Impeding The High Prevalence Of Hepatitis B In Nigeria: The Pharmacist’s Perspective

Communicable disease also known as transmissible or infectious disease (Muhammed Khalid Anser et al, 2020) caused by microorganisms such as parasites, bacteria, viruses and fungi that can be spread directly or indirectly from one person to another are currently diseases of public health concern. Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), and Hepatitis C virus (HCV) are the three most common chronic viral infections of public health importance with great socioeconomic impact worldwide (Lawal MA et al, 2020). In Nigeria while HIV programmes have stem the tide of the disease, HCV disease is still being largely alien and Hepatitis B disease has recently recorded high prevalence data as reported by Berinyuy B et al, 2019.

Hepatitis B virus (HBV) is a hepadnavirus that infects the hepatocytes. Chronic hepatitis B infection is endemic in Asia and Africa with more than 75% of the world’s chronic hepatitis B surface antigen (HBsAg) carriers being of Asian and African origins (C.-L. Lai et al, 1998) and a high prevalence of HBV infection was seen among blacks (O. Adekanle et al, 2010) with chronic complications like liver cirrhosis and liver cancer noted. The prevalence of HBsAg is increased in individuals with multiple sexual partners, sickle cell anaemic patients, long distance truck drivers, and injection drug users as well as men who have sex with men.

Several studies have highlighted the importance of the control of viral hepatitis through health education, hepatitis B vaccination of at risk population, and treatment of infected persons. Thus, the lack of adequate hospital policy to enforce mandatory hepatitis B test as well as its poor implementation may hinder the effective control of HBV. Many health care workers that started HBV vaccine did not complete probably due to fear or side effects of the vaccine (Olusegun Adekanle et al, 2010)

PREVALENCE OF HEPATITIS B INFECTION IN NIGERIA

Globally, over 350 million people are chronically infected with HBV and in Africa about 100 million individuals are estimated to be infected with HBV (Lawal MA et al, 2020). Berinyuy B Eustace et al, 2019 in a review reported that Nigeria, has been documented as highly endemic for HBV infection and about 75% of its population is likely to have been exposed to the virus at one time or the other in their lives. The report showed that currently about 18 million Nigerians are infected. A prevalence rate of 4.3% was reported from Port Harcourt, 5.7% from Ilorin, 11.6% from Maiduguri and 8.3% from Zaria. A seroprevalence of 23.3% was reported among patients attending all clinics at the Aminu Kano Teaching Hospital (Berinyuy B Eustace et al, 2019).

Even though HBV has become a major source of health concern worldwide, we should also be reminded by the good news that it is the only Sexually transmitted disease that can be prevented by vaccination (CDC, 2005).The prevention of HBV globally has become one of the topmost priorities of major political actors and decision makers in recent years. The disease is prevented using safe and effective vaccine which became available in 1982 through funding and implementation of Hepatitis B immunization programs (Berinyuy B Eustace et al, 2019).

We must acknowledge that the rise of acute HBV infections is also associated with the opioid crisis, and that a portion of these acute infections will result in increased chronic HBV infections (approximately 10%) (Bach AT, Goad JA, 2015).

There has not been any universal agreement on drugs used for the temporary treatment of the HBV in the world even though two therapeutic agents such as interferon alpha (IFNa) and lamivudine are currently used by many countries for the treatment of the disease. Interferon-alpha is a potent cytokine with antiviral and immunomodulating actions which is produced in response to viral

infection (Sen G, Ransohoff R. 1993).

Some of the general management strategies for HBV recommended by medical experts include the avoidance of heavy alcohol consumption, unprotected sexual intercourse with partners who are not vaccinated, sharing of needles or other items that potentially contain blood such as shavers or toothbrushes and donation of blood or organs. They also recommend the screening of family members and sexual partners for HBV infection and vaccination of those who are sero-negative (Berinyuy B Eustace et al, 2019). Others are Patient education and long-term follow-up with regular testing of liver biochemistry and surveillance of hepatocellular carcinoma in high risk groups (Batholomew C, 2011).

THE ROLES OF CLINICAL PHARMACISTS TO REDUCE THE OVERALL BURDEN OF DISEASE

Patients living with HIV/HCV coinfection whose treatment is managed by clinical Pharmacists within the context of a multidisciplinary care team have been reported to obtain favourable treatment outcomes that are comparable to clinical trials. Given this capacity, clinical Pharmacists should receive ongoing clinical training and support to conduct and expand these roles in the treatment of HBV and be incorporated into multidisciplinary healthcare teams.

Antonio Olea et al, 2018 reported certain roles of a clinical Pharmacist in the management of Direct Acting Antiretroviral therapy (DAA) in individuals living with HIV/HCV co infection which can be applied in the context of the prevailing Hepatitis B prevalence. The role of the clinical Pharmacist was categorized into eight main categories: 1) Prior Authorization completion; 2) Medication adherence counselling; 3) Drug-drug counselling and screening; 4) Medication counselling regarding common Adverse Events (AEs); 5) Counselling regarding treatment outcomes and risk of reinfection; 6) ordering laboratory tests and interpretation of laboratory values; 7) medication Adverse Event assessment; and 8) others (including refilling medications and management of other comorbidities). These were coming from past identified roles in reviewing patients’ medical records to identify appropriate ART and DAA medication regimens, acquisition of medications through prior authorizations, identifying potential DDIs, and monitoring laboratory tests to avoid AEs. Additional tasks have included simplifying medication regimens to reduce pill burden, medication adherence counseling, monitoring for AEs, and counseling and educating patients about HIV and/or HCV treatment (Antonio Olea et al, 2018). In a patient satisfaction survey, Martin MT et al, 2016 reported patient’s 100% satisfaction with the clinical services provided by the Pharmacist, including time

spent during visits, medication adherence counseling, and

education on HCV disease state, medication storage, and

administration and have supported the inclusion of a clinical Pharmacist in healthcare teams for distinct disease states.

Today, Pharmacists are recognized by the CDC and FDA as immunization providers (Bach AT, Goad JA, 2015). The profession of pharmacy can look to existing best practices and successful models to provide vaccines having multiple doses or short follow-up requirements to identify methods for improving HBV vaccine services in the community pharmacy setting. Freeland C and Ventricelli DJ 2020 reports such methods as including different reminder options, like creating an order for follow-up doses when the first dose is administered, providing patient reminders through smartphone applications or text messaging, and aligning future vaccine dosages with medication synchronization models. It is reported that these are currently being practiced in the USA for chronic disease management which we posit can be applied for the community pharmacies’ ability to provide the full HBV vaccine series to their patients. The pharmacists’ long-standing history of involvement with vaccine storage, preparation, distribution, education, and, in more recent years, as immunization providers themselves, lends support to their ability to provide this public health service (Pringle JL et al, 2019)

CONCLUSION

Pharmacists have an opportunity to save lives and advance the profession by

embracing the task of reducing HBV incidence in Nigeria by evolving their current practices to align with current international best practices. They already have patient goodwill in terms of previous involvement in chronic disease states which can be translated in curbing the menace of HBV rise among the citizenry.

*Tang’an Zughumnaan Bitrus and *Michael Danzaria.

*Clinical Pharmacist at Federal Teaching Hospital, Gombe Nigeria.

Correspondence should be addressed to Michael Danzaria:

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