HepEquity Blog: Local Hepatitis Elimination and Prevention Program (LHEAP) Launches in Rawalpindi, Pakistan

CGHE Hepatitis Evaluation, Research, and Outreach (HERO) fellow, Dr. Nida Ali, serves as the Project Lead, and training and testing efforts are already underway

The burden of viral hepatitis in Pakistan is extremely high. With an overall prevalence of 2.4% for hepatitis B and 4.8% for hepatitis C, the country has the second-highest burden of disease in the world. With the WHO goal of elimination by 2030 looming as rates rise, there is an urgent need to increase testing and treatment in Pakistan.

This month, the district of Rawalpindi, in partnership with the Coalition for Global Hepatitis Elimination, launched the Local Hepatitis Elimination and Prevention Program (LHEAP) to provide an ambitious and comprehensive approach to providing hepatitis services. Under the leadership of the Punjab Caretaker Minister for Primary and Secondary Healthcare, Dr Jamal Nasir, the program was inaugurated at the Rawalpindi Arts Council. Coalition HERO fellow, Dr. Nida Ali, serves as the program lead.

Hepatitis testing is being offered door-to-door to residents, and vaccination and treatment are offered at no charge. Dr. Ali is hopeful that this approach will be effective, since so many people are unaware of the need for testing and care:

Just like the rest of the world, the biggest barrier we have is underdiagnosis and patients seeking care only when they experience symptoms of decompensation. This is associated with low health literacy and primary health not being a priority for the community where they struggle from day to day to make ends meet.

Since the launch, program administrators, including Dr. Ali, have held a kickoff event with healthcare providers in the region, a screening camp for an artists’ community in Rawalpindi, and a training event in which COVID-19 vaccinators are being recommissioned as Frontline Elimination Workers for the LHEAP project. Additionally, the LHEAP team is supporting a police camp cohort study, in which 227 HCV positive officers are being interviewed.

*Dr. Nida Ali interviews a police officer.*

Door-to-door screenings and community outreach to places like mosques have been underway for two weeks. More than ten thousand people have been screened so far, with 61 positive cases of hepatitis B and 139 cases C diagnosed. Those who test positive are linked to care, and in the case of hepatitis C, curative medicine. In addition to screening, more than 2600 people have been vaccinated for hepatitis B.

According to Dr. Ali, the community response has been, for the most part, welcoming. “Initially when our teams went to the households, the community was skeptical. However, after day one, when few cases were identified, the word spread like wildfire. Identification of those few cases in the community created demand for screening, and we saw increased uptake of screening and vaccination.”

The initial results indicate a promising future for the LHEAP program. “We have implemented the pilot successfully,” says Dr. Ali.

Now we know what to expect in the field. We are in the planning phase of full implementation. District Health Authority Rawalpindi and Hepatitis Control Program have generously offered the resources available at their disposal. We are also building a network of local small business owners who are supporting the program.

As the LHEAP program continues to grow, Dr. Ali and other stakeholders are optimistic that it will serve as a model for other regions in Pakistan and beyond.

By leveraging the expertise of Dr. Nida Ali and the collaborative efforts of the CGHE in-country partners, the program aims to make a lasting impact on the lives of those affected by hepatitis in Rawalpindi and make major strides towards elimination goals.