Special Issue Introduction
According to the 2021 WHO interim report1
, globally 296 million individuals are chronically infected with hepatitis B virus (HBV). This is an increase of 50 million HBV carriers since the last WHO report in 20172
. In contrast to AIDS, tuberculosis and malaria, where mortality is on the decline, death attributable to viral hepatitis is still on the rise3, despite the WHO call for the elimination of hepatitis as a public health problem by 2030. Africa, the world’s second largest continent, consisting of many low middle-income countries, accounts for 16% of the global population. Between 20%-30% of the global HBV carriers reside in sub-Saharan Africa (sSA) and this is probably an underestimate because of lack of surveillance and a paucity of data. In SSA, the recorded annual death from HBV-associated hepatocellular carcinoma (HCC) is virtually the same as the total number of HCC cases diagnosed in the population, highlighting inadequacy in the preventive, screening and treatment programs that are currently available on this subcontinent. HBV has been eclipsed by the blockbusters AIDS, tuberculosis and malaria and more recently by COVID-19. If we are going to respond to the WHO call, we need to focus on reaching populations in sSA in order to achieve equitable progress against HBV. This requires a concerted effort to sensitize policy and decision makers to the challenges faced in sSA in combatting HBV4
. The objective of this special issue is to chart the progress made in sSA and to discuss the unique challenges faced in the elimination of HBV and associated liver cancer as public health problems on the subcontinent.
We invite original or review manuscripts, perspectives, opinions and commentary on different aspects, including but not limited to:
● Finding the missing millions of HBV infection and HCC cases through surveillance and establishment of cancer registries
● Developing and decentralizing infrastructural and human capacity for HBV, and accessing those already established for other diseases including AIDS, tuberculosis and malaria
● Interrupting HBV transmission including perinatal mother-to-child transmission, transfusion-transmitted infections and transmission in people-who-inject-drug networks
● Determining infant HBV vaccine coverage, including of the birth-dose and ensuring successful immunization of other high-risk groups
● Improving access to testing and treatment, with concomitant measures to address stigma
● Addressing management of HBV-HIV co-infection, considering that sSA is the epicentre of the HIV pandemic
● Advancing understanding of the epidemiology and characteristics of occult HBV infection
● Characterising liver disease in HBV infection, including insights into cirrhosis and HCC
● Mobilizing civil society to increase awareness and advocacy, including patient and public participation in research
● Overcoming political inertia in combatting HBV infection, increasing advocacy in order to harness the required resources
● Harnessing international collaboration of stakeholders in order to attract funding, negotiate costs, develop human capacity and infrastructure in order to avoid working in silos
1. WHO. Interim guidance for country validation of viral hepatitis elimination. 2021. https://www.who.int/publications/i/item/9789240028395
2. WHO. WHO guidelines on hepatitis B and C testing. 2017. https://apps.who.int/iris/bitstream/handle/10665/254621/9789241549981-eng.pdf?sequence=1
[accessed April 2021 2021].
3. Thomas DL. Global Elimination of Chronic Hepatitis. The New England journal of medicine 2019; 380(21): 2041-50.
4. Kramvis A. Challenges for hepatitis B virus cure in resource-limited settings in sub-Saharan Africa. Curr Opin HIV AIDS 2020; 15(3): 185-92.