Hepatitis B Treatment - where there is no liver specialist

Effective treatments for managing chronic hepatitis B are available.

As of June 2022, none of the available approved treatments can provide functional CURE. It is, however, known that with adequate suppression of viral load, the unwanted sequelae of chronic hepatitis B, namely: cirrhosis and liver cancer are extremely rare.

It is also a fact that not every patient with a diagnosis of chronic hepatitis B will need to be given treatment at the time of diagnosis.

Only approximately 30% will meet the criteria for treatment. Of the remainder, a further 30% will need to be treated at some point in their lives.

The decision to treat or not to treat is often laid upon specialist doctors, called, hepatologists.

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Only approximately 30% will meet the criteria for treatment. Of the remainder, a further 30% will need to be treated at some point in their lives. ... N. G. Ladep

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Unfortunately, hepatologists are not a common find. Worse still is the fact that the burden of hepatitis B is highest in parts of the world where the ratio of doctor to patient population is lowest.

There is thus a need for role sharing and support in order that non-hepatologists are empowered with tools that will help curb the current dangerous trend of excess deaths from liver diseases due to hepatitis B.

Fortunately, the World Health Organisation had provided simplified algorithms to support the management of chronic hepatitis B in developing countries. The parameters that are required to make decisions are often clinical, with only a fraction of the patients that would require tertiary care investigations and treatment.

GUIDELINES FOR THE PREVENTION, CARE AND TREATMENT OF PERSONS WITH CHRONIC HEPATITIS B INFECTION - WHO 2015

Some of the algorithms that are required for decision-making prior to treatment, monitoring or referral require Wi-Fi accessibility, a feature that is a luxury in many of the poorest communities.

It is in the backdrop of the above circumstances that I produced an offline app for use that can assist community practitioners, as well as non-specialist doctors, make decisions in the management of patients with hepatitis B.

The features of this app are:

1. Hepatitis B treatment decision maker - multiple parameters, a selection of relevant ones can then informs the clinician on what action to take

2. FIB-4 calculator - a validated non-invasive liver stiffness calculator, otherwise called a poor man’s liver biopsy

3. Child-Pugh calculator - for prognostication of cirrhosis based on clinical information of the patient

How the app operates is shown in the video below:

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Next steps

1. Pilot trial of the tool in interested centres in developing countries

2. Validate the tool and make adjustments as would be needed

3. Discuss integration of the tool in national health care systems of interested countries

4. Provide ongoing support

How you can help us

1. Push this article around by sharing in order that policymakers grant us the ambiance to engage with their health systems

2. Participation in the pilot study

3. Comment on the video linked to this article