INTRODUCTION

Hepatitis Prevention and Control Program (HPCP) was launched in the year 2006. Its main task is prevention and control of Hepatitis in Punjab. Spread of Hepatitis has reached alarming proportions in the province with an estimated 2% prevalence of Hepatitis B and 8.9% prevalence of Hepatitis C (BOS Survey 2018). The province-wide Program supports the National Hepatitis Strategic Framework (NHSF) through provision of viral Hepatitis prevention services to at-risk adults, children, newborns as well as others who are not at risk. This is done through free Hepatitis B vaccine and Hepatitis C & B serologic testing, treatment and province-wide viral Hepatitis-related education, consultation, and referral services. The program also focuses on strategies and designing interventions against risk factors that are responsible for disease transmission

VISION

A world where viral hepatitis transmission is halted and everyone living with viral hepatitis has access to safe, affordable, and effective prevention, care and treatment services. Program objective is to achieve Hepatitis free Punjab with zero deaths caused by complications of hepatitis.

OBJECTIVES

·         Institutionalization of prevention and control interventions at selected Secondary Healthcare Facilities in Punjab

·         Implement revised and updated service delivery for prevention and control of Hepatitis B & C for screening, diagnosis, and treatment at selected Secondary Healthcare Facilities

·        Institutionalize reliable, integrated disease surveillance system for registered patients

·        To provide legislative framework in terms of Hepatitis Control (Act/Rules) for the prevention and control of Hepatitis

·        Information, Education, Communication and Advocacy campaigns to enhance awareness among stakeholders with special focus on general population using different communication methods accordingly

GOALS

The overall goal of the project is to reduce morbidity and mortality due to Hepatitis B&C by working in all focus areas defined in Hepatitis Act 2018: · Robust Surveillance in all health facilities · Introduction of Auto Disabled (AD) syringes · Registration of Barbers & Beauty Salons · Mandatory screening of blood before Blood Transfusion · Implementation of Healthcare Waste Management in all health facilities · Mandatory testing before Dialysis, Surgeries and Organ Transplant · Mandatory testing of Prisoners within 7 days of incarceration · Compulsory Hepatitis B vaccination of newborns within 24 hours.

 

GUIDELINES

·         Comprehensive National Hepatitis Strategic Planning for the elimination of HCV infection

·         Simple and standardized algorithms across the continuum of care

·         Integration of Hepatitis testing, care, and treatment with other services

·         Strategies to strengthen linkage from testing to care, treatment, and prevention

·         Decentralized services, support by task-sharing

BRIEF HISTORY

Federal Level National Hepatitis Prevention Control program PMU was established in 2005 than it was modified to prime Minister program for Prevention and Control of Hepatitis after 18^th amendment in the constitution of Pakistan health became a Provincial subject post devolution federal program devolved for province in 2011.

The development scheme of Prevention & Control of Hepatitis was implemented during the period 2012 to June 2016. In this phase, several interventions were undertaken, Hepatitis sentinel sites were established and linkages with diagnostic labs were established for PCR.   However, these interventions need to be pursued more aggressively to address the associated morbidity and mortality in a sustainable and outcome-oriented manner. This scenario led to the development and approval of a new development scheme for the period 2016-2019. This would be second phase for the prevention and control of Hepatitis incorporating contemporary scientific intervention and globally acknowledged good practices for prevention.

            Resources were to be provided through Annual Development Program (ADP) by the Provincial Government & wherein the PSDP allocation (8th NFC Award) under 18th amendment by the Federal Govt. would be continued. Keeping in view the magnitude of disease burden according to prevalence survey and number of patients who are in waiting list at various Hepatitis sentinel sites due to limited medicines available under the program, it was decided to revise the PC-1 to increase the quantity of medicines and treatment facilities for patients suffering from Hepatitis. Previously eighty Sentinel Sites were barely functional, and their main focus was on registration of patients and provision of treatment accordingly. Where registration, screening, vaccination and counselling for prevention measures will be done, secondly, to improve case diagnosis and program outreach. Then it by faregate in two programs one is Hepatitis control Program and second is Infection control Program and each have separate PC-1 and budget in 2016-17 in January 2017 PMU at provincial level had been functional in DG office 24-cooper road Lahore and clinic were established in August 2017 in selective district MIS for Hepatitis is also functional on 7^th August 2017 and 2018 Hospital Waste Management MIS in Functional. 2017-19 first revision of PC-1 and July 2019 to June 2020 no cost extension and (2020-22) second revision of both PC-1 Infection Control Program declared successful by DG M&E in 2021, running in ND mode and Hepatitis Control Program declared successful by DG M&E in 2022, running in ND Mode

