Manipur: National Viral Hepatitis Control Programme more accessible with increase of its implementation centres

Contributing its role to achieve the target of elimination of viral Hepatitis B and C by 2030 set by World Health Organization (WHO), the Manipur government had strengthened its National Viral Hepatitis Control Programme (NVHCP) by expanding its implementation from hospitals to healthcare centres.

Viral Hepatitis B and C are highly co-infectious diseases to people living with HIV and AIDS and vulnerable to people who inject drugs. Manipur, being a state with a high number of injecting drug users and a high prevalence rate of people living with HIV and AIDS, NVHCP is unable to implement at a wider scale due to the COVID-19 pandemic. But with the decrease in COVID-19 cases, the health department had geared up to reach the benefit of NVHCP in every part of Manipur.

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In an exclusive interview with this reporter, the state nodal officer of NVHCP, Dr RK Rosie said that like other states of India, NVHCP was also implemented in Manipur in 2019. Initially, it was implemented only at Jawaharlal Nehru Institute of Medical Sciences (JNIMS) and Regional Institute of Medical Sciences (RIMS) whereby setting up Model Treatment Centres. But now the said programme is also made availing not only at the hospital level but also at primary health centres (PHC) and community health centres (CHC). 

She said that under the directives of the Ministry of Health and Family Welfare, implementation of NVHCP was started in all districts of Manipur in phase wise manner. After implementing the programme at RIMS and JNIMS, it was executed in all 16 districts of Manipur at its concerned district hospital. 

Rosie continued and informed that besides hospitals, free treatment service for Hepatitis B and C under NVHCP has started providing in PHC Bashikhong, PHC Keirao Mateng and PHC Sawombung in Imphal East; CHC Sekmai, CHC Wangoi and CHC Khumbong in Imphal West; CHC Yairipok in Thoubal district; CHC Nambol under Bishnupur district; PHC Komlathabi in Chandel district; CHC Singhat in Churachandpur district; PHC Oinamlong in Tamenglong district; sub district hospital Mao in Senapati district; CHC Somdal in Ukhrul; CHC Sugnu in Kakching; CHC Nungba in Noney district; CHC Saikul in Kangpokpi district and PHC Tengnoupal in Tengnoupal district. 

She said that early detection of viral Hepatitis status is the best method to stop the spreading of this disease. With this view, the NVHCP implementation centre has been increasing to get the free service with ease. 
 
In PHC and CHC, only screening facilities for Hepatitis B and C are being provided so far. However, within a few months, treatment will also start as training for healthcare workers is completed. Once both test and treat services are started in PHC and CHC, the inconvenience face by patients from far-flung areas to avail of this free treatment service will be reduced to some extent. This will surely help to figure out patient who are infected with Hepatitis B and Hepatitis C, she added.

Rosie continued and explained that though there is a decentralization of NVHCP at district hospital, PHC and CHC but only uncomplicated patient will be treated in this health centres. All the complicated patient should compulsorily get their treatment service from Model Treatment Centre RIMS and JNIMS. 

Stating about viral load testing, she said that treatment of a patient has to be started based on result of viral load testing which is conducted after screening. Earlier viral load testing was done only at RIMS and JNIMS through Real-Time reverse Transcription-Polymerase Chain (RT-PCR) but this testing service are also started at District Hospital Churachandpur, District Hospital Chandel, District Hospital Tamenglong, District Hospital Jiribam and District Hospital Ukhrul through TrueNAT.

This viral load testing facility will be made available in Moreh Primary Health Centre, District Hospital Bishnupur and District Hospital within few months. Training for health care workers who will facilitate this service was also completed, she added. 

Rosie said that NVHCP was implemented in Manipur in 2019 but unable to execute effectively due to COVID-19 pandemic. With the decentralization of this programme at district and sub district level, its coverage has been increased tremendously. 
In the beginning NVHCP provided test and treat service only for Hepatitis C. And for Hepatitis B only screening was done but from July 2021, treatment was included. Just from March 2022 to March 2023, the number of patients screened for Hepatitis C was 47,000. Out of it, 3000 of them tested positive. Among this 3000 positive patient, 1800 are eligible for treatment according to result of viral load testing. All this 1800 patient had initiated the treatment. Of them 1300 had successfully completed their treatment course. 

About Hepatitis B, as many as 39,000 patients were screened. Out of it 469 had tested positive and amongst them 262 are eligible to begin treatment based on viral load testing. All of them had started their treatment, she added.
 
Explaining about differences of Hepatitis B and Hepatitis C, she said that hepatitis B is preventable through vaccination but the treatment is lifelong once it is infected to keep the virus under control. In the case of Hepatitis C, there is no vaccine yet it is curable through proper treatment. 

Viral Hepatitis is an inflammation of the liver that can lead to liver cancer or scarring of liver. Hepatitis B and C remain asymptomatic until had already wreaked havoc on the liver. As such these viruses are regarded as silent killer, she informed. 

She said that Viral Hepatitis B and Care spread through contact with infected blood or bodily fluids. This can happen during sharing of needles and other personal items such as razors and toothbrushes and unsafe sex and from infected mother to a baby during childbirth. 

The total infection rate of Hepatitis B is higher than Hepatitis C in the world and in India as well. The number of persons contracted by Hepatitis B and Hepatitis C in the world is 269 million and 58 million respectively. While in India, 40 million are infected by Hepatitis B and 6-12 million by Hepatitis C. But in the case of Manipur, positivity rate of Hepatitis C is higher than Hepatitis B, she added. 

She also said that Hepatitis B and C are co-infectious disease of people with HIV and AIDS, the state health department in association with Manipur State AIDS Control Society has taken up measures to detect prevalence of Hepatitis B and C among this vulnerable group. 

Hepatitis B vaccination for high-risk group like injecting drug users, man having sex with man, health care worker, PLHIV etc, she stated while appealing to people of the state to come forward for early detection of Hepatitis B and C status as their contribution to eliminate viral Hepatitis by 2030 successfully.