Hepatitis Prevention and Treatment Program

Vision

To make a Hepatitis free Pakistan that everyone has access to safe, affordable and effective Prevention, Care and Treatment services.

Strategic Goal 1

Creation of a Surveillance System

A person infected with Hepatitis B or C virus becomes a Potential source of infection to others as well. However, an effective surveillance system that can identify and investigate infected persons can prevent further transmission.

Unfortunately, Hepatitis surveillance in Pakistan has remained periodic. The last large scale surveillance data were collected and analyzed in 2011 in collaboration with the CDC. At present, the Government of Punjab has developed 80 sentinel sites across Punjab for detecting outbreaks of Viral Hepatitis but a worthwhile study is yet to be conducted. One of the goals of PKLI will be to link all these sites to remain data server that will be located at the PKLI – Hepatitis Prevention and Treatment Clinic (HPTC). This will help to consolidate data regarding the prevalence of Hepatitis in Punjab and implement preventive measures to arrest the outbreak.

As a part of an effective surveillance system PKLI aims to take the following steps:

Action 1.1

Access burden of disease by monitoring trends in incidence of Viral Hepatitis and risk factors of associated with its transmission.

Action 1.2

Provide guidance to clinicians, public and private hospitals and other healthcare settings regarding case ascertainment, reporting, investigation and follow-up of persons with acute Viral Hepatitis.

Action 1.3

Established computerized systems for collection of a minimum set of standardized data elements, including demographics and other important clinical data, on all reported cases of Viral Hepatitis. This information will be used for policy making at the provincial and national level to combat this disease.

Action 1.4

An effective reporting system can be implemented overtime by making reporting compulsory on various levels like laboratories, blood banks, screening sites or clinics dialysis centers or public and private hospitals. Guidelines for monitoring and reporting of Hepatitis prevalence in high risk groups like prison inmates, intravenous drug users (IDUs), sex workers, in healthcare settings like dental clinics, dialysis units, and hijama clinics will also be established.

Action 1.5

Ensure periodic and regular evaluations of the surveillance system to check for quality, completeness, timeliness and validity of the data. Standardized indicators will be established for this purpose.

Strategic Goal 3

Education and Behavioral Change

Hepatitis has become one of the leading causes of deaths in Pakistan and yet knowledge level amongst people regarding this disease is scant at best. Public awareness campaigns are close to none resulting in lack of awareness regarding modes of transmission, diagnosis, prevention and treatment of Viral Hepatitis. Moreover, the symptoms of a failing Liver can cause grave suffering and such information is also not widely available with public.

Action 3.1

Develop interactive and practical educational and training programs to educate public about Hepatitis transmission, prevention and treatment. Various ways of communication like seminars, lectures, social media, electronic media, print media, etc. will be employed to spread the information.

Action 3.2

Educate school/ college / university students about blood borne disease as part of primary public health responsibility. Impart education on Hepatitis in madrassas that can play a very significant role in combating the spread of Viral Hepatitis.

Action 3.3

Provide education and training to healthcare providers on the necessity of Hepatitis screening, interpretation of tests, referrals to specialists and vaccination among high risk groups.

Action 3.4

Support groups comprised of social workers, healthcare personnel and family members will be formed to help patients and their families cope with their illness. These groups will also educate about transmission mode of viral Hepatitis and create awareness that victors of Viral Hepatitis should not be isolated and stigmatized because of their malady.

Strategic Goal 2

Injection Safety and Infection Control

According to a study conducted by WHO, sixteen billion injections are given worldwide, out of which more than 70% injections are unnecessary. These unsafe injections cause 21 million Hep B infections and 2 million Hep C infections. The reason for such a common occurrence is that infections on needles are invisible to the naked eye and the unsuspected recipients have absolutely no idea of the risks of disease transmission. As the time passes, the absence of any initial symptoms does not pose any threat or give any warnings to its victims. Outbreaks related to unsafe injection practices indicate that some healthcare personnel are unaware of, do not understand, or do not adhere to basic principles of infection control and aseptic technique. In Pakistan, many syringes are used over multiple times and sometimes disposed of to be used again. There is no proper disposal mechanism that ensure one-time usage.

Action 2.1

Warn patients against the use of unnecessary injections through public campaigns and health education and encourage them to ask for a new syringe every time when an injection is being administered or a needle is being used.

Action 2.2

Employ best practices, promote legislation and prepare guidelines for administering medical injections like intravenous infusions, blood collection and donation, and dental procedures.

Action 2.3

Develop general safety practices, particularly emphasizing on adoption of universal precautions for hand hygiene, avoidance of cross – contamination and wearing barrier protection gloves. Guidelines will be developed for appropriate disposal of sharp waste and minimal manipulation of sharp instruments to prevent unsuspected infection transmission.

Action 2.4

Introduce newer technologies that support best practices of injection, for example, promote the use of auto-disable syringes and single-use vials across all healthcare facilities.

Action 2.5

Address Hepatitis spread via barbers, beauty clinics, dental clinics and other sources and implementation standardization techniques through awareness campaign.

Strategic Goal 4

Hepatitis B Mass Vaccination and Screening of Pregnant Females

Though there is no available treatment for Hepatitis B, it can be prevented through vaccination, which is 95% effective in most of the cases. Since its availability, over 1 billion doses of Hepatitis B have been used worldwide. WHO recommends that all infants receive the Hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.

Action 4.1

Provide education and counselling to general public in collaboration with private providers, non-governmental organizations (NGOs) and hospitals. Educate the community, including doctors, lady health workers (LWH) and midwives, on the importance of vaccination, its dosage, and timely notification of vaccination at child’s birth.

Action 4.2

Identify and engage appropriate stakeholders including NGOs, social workers and medical community to assist the vaccination of persons in identified high risk groups.

Action 4.3

Develop policies to ensure vaccination of students of medicine, dentistry, pharmacy, nursing and paramedics and create SOPs for administration of vaccination when appropriate.

Action 4.4

Collaborate with the government to meet the goals of reduction in the overall incidence of Hepatitis B by implementing stringent policies of Hepatitis B vaccination at the time of birth. In addition, all mothers should be screened for the presence of Hepatitis B surface antigen.

PKLI’s HPTP outreach is progressing day by day and has established 19 Hepatitis Clinics in Lahore, Kasur, Rajanpur, Jhelum, Mandi bahauddin, Chiniot, Chakwal, Narowal, Khanewal, Shujabad, Lodhran, Okara, Hafizabad, Attock, Mianwali, Bahawalnagar, Nankana Sahib, Pakpattan and Bhakkar. PKLI has planned to set up a total of 25 Hepatitis Clinics across Punjab.

HPTP Directorate

Lahore

Pakistan Kidney and Liver Institute and Research Center (PKLI&RC)

Address: CCA, Avenue 3, DHA Phase 6, Lahore, Pakistan

Tel: (+92) 42 37181609