Accelerating the Hepatitis B Response in Zambia (ACCELERATE)

DURATION   18 months
STARTING DATE   January 2021
GEOGRAPHIC REACH   Zambia
PARTNER    University Teaching Hospital HIV AIDS Programme (UTH-HAP)

AIM    

The project aimed to address fundamental barriers to viral hepatitis in Zambia by implementing a multi-faceted, decentralized, integrated healthcare worker training programme. Accelerating the Hepatitis B Response in Zambia (ACCELERATE) catalyzed substantial increases in hepatitis B testing and treatment in Zambia by cultivating a core group of local hepatitis experts, increasing healthcare professional competency and raising awareness among community health workers.

CONTEXT                                                                                                           

Zambia is a landlocked country in Southern Africa that has a disproportionately high burden of infectious diseases (ID), including HIV, tuberculosis, and viral hepatitis. 

Our grantee started a “training of trainers” programme on hepatitis as Zambia had very few public health or clinical leaders prepared to train other health workers on viral hepatitis.  

UTH-HAP has also worked with hospital leadership to ensure the decentralization of testing to various points and the orientation of nurses to offering tests. More service delivery points, such as antenatal, sexually transmitted infection (STI) and antiretroviral therapy (ART) clinics and sites doing HIV testing, are now integrating hepatitis into their routine services. When kits are available, hepatitis testing can now be offered at any service delivery point by a trained provider. 

The ACCELERATE programme estimates that a total of 222,000 people are eligible for HBV treatment in Zambia, including 72,000 people for co-infection (HIV and HBV) and 150,000 for HBV mono-infection. The programme estimates, however, that 30.3% of the treatment need is being met. The gap is primarily among people with HBV only and not living with HIV, where only 1.7% of the need is being completed compared with 90% among people with both HIV and HBV. This poses a severe challenge to health equity, which global health donors must address together.  

CATALYTIC IMPACT 

At the end of this project, 31 doctors were certified as hepatitis expert trainers. Before this programme, there were only five doctor experts in hepatitis in Zambia. This group will spearhead advocacy at the Ministry of Health (MoH) and its facilities. The expert trainers will also be assigned to HIV technical working groups where HBV integration is planned, including by building hepatitis components in Zambia’s application to the Global Fund. As a catalytic result, five project team members have been assigned to lead the national responses, and the MoH recognized hepatitis as a vital area that needs attention. The programme has empowered 81 HIV mentors to drive hepatitis care at hundreds of outlying facilities. 

Leveraging existing healthcare workforce programmes such as the ECHO model and HIV/TB mentorship programme to scale up hepatitis B education and training promises to catalyze strides toward hepatitis B elimination in the entire country.

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