Hepatitis Control Program

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 designinh interventions against risk factors that are responsible for disease transmission.

 

Vision:

A Hepatitis free Punjab with zero deaths caused by complications of hepatitis.

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:

1. Robust Surveillance in all health facilities
2. Introduction of Auto Disabled (AD) syringes 
3. Registration of Barbers & Beauty Salons
4. Mandatory screening of blood before Blood Transfusion
5. Implementation of Healthcare Waste Management in all health facilities
6. Mandatory testing before Dialysis, Surgeries and Organ Transplant
7. Mandatory testing of Prisoners within 7 days of incarceration
8. Compulsory Hepatitis B vaccination of newborns within 24 hours

Guidelines

1. Comprehensive National Hepatitis Strategic Planning for the elimination of HCV infection
2. Simple and standardized algorithms across the continuum of care
3. Integration of Hepatitis testing, care and treatment with other services
4. Strategies to strengthen linkage from testing to care, treatment and prevention
5. Decentralized services, support by task-sharing
6. Community engagement and peer support to address stigma, discrimination, and reach vulnerable or disadvantaged communities
7. Efficient procurement and supply chain management of medicines and diagnostics
8. Data systems to monitor the quality of individual care and the cascade of care

OBJECTIVES

1. Institutionalization of prevention and control interventions at selected Secondary Healthcare Facilities in Punjab
2. Implement revised and updated service delivery for prevention and control of Hepatitis B & C for screening, diagnosis and treatment at selected Secondary Healthcare Facilities
3. Institutionalize reliable, integrated disease surveillance system for registered patients
4. To provide legislative framework in terms of Hepatitis Control (Act/Rules) for the prevention and control of Hepatitis
5. Information, Education, Communication and Advocacy campaigns to enhance awareness among stakeholders with special focus on general population using different communication methods accordingly

Brief History 

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.

Achievement of Hepatitis Control Program

1. The Program has achieved following milestones implementing its four-pronged strategy of “Educate, Prevent, Test and Treat” 
2.  Macro-elimination through Hepatitis Clinics
3.  Micro-elimination- door-to-door campaign
4.  Special Initiatives for universities, colleges, madrassas, and prisons etc. and collaboration with private stakeholders.

1. 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 2,019,179 have been registered, 1,610,858 screened, 1,437,153 vaccinated, 415088 patients given free of cost medicines for Hepatitis B and C.
2. Establishment of state-of-the-art and Center-of-Excellence Hepatitis PCR lab with advanced and high throughput equipment of ROCHE COBAS 6800 and Abbott M-2000.Total 3,67,334 PCR tests conducted till date: 3,24,686 for Hepatitis C, 37,988 for Hepatitis B and 4,660 for both B and C more than 200000 COVID-19 tests. His Excellency Chief Minister Sardar Muhammad Usman Buzdar visited and appreciated the lab services on 8^th April 2020.
3. 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  
4. WHO EMRO Region conference 2019 held in Lahore (3-5^th December 2019), as a token of appreciation for achievements for Control & Prevention of Hepatitis in Punjab.

ADDITIONAL ACHIEVEMENTS

1. Punjab Hepatitis Action Plan (2019)
2. Punjab HCV Treatment Guidelines (2020)
3. Hepatitis C Micro-elimination in UC Panwan, District NNS (2019)
4. Screening and Vaccination Camps for 30,000 enrolled students in Islamia University, Bahawalpur as a special initiative (2019-2020)
5. Collaboration with private stakeholders: MoUs signed with Sarwar Foundation, Liver Care Society of Pakistan, Life Care Hospital Lahore, Ulfat Trust Hospital, Chiniot, PARSA Trust, GJW and The Health foundation (THF), Noor Jahan Hospital Mandi Bahauddin, Laboratory Company of Pakistan UC Rangpur of District Sialkot, Islamia University Bahawalpur, Government Gynae Hospital New Karole UC-37, Lahore 
6. Screening and Vaccination Camps all over Punjab in Oct 2019: 300,000 patients registered
7. Covid-19 PCR samples testing at HCP Central Lab: > 200,000 Covid-19 samples processed so far.

 

PLANNED INNTIATIVES:

1. Comprehensive Advocacy, Communication and Social Mobilization (ACSM)
2. Injection Safety/procurement of AD syringes
3. Blood Safety (CLIA screening of blood donors and RT-NAAT Confirmation of CLIA negative donors)
4. Notification of additional health inspectors for barbers and salons
5. Harm-reduction (Joint activities for IDUs with PACP/ Nai Zindagi)
6. Scale up Micro-elimination in all High Prevalent Districts as indicated by PMRC Survey 2008.
7. Integration of Hepatitis clinic of SHCMED
8. Strengthening and expansion of PCR facilities.
9. Service delivery via established hepatitis clinics in all prisons of Punjab.
10. Scale up of Micro-elimination of Hepatitis C in high prevalent districts across Punjab
11. ENDHEP 2030 Project strengthening 47 RHCs in selected 6 high prevalent Districts of Punjab.
12. Roll out plan for Hepatitis free universities of Punjab and madrassas
13. To work as per aspirations of PM’s Federal Program for Hepatitis C Elimination 
14. Public-Private Partnership (PESSI etc.)
15. Collaboration with parastatal organizations like Sarwar Foundation.

HEPATITIS C PATIENT SUCCESS STORIES

THQ HOSPITAL TAXILA

NAME:                 GULDAD KHAN

S/O:                      AHMED DAD

AGE:                     53

OCCUPATION:   IRON AND STEEL WORKER

Brief Story 

I am labor worker working in Taxila. I started having symptoms of weakness fatigue and body aches. During a routine medical examination doctor referred me to Hepatitis clinic being held at Tehsil Headquarter hospital Taxila where I was diagnosed as a case of hepatitis C. After that a PCR test was performed which showed active disease.

