testing and treatment, hepatitis C has all but disappeared from that country. So, it is possible to work to eliminate this disease, but we cannot do it alone. We have to work together with public and private sector partners. across the disease continuum because, as I mentioned, you have to have awareness; you have to have testing and screening as well as treatment. And we have to make this work through partnerszhips, especially to look for ways to finance the diagnosis and the treatment for this disease. We want to work with both the government, the World Bank, and other donors to make sure that we achieve what is called a gold-tier status on the path to eliminate hepatitis C, as described by the WHO criteria. A gold-tier status according to WHO in countries that have been able to effectively manage or reduce this disease burden.
What are the most prevalent hepatitis B and C genotypes in this region, and how does this influence Roach diagnostics and treatment strategies?
The most prevalent hepatitis B genotype, according to a 2021 NCBI study, is a subgenotype 4A, and there is also an evolution of HPV sub-genotype sequences in Nigeria and other countries. There is also a new genotype of amino acid AYW that was identified and is expanding in the region. There is also genotype E that is highly prevalent across West Africa. This genotype is relatively recent, but it is spreading in the region. In terms of hepatitis C, genotype one is the most common in West Africa. And genotype two is also prevalent in West Africa, although this one is more manageable and has a better response to ant iviral therapies. Roche again plays an important role because our diagnostic tools are able to detect the specific genotypes for hepatitis B and hepatitis C. This means that we can have more accurate diagnostics and effective viral load monitoring. Viral load monitoring means that we can track the progression of the disease or the effectiveness of the treatment. By understanding the prevalent genotypes, in Roche we can develop and recommend treatment protocols that are optimised for each of these genotypes, particularly for HPV, hepatitis B sub-genotype A4, and hepatitis C genotype 1, which are again the most prevalent.
How is Roche addressing the challenges of co-infection with hepatitis B and HIV, particularly in terms of diagnosis and treatment?
To handle this disease, we need collaboration among the private and public sectors and specifically companies like Roche that have the capabilities to provide the testing for hepatitis. We support the healthcare providers to enable integrated testing across different types of disease. For example, we have instruments already in the country that can allow the healthcare facilities to test for HIV, tuberculosis, hepatitis, and other diseases simultaneously. When this approach is applied, a co-infection is identified early, and surveillance and treatment can be put into place for the benefit of the patients. We also support training and laboratory quality management and improvement programmes in partnership with the stakeholders to optimise the work at the laboratory. We support an integrated diagnostics network to increase access to multiple pathogen testing capabilities. We also work with the government to ensure that we prioritise early diagnostics because if you catch the disease at an early stage, there is better management of the disease, and the outcomes are optimised. Currently, Nigeria does have HPV guidelines that the government announced in 2023, and in these guidelines, testing plays a very important part to ensure that hepatitis is managed and treated correctly in the country.
Nigeria is a pioneer in HPV birth dose vaccination. How has this impacted chronic hepatitis B prevalence among children under five? Compared to other African nations, how does Nigeria’s approach stand out?
So, there is good news and not so good news in terms of vaccine adoption in Nigeria. The introduction of the HPV vaccine at birth has reduced the prevalence of chronic hepatitis B among children under five, and this is very good news. We are still not yet at the global level that has seen a decline from about 5 percent in the pre-existing area to less than 1 percent as of 2019, but Nigeria is well on its way. However, despite this adoption, there are a lot of disparities among the different regions in Nigeria. Some regions achieve much higher vaccination coverage than others, and this, of course, results in different impacts across the country, with some regions experiencing lower prevalence than others. Something else that needs to be improved is that the coverage rate of the hepatitis B birth dose vaccine is significantly low at 18 percent. This is across Africa, compared to 80 percent in the Western Pacific, 65 percent in the Americas, and 58 percent in Southeast Asia. So, across Africa, there is still a lot to be done to increase the coverage of the hepatitis B birth dose vaccine. There has to be an improvement. Only 15 member countries in Africa have adopted the vaccination. And that is 15 out of more than 50 countries. So, there’s still a lot to be done across Africa to improve access to the hepatitis B vaccine. Fortunately, Nigeria is one of those 15 countries that have adopted the vaccine for Hepatitis B at birth. There has been a reduction in the incidence of transmission of a hepatitis B infection in children below five years old, including a significant reduction of this disease among children.
Given the challenges associated with serological assays and blood screening, particularly in low- and middle-income countries such as Nigeria, what specific strategies is Roche implementing to bridge the gap between the need for affordable, accurate blood safety testing and the current regulatory hurdles?
I will start by specifically mentioning blood screening, which is very important to stop the spread of this disease. So, we are currently working with the blood bank associations and blood bank authorities in Nigeria to build capacity in blood screening and safety. This includes training healthcare professionals, improving laboratory infrastructure, and ensuring that the facilities in Nigeria can effectively use brush diagnostic tools. Another way that we are working with health authorities in Nigeria is trying to educate and being able to implement centres that can detect different infections, including hepatitis, HIV, and TB. That way we can maximise the resources both in terms of personnel but also of the costs associated with screening. So, these are two specific ways in which Roche has been working to improve the diagnostics and screening of HPV and other diseases. We also want to work with different stakeholders to co-create innovative funding models with both the public and private sectors in coming up with solutions to testing more cost-effectively and build diagnostic platforms that are tailored for using resource-limited settings.
“So, across Africa, there is still a lot to be done to increase the coverage of the hepatitis B birth dose vaccine. There has to be an improvement.”
