TB HIV Care is a national non-profit organisation with a long history of working to prevent, find and treat TB and HIV. In 2015, TB HIV expanded focus to include viral hepatitis. Viral hepatitis is included in the organisations strategic plan.
Prevention. TB HIV Care runs ongoing programmes for people who inject drugs (PWID) as well as sex workers. Services for PWID includes the provision of sterile injecting equipment and condoms and lubricant for the prevention of HIV and viral hepatitis, to approximately 2800 people in 3 cities. Two opioid substitution therapy demonstration projects are in operation, which have included HBV and HCV testing and referral for treatment. The SW programme includes condom and lubricant distribution as well as pre-exposure prophylaxis. Both key population programme provides hepatitis education and distribute hepatitis information materials that we have developed for the South African context to service users in several languages. TB HIV Care partners with the National Department of Health and Rotary International in their annual Family Health Days – where TB HIV Care supports viral hepatitis B and C testing and referral for treatment in selected sites. As part of TB HIV Care’s PWID programme, annual hepatitis C testing will be offered to PWID who are new to the programme as part of outreach, as well as to all people who are put onto OST.
Service delivery and implementation research. Between 2015 and 2018 THC led a cross sectional viral hepatitis prevalence survey in key populations (PWID, SWs and men who have sex with men (MSM)). The initiative provided HBV and HCV counselling and testing and, where necessary, HBV vaccinations and/or referrals for ongoing monitoring or treatment to a total of 3500 key populations. As part of this project 2646 people received at least one dose of HBV vaccination. The study highlighted a high prevalence of HCV among people who inject drugs (45%, 423 /941). THC is now exploring ways to implement innovative, community-based screening, diagnosis and treatment for people who inject drugs. TB HIV Care is partnering with the National Institute of Communicable Diseases on two studies, one around assessing occult hepatitis B among key populations and the other around HCV phylogenetic testing. We have continued to routinely screen for HBV and HCV in our clients on opioid substitution therapy. In April 2019 we started a small pilot cohort (13 people) of treating people living with hepatitis C who were on opioid substitution therapy in Cape Town from our drop in centre.
Advocacy and capacity building. TB HIV Care takes an active role in advocating for and supporting an improved national response to hepatitis. This includes working with National Department of Health (NDoH) on hepatitis awareness days and strategy and policy development. Key interventions have included support and input on the development of the National Viral Hepatitis Management Guidelines and National Hepatitis Action Plan, and raising hepatitis as a priority area with Central Drug Authority and the South African National AIDS Council and on the Global Fund South African Concept note. We are also vocal advocates for the provision of Direct Acting Antivirals on the national public healthcare system. Representative of TB HIV Care is a member of the National Department of Health’s Hepatitis Technical Working Group, and co-leading the sub-committee on hepatitis services for key populations and direct acting anti-viral cost reduction strategy. THC also actively disseminates the results of implementation research at conferences, in academic articles and the media as a means of raising awareness. Findings from the above-mentioned key populations hepatitis study were presented at: The Liver Meeting (2017), the South African AIDS Conference (2017), the International Network of Hepatitis among Substance Users (INHSU) Meeting (2018), the Southern African HIV Clinician Society’s Conference (2018), and abstracts have been submitted to the International AIDS Conference (2019), the South African AIDS Conference (2019), the viral hepatitis-HIV co-infection preconference to the 2019 International AIDS Conference. A representative of TB HIV Care has been involved in the organisation of the HIV-hepatitis co-infection conference at AIDS 2016, and is part of the international organising committee for IAS 2019. A representative of TB HIV Care is part of the international organising committee for INHSU 2019, and co-chair of the the INSHU satellite session at the International Harm Reduction Conference (2019). TB HIV Care will co-host an INSHU Africa satellite meeting in Cape Town in 2020. TB HIV Care has been represented on the World Health Organisation’s Working Group on Hepatitis and Substance Use since 2018.
The first publication of the hepatitis study findings is available (https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0298-2), with several others under development, including a qualitative study on facilitators and barriers to linkage to care.
THC further hosts events annually on World Hepatitis Day to build awareness about hepatitis amongst service users, local authorities and the public more broadly. In 2018, TB HIV Care partnered with the National Department of Health to host four provincial hepatitis events raising awareness around the National Hepatitis Action Plan and Guidelines and to disseminate findings from the completed multi-site study. TB HIV Care is working with government to enhance HIV and related guidelines to improve access to point of care hepatitis testing, including as part of work up for HIV treatment and for PrEP.