ACHIEVEMENT OF HEPATITIS CONTROL PROGRAM

·        The Program has achieved following milestones implementing its four-pronged strategy of “Educate, Prevent, Test and Treat” 

·        Micro-elimination through Hepatitis Clinics

·        Micro-elimination- door-to-door campaign

·        Special Initiatives for universities, colleges, madrassas, and prisons etc. and collaboration with private stakeholders.

ADDITIONAL ACHIEVEMENTS

1. The Program has achieved following milestones implementing its four-pronged strategy of “Educate, Prevent, Test and Treat” 

·        Macro-elimination through Hepatitis Clinics

·        Micro-elimination- door-to-door campaign

·        Special Initiatives for universities, colleges, madrassas, and prisons etc. and collaboration with private stakeholders.

·        Establishment of 281 Hepatitis Clinics at DHQ / THQ Hospitals, Teaching Hospitals, and partner organizations for free of cost Registration, Screening, Vaccination, PCR processing and Medicine delivery to all Hepatitis Patients. All services recorded and reported through electronic Medical Record (EMR). So far 2,475,942 have been registered, 2,195,373 screened, 2,050,209 vaccinated, 511,503patients given free of cost medicines for Hepatitis B and C.

·        Establishment of state-of-the-art and Centre-of-Excellence Hepatitis PCR lab with advanced and high throughput equipment of ROCHE COBAS 6800 and Abbott M-2000.Total 818,682 PCR tests conducted till date (06-12-2022) in which  706,763 for Hepatitis C, 96,126  for Hepatitis B and 15,793 for both B and C more than 200,000 COVID-19 tests. His Excellency Chief Minister Sardar Muhammad Usman Buzdar visited and appreciated the lab services on 8th April 2020.

·        Hepatitis Act 2018 promulgated for provision of legal backstopping for prevention of Hepatitis in the Province. Includes Rules for enforcement mechanisms on injection safety, blood safety, Organ transplant, dialysis, surgeries, harm reduction. hepatitis B vaccination of the newborn and Centralized licensing for barbers and beauty salons and hospital waste management  

·        WHO EMRO Region conference 2019 held in Lahore (3-5th December 2019), as a token of appreciation for achievements for Control & Prevention of Hepatitis in Punjab.

          PLANNED INNTIATIVES

·        Comprehensive Advocacy, Communication and Social Mobilization (ACSM)

·        Injection Safety/procurement of AD syringes

·        Blood Safety (CLIA screening of blood donors and RT-NAAT Confirmation of CLIA negative donors)

·        Notification of additional health inspectors for barbers and salons

·        Harm-reduction (Joint activities for IDUs with PACP/ Nai Zindagi)

·        Scale up Micro-elimination in all High Prevalent Districts as indicated by PMRC Survey 2008.

·        Integration of Hepatitis clinic of SHCMED

·        Strengthening and expansion of PCR facilities.

·        Service delivery via established hepatitis clinics in all prisons of Punjab.

·        Scale up of Micro-elimination of Hepatitis C in high prevalent districts across Punjab

·        ENDHEP 2030 Project strengthening 47 RHCs in selected 6 high prevalent Districts of Punjab.

·        Roll out plan for Hepatitis free universities of Punjab and madrassas

·        To work as per aspirations of PM’s Federal Program for Hepatitis C Elimination 

·        Public-Private Partnership (PESSI etc.)