How is Roche working to develop and implement point-of-care or emergency blood safety testing solutions that are both affordable?
Roche is currently working to expand its point of testing, which is crucial for blood safety in remote and underserved areas. We aim to provide these easy-to-use devices that can enable healthcare providers to conduct blood safety tests on site, provide immediate results, and reduce the need for complex laboratory infrastructure. Roche point-of-care solutions are designed to be both affordable and scalable, making them ideal for widespread use in low- and middle-income countries. So, Roche has a strategy of both having point-of-care solutions for remote areas and, at the same time, having tests in laboratory settings that allow for higher volume testing.
Given the emphasis on national progress towards elimination of disease and the target of fully funding elimination programs by 2020, what role does Roche Diagnostics envision for itself in supporting governments and healthcare systems in Nigeria and the Anglo-West African region to achieve these goals?
To achieve these goals, it is critical that we ensure investments in preventive care. For example, especially diagnostic, and this is aligned with a WHO resolution that calls for all countries to strengthen their diagnostic systems and invest more in testing capabilities. We believe that with more investments in preventive care and early testing and screening, we can reduce maternal and child mortality and reduce the burden of preventable diseases like hepatitis, HIV, and tuberculosis. We are also encouraging the government and working with them to increase access to health coverage or the universal health coverage that is being implemented in Nigeria. This is critical because without universal health coverage, those populations in poor areas will not be able to afford testing and treatment. So, we are working with different health authorities to try to increase the number of people that are covered under universal health coverage. Again, because we believe that enhanced diagnostic capacity contributes to a strong and resilient health system, we are working to improve policy decision-making that makes diagnosis an important part of the health investment in the country. We are also stimulating dialogue among stakeholders, improving and prioritising access to quality diagnostics and laboratory systems, strengthening them, and shaping the right policy environment to drive diagnostic investments, which, as I mentioned, are a critical part of a robust health system.
Considering the need for innovative financing to support elimination programmes, how is Roche Diagnostics working with governments and financial institutions in the West African region to develop and implement sustainable financing models for healthcare, particularly in the context of disease elimination?
To reduce the disease burden and eliminate some of these diseases, there is definitely a need to improve the healthcare systems in Nigeria and Anglo-West Africa. A very important part is to achieve universal health coverage, and this is also a goal of the government. These will increase accessibility and affordability for all Nigerians. Currently, only about 5 percent of Nigerians are covered under universal health coverage, which is not enough. This means that there is an urgent call for healthcare organisations to consider how we have a cost of managing care addressed. So, one goal in which Roche plays a part is increasing accessibility for universal health coverage. Supported by the recent adoption of the WHO resolution on strength in diagnostic capacity, we are working with healthcare stakeholders to improve and prioritise access to quality diagnostics and laboratory systems because having a strong diagnostic infrastructure is key for a good healthcare system. This is very important, and this is something that Roche is working very hard Won. A strong diagnostic infrastructure will make the health system more resilient and will respond to population needs, especially when there are disease outbreaks, external shocks, or pandemics like the one that we recently experienced with monkeypox. The same as with COVID-19, enabled to manage pandemics like a monkeypox, the diagnostics and screening are essential. Again, as a summary, we need to work together with different stakeholders to improve access and affordability to the best quality diagnostics and, of course, treatment, and the universal health coverage that is one of the main projects of the Nigerian government is a very, very important part.
What are the remaining gaps in hepatitis B prevention and control in Nigeria, and how can they be addressed?
There is still a lot to do to have more cooperation from the public and private sectors. Specifically, in the case of hepatitis, to be able to have better control and management, there needs to be more awareness. As I mentioned earlier, 80 percent of people affected by hepatitis don’t know they carry the disease. So there has to be more awareness and more screening and testing. This can be done; as I mentioned, there is an example in Egypt in which they eliminated hepatitis C with a combination of screening and treatment. There are also other examples in other countries, both in Africa and worldwide, in which, with improved access to testing and more awareness, the disease burden has been reduced. In the media, it also plays an important part to increase public knowledge about hepatitis and also to tell the public about the diagnostics and treatments available to them. This is especially so in underserved communities. In summary, I think that there has to be a strong partnership between private sector healthcare providers and the government to take coordinated action against viral hepatitis. We need to work together to look for innovative ways for funding, improve diagnostic laboratory infrastructure, and prioritise access to testing and care for all Nigerian patients, even in the most remote communities.
What are developed countries, and what are they doing differently than us?
The developed countries have more robust systems in terms of health coverage for the population. So, there are more people that can either get their health needs subsidised or covered by the government. That is still not the case in most of Africa. In Nigeria, most healthcare expenses are out of pocket, and this hurts particularly the poor people that do not have enough money to pay for their healthcare needs. So, the government has to increase the coverage and the funding for healthcare access because it is not enough to be enrolled in a universal healthcare access program if there is no funding to effectively diagnose and treat the patients that are enrolled. So, one thing is the coverage or the amount of the number of people that are enrolled, but another thing that is even more important is that then the government has the funds for people to be diagnosed and treated, either subsidised or covered 100 percent of the cost for the population. That is a general point, but more developed countries also do a very good job in preventing disease or disease progression through vaccination and more robust diagnostic infrastructure. Diagnostics is very important, especially early diagnostics, because if you can’t, if you are able to diagnose early, then the treatments are cheaper and the outcomes are better.