 According to my doctor I had to undergo treatment for hepatitis C, at first I was worried about the treatment cost of hepatitis. I was counselled by concerned doctor not to worry as Punjab Government is providing free medicine for hepatitis B and hepatitis C. After my PCR for hepatitis C I was provided with medicine for 3 months, during this period I was on regular follow-up with my doctor and followed every instruction. Today I have completed my treatment.

After a long battle with hepatitis today I got my PCR reporting showing that I have completely defeated this disease with the Grace of Allah and with the help of doctors and paramedics of THQ Hospital Taxila. I would really appreciate the effects and this endeavor of Government of Punjab for providing free treatment for hepatitis through its Hepatitis Control Program.

DHQ HOSPITAL RAJANPUR

 

 

NAME:                HAMEEDA BIBI 

AGE:                   36

ADDRESS:           RAJANPUR 

OCCUPATION:   HOUSEWIFE

 

 

Brief Story

 

I come to know about my HCV positivity status about 02 years back when I got my blood checkup done for Hepatitis C from Private laboratory, Rajanpur. After that I spent around

10000/- more on another test, which further confirmed the laboratory diagnosis. The physician informed me about the expenditure involved in the treatment of Hepatitis which was beyond my reach.

There was severe pain in my legs, and I was unable to perform any household chores. From some knows sources I came to know that the treatment of Hepatitis C is done in private Hakeem in Rajanpur city. I took treatment from there for two to three months but there was no relief. After this I come to know from LHV worker that Punjab Govt. is providing free treatment for Hepatitis C. She accompanied me to DHQ Hospital Rajanpur for this initiative which has sparked a ray of hope again in my life.

I have been successfully treated for the same. I achieved sustained viral response (SVR). 

have been provided with the certificate of being Hepatitis-C cured.

 

 

Brief Story 

I came to know of my status as Anti-HCV positive when I went for a regular dental checkup after which I had to consult another doctor who informed me that I will have to get a PCR test for further management of the disease. I got really scared because I was previously un aware of my condition. I went to get my PCR done privately which cost me around twelve thousand rupees resulting in a positive report with high viral load. Upon further consultation I was informed of the medication which would cost me thousands of rupees more that were out of my reach. Then someone told me about the Hepatitis Clinic at THQ hospital Gujar khan and how their treatment was free of cost from start to end along with very good patient care therefore I went to hepatitis clinic and got three months’ free medication and Hepatitis B vaccination and regular follow ups.

After completion of my medication I had my PCR again free of cost which had previously cost me so much from the same clinic and whose result I just received and is negative meaning I have had a successful treatment by the grace of Allah and thanks to Hepatitis Control Program, Punjab Government for helping me and others like me in fighting this dreadful and treatable disease if started timely.

Brief Story

I came to know about my HCV positive status 5 months back, when I got my blood test done from a private laboratory after that I spent some more amount on another test which further confirmed the diagnosis. The physician informed me about the expenditure involved in the treatment of hepatitis which was beyond my reach.

There were severe body aches and I was unable to work then I came to know about free treatment provided by Punjab gov’t in THQ Murree. I was given full treatment of Hepatitis C free of cost. My health condition has improved; I feel much better now I whole heartedly thank Punjab gov’t hepatitis clinic in THQ Murree.

I have been successfully treated I achieved SVR (sustained viral Response) and aim now Hepatitis C cured.

 

FAQs

Q 1: What is Hepatitis?

Ans: Hepatitis is inflammation of the liver

Q 2: What are the types of Hepatitis?

Ans: There are five types of Hepatitis (A, B, C, D, E)

Hepatitis B, C & D are blood borne Hepatitis i.e they spread from blood contact of an infected person.

Q 3: How Hepatitis Spreads?

Ans: Hepatitis B & C spreads through following ways:

1. Reuse of syringes
2. Unsafe blood transfusion
3. Unsafe dental and surgical instruments
4. Reuse of someone else’s used blades, razors, nail cutters, tooth brushes and combs
5. Use of unsafe/ unsterilized instruments during manicure, pedicure and ear & nose piercing procedures.

Q 4: How can we stay safe from Hepatitis?

Ans:

1. Frequent hand washing and use of clean drinking water can keep you safe from Hepatitis A & E.
2. Three shots of Hepatitis B vaccine (0, 1, 6) can save from Hepatitis B infection.
3. Safe blood transfusion, safe surgery with sterilized instruments, safe dental procedures, use of safe and sterilized equipment for barbers and beauty procedures, use of new syringe for injection can save us from blood borne viral Hepatitis B, C & D. 

Q 5: What you can do to stay safe from Hepatitis?

Ans: 

1. Always insist on use of new syringe for injection
2. For surgery and dental procedures, make sure the equipment in use are safe and sterilized
3. While taking blood transfusion make sure the blood being used is safe/ screened properly.
4. Always insist for use of safe and sterilized instruments from babers, beauticians and ear & nose piercing.
5. If any member of family is hepatitis positive ensure contacts screening and hepatitis B vaccination of household contacts.
6. Government of Punjab is extending free treatment facilities for hepatitis in DHQ, THQ and Teaching Hospitals of Punjab.

 

Hepatitis is preventable and treatable, Get tested – Get Vaccinated – Get treated

About Us

Telephone: 042-99295822

Address: 24-Cooper Road-Lahore, Pakistan

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Email: Pm.hcp.pb@gmail.com