The Coalition for Global Hepatitis Elimination, Partners in Health Malawi and the Ministry of Health Malawi announce a partnership to improve hepatitis B (HBV) and hepatitis C (HCV) testing and treatment policies to reduce deaths from liver disease and liver cancer. Malawi will join four other countries in the project for Hepatitis Evaluations to Amplify Testing and Treatment (HEAT).

Launched in 2020, The Coalition’s HEAT project helps countries scale–up testing to levels needed to eliminate hepatitis. In 2019, at least 80% of persons living with HBV or hepatitis C virus unaware of their infection [1]. To overcome this diagnosis challenge, known as the “Missing Millions,” countries will have to develop appropriate testing policies, technologies and implementation strategies to ensure elimination is programmatically and economically feasible. Ultimately, scale up of hepatitis testing will require a mix of laboratory and point-of-care based testing services which have different pros and cons in terms of throughput and accessibility. Planning and implementation of the most efficient and cost-effective mix of hepatitis testing technologies is dependent on the epidemiologic situation, the current capacity for laboratory and point of-care testing, and the education and skills of clinicians and outreach workers. The HEAT awards support activities including baseline epidemiological evaluations, laboratory capacity evaluations, and epidemiological modeling to inform development of improved testing and treatment policies.

In Malawi, the burden of HBV and HCV in the general population and the mortality due these infections are not well known due to limited large population data. The Institute of Health Metrics and Evaluation estimates there are 1.4 million persons living with HBV and 296,000 persons living with HCV [2]. Little to no testing for HBV and HCV is ongoing, and treatment is not routinely accessible. Recognizing the opportunity to improve access for patients, the Malawi Ministry of Health recently drafted updated HBV and HCV clinical guidelines and developed a national action plan for scaling up HBV and HCV testing and treatment. By participating in the HEAT project, Malawi Ministry of Health, Partners in Health, the Coalition, and other local partners can expand access to hepatitis testing and improve progress toward national elimination planning efforts.

 Key project activities proposed by Partners In Health Malawi and the Ministry of Health include:

• Synthesize available data on HBV and HCV burden of disease based on literature review and retrospective review of hospital records, blood bank information systems, and cancer registries

• Assess the laboratory capacity for scaling up HBV and HCV testing nationally

• Finalize locally adapted clinical guidelines for HBV and HCV and training of healthcare workers

• Publish a national action plan for the elimination of viral hepatitis with appropriate targets and a monitoring and evaluation framework

“The goal is to develop policies that will aid in the provision of high quality testing and treatment services,” says Dr. Ethel Rambiki, the National Hepatitis Focal Point for the Malawi Ministry of Health. 

The project was commenced in March 2022 and will continue through early 2023. The Coalition looks forward to collaborating with the Ministry of Health and Partners in Health to implement this project and set the foundation for HBV and HCV elimination in Malawi.

To date, HEAT projects have been implemented in Ghana, Moldova, and Vietnam. In Ghana, the project was implemented by a local coalition of partners, including the Ghana Health Services, the University of Cape Coast, and the Hepatitis Foundation of Ghana. The project was completed in December 2021. The project in Moldova was led by the National Public Health Agency and in Vietnam by the Vietnam Viral Hepatitis Alliance. Additional HEAT countries are under consideration.

The Coalition for Global Hepatitis Elimination

The mission of the Coalition for Global Hepatitis Elimination is to strengthen the capacity of national and sub national hepatitis B and hepatitis C elimination programs through technical assistance and knowledge sharing among partners united in a community of practice.

Contact:

Coalition for Global Hepatitis Elimination

The Task Force for Global Health

globalhep [at] taskforce.org

330 Ponce de Leon Ave

Decatur, GA 30030

[1] Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016–2021: actions for impact. Geneva: World Health Organization; 2021

[2] Institute on Health Metrics and Evaluation. Global Burden of Disease Study 2019. https://www.globalhep.org/country-progress/malawi