23 Nov 2022
Working with clinicians in Vanuatu to fight hepatitis B
Doherty Institute epidemiologist Dr Nicole Allard recently travelled to Vanuatu with the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM Global) to deliver the Island’s first-ever hepatitis B training.
It is estimated that almost 1 in 10 people lives with hepatitis B in Vanuatu.
While the administration of birth dose of the hepatitis B vaccine has made an impact in transmission, there is still ongoing transmission, and the country is unlikely to meet global elimination goals without investment.
During the pandemic, birth dose coverage fell to 62 per cent because of health system pressures. Prevalence in older age groups is high with up to one in five people in these groups affected by hepatitis B, and clinicians report liver disease and liver cancer being common among families. Previous mortality study in 2016 estimated that 18 per cent of men and 8 per cent women die due to liver disease in Vanuatu.
The country faces a number of challenges, with its geography, human resources and health services including limited test availability, hindering its fight against hepatitis B.
Clinicians rely on hepatitis B surface antigen rapid tests and liver function tests to determine treatment with viral load testing only available at a few sites. There are GeneXpert® machines rolled out across the country for COVID-19 and tuberculosis testing, but there’s limited testing available for hepatitis B viral load (less than a 100 done in 2022). Antiviral treatment programs are early in implementation with an estimated few hundred patients starting tenofovir out of the estimated 8,000 who need treatment to prevent poor outcomes.
The training covered hepatitis B, HIV, STIs and monkeypox. The hepatitis B component aimed to prepare the health workforce for more wider scale roll out of treatment.
Dr Nicole Allard is a General Practitioner, an epidemiologist at the WHO Collaborating Centre for Viral Hepatitis at the Royal Melbourne Hospital’s Victorian Infection Disease Reference Laboratory (VIDRL) and a senior fellow in the University of Melbourne’s Department of Infectious Diseases at the Doherty Institute. Her work focuses on viral hepatitis epidemiology and mixed methods research. She already produced a Hepatitis B curriculum for ASHM global for countries in the Asia Pacific region and participated in situational analyses of viral hepatitis in Vanuatu, Solomon Islands and Cambodia for WHO.
In the week-long training, Dr Allard talked to clinicians (doctors, nurses, lab technicians and health promotion staff) from across the archipelago about clinical management of hepatitis B.
“The training was really well received with all the participants reporting that it was very useful or essential to their clinical practice,” Dr Allard said.
“Some attendees told us that before they diagnosed hepatitis B but were unclear on next steps, and now they know what to do. There was a lot of interest in simplifying guidelines and a flow chart was developed with participants to summarise the guidelines.”
The training was organised by ASHM Global and the Vanuatu Ministry of Health, and funded by the WHO Vanuatu office and the Australian Department of Foreign Affairs and Trade.
The facilitators included Dr Nicole Allard delivering hepatitis B training, Cherie Bennett delivering syndromic management of STIs, HIV and Monkeypox, Yannick Tarivuhavuha from VPride and Ministry of Health staff.