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A programme to treat chronic hepatitis B in Kiribati: progress and challenges
Alice U Lee1,2, Kathy Jackson3, Rosemary Tekoaua4
1University of Sydney, Concord Repatriation General Hospital, Department of Gastroenterology and Liver Services, Concord, New South Wales 2139, Australia.
Insights
A new chronic hepatitis B (CHB) treatment program in Kiribati addresses regional health disparities. This initiative provides essential care and training, improving outcomes for CHB patients in the Pacific islands.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Chronic hepatitis B (CHB) affects over 290 million globally, with high prevalence in Pacific islands.
- Kiribati faces unique challenges including geographic isolation, low immunization rates, and co-infections impacting CHB treatment effectiveness.
- Limited infrastructure hinders effective training, communication, and laboratory services for CHB management.
Purpose of the Study:
- To establish the first national CHB treatment program in the Pacific islands, tailored to Kiribati's specific needs.
- To improve access to direct patient care, diagnostics, and public education for CHB.
Main Methods:
- Implementation of a CHB treatment program aligned with WHO guidelines and local requirements.
- Comprehensive services including patient care, laboratory support, public education, and medical training.
- Screening of thousands, molecular testing for 845 positive patients, and initiation of treatment for 79 patients.
Main Results:
- Development of patient education materials, training programs, and treatment protocols.
- Establishment of regular expert consultations and onsite visits to support the program.
- Successful initiation of a national CHB treatment program in a challenging, remote setting.
Conclusions:
- This program represents a significant step in addressing CHB in the Pacific islands.
- Key success factors include local partnerships, understanding barriers, flexibility, and international support.
- The model provides valuable insights for establishing similar programs in resource-limited, geographically dispersed regions.
Problem:
Over 290 million people worldwide suffer from chronic hepatitis B (CHB), with the highest prevalence in the Pacific islands. Mortality attributable to this disease exceeds that from HIV, tuberculosis and malaria combined in this region.
Context:
CHB is a major health problem in the Pacific island nation of Kiribati. Medical care is complicated by vast expanses of ocean separating population centres in its constituent islands. Birth-dose hepatitis B immunization rates need improvement. High rates of obesity, metabolic syndrome, and co-infection with hepatitis B and hepatitis D in Kiribati make treatment less effective. Staff allocation, training and retention are difficult. Limited infrastructure creates challenges in training, communications, laboratory testing and record-keeping.
Action:
We have established a CHB treatment programme in Kiribati based on World Health Organization (WHO) guidelines and local needs. It includes direct patient care; laboratory, radiology and pharmacy support; public education; training; and data management. Thousands of individuals have been screened, and 845 hepatitis B-positive patients have had blood sent to Australia for molecular testing. Patient education pamphlets, medical training programmes and treatment protocols have been developed. Seventy-nine patients have started treatment. Regular onsite visits by technical experts are scheduled throughout the year.
Lessons Learnt And Discussion:
This is the first national CHB treatment programme established in the Pacific islands region. Unique challenges exist in Kiribati, as they do in each nation affected by CHB. Close engagement with local partners, knowledge of the barriers involved, flexibility, advocacy, and support from WHO and volunteer technical experts are key attributes of a successful treatment programme.
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