How needle sharing, risky traditions are fuelling hepatitis crisis

Dr Nazila Ganatra, Head of Viral, Hepatitis and Sexual Transmission Infections NASCOP, during a past event. [File, Standard] At just 36 years old, Neema Said has lived through pain that could break anyone. A recovering drug addict and a mother, her life once teetered on the edge of ruin. Alone, rejected, and battling internally. "I was injecting heroin for four years," she recalls. "It destroyed me. I lost my dignity, my health, and suffered discrimination, even from my own family and peers." Her turnaround began when a fellow addict introduced her to Reachout Centre Trust, one of rehabilitation centres transforming lives by eliminating hepatitis C, in Mombasa County. Through counselling and the methadone programme, Neema slowly began to heal. Sadly, during rehabilitation, she got pregnant and would be screened positive for hepatitis C. For a moment, her world shuttered. "My heart sank when I tested positive for hepatitis C. My mind was in turmoil. I thought it was only a matter of time before death caught up with me," she narrates her encounter. "I had lived a reckless life as a drug addict. Sharing needles was the norm. Many of my peers were also battling the disease." Though shaken, Neema held on. She began treatment and, after three months, was cured of the virus. Her survival became her turning point. Today, Neema is among the celebrated women in the Coast region championing the elimination of hepatitis C through grass-roots advocacy. As Kenya joins the rest of the world in commemorating World Hepatitis Day, Neema is using her voice and lived experience to advocate for increased screening, treatment, and rehabilitation - particularly among people who inject drugs, the group most vulnerable to hepatitis C due to shared contaminated needles. Her role is in line with this year's theme ''Let's break it down calls for urgent action to dismantle the financial, social and systemic barriers that stand in the way of hepatitis elimination and liver cancer prevention". "Women must be each other's gatekeepers," Neema says. "Hepatitis isn't the end. I want to be a woman leader for women, by a woman." At Reachout, clinician Sammy Langat, who oversees the hepatitis programme, notes that more than 400 people have been screened since 2021. Of these, 90 tested hepatitis C positive, most of them former injecting drug users. "The burden of injecting drugs is heavy. It worries that addicts share contaminated needles, leading to high spread of the virus," Langat admits. With only four years shy to Kenya's target of eliminating hepatitis by 2030, use of contaminated needles remain a hitch in achieving the targets. Globally, about 304 million people are living with viral hepatitis B and C. In Kenya,hepatitis B and C viruses are endemic, with a prevalence of three percent for hepatitis B, while hepatitis B and HIV co-infection stands at 4.9 per cent, with in-hospital settings being 53 percent. Prevalence of hepatitis C among the general population is estimated to be at between 0.2 to 0.9 per cent. Hepatitis is categorised into A, B, C, D, and E, according to Dr Nazila Ganatra, Head of Sexually Transmitted Infections and Hepatitis Unit at National Syndemic Disease Control Council (NASCOP). Hepatitis B and C she says are more severe in human and lead to chronic liver disease, cirrhosis and hepatocellular carcinoma. "Hepatitis C in Kenya is more prevalent among the people who inject drugs with an estimated antibody prevalence19- 25.9 percent in Nairobi and the Coast region with a Polymerase Chain Reaction (PCR) positivity ranging from 52 to 62 per cent," says Ganatra. Similar to the global scenario, hepatitis in Kenya is disproportionately distributed within counties and population. Geographically, Turkana, Baringo, and Migori exhibit particularly high hepatitis B, at 16.8, 11.9, and 10 per cent respectively. Omu Anzala, a virologist at the University of Nairobi, explains that hepatitis istransmitted in different modes namely sex, injection of contaminated sharp objects like needles, breastfeeding, mother to child at birth, and contamination of blood products. In some counties like Baringo, transmission of the disease is linked to cultural practices like piercing of ears. "If people use unsterilised needles, have unprotected sex, they risk acquiring Hepatitis," says Prof Anzala. However, hepatitis C, unlike hepatitis B is treatable. "Treatment and prevention of hepatitis C is available. People should get tested," adds Anzala. "Ideal way of handling hepatitis C is get tested as early as possible, and if someone in a household gets infected, we need to have other members screened, and if positive, start treatment,". Though early diagnosis is encouraged, Ganatra notes that hepatitis C infections are often asymptomatic, making early diagnosis rare. Chronic hepatitis C infections may go undetected for decades until significant liver damage occurs. Hepatitis C diagnosis involves two key steps - first, a serological test to detect anti-hepatitis C antibodies, which indicates past exposure to the virus. This is followed by a nucleic acid test (NAT), commonly known as a PCR test, to detect hepatitis C (Ribonucleic Acid)RNA, and confirm an active or chronic infection requiring treatment. But Ganatra says about 30 per cent of people clear the infection naturally without treatment, although they will still test positive for anti-hepatitis C antibodies. Further, scientists have developed new diagnostic tests, like the hepatitis C core antigen test, to simplify the diagnostic process. "Once a patient is diagnosed with hepatitis C, an assessment of liver damage (fibrosis or cirrhosis) is essential to guide on treatment," explains Ganatra. The preferred drugs for treatment of hepatitis C are the DAA (direct acting anti-virals). The drugs are used in combination to give an optimal viral load suppression, with cure rates of 97 per cent. Hepatitis B is preventable through vaccination and there are treatments available for hepatitis C that have a 95 per cent cure rate given for 12 weeks. "The Ministry of Health offers three dose primary series of Pentavalent vaccine at 6, 10 and 14 weeks respectively," says the official noting that Hepatitis B birth-dose vaccine is yet to be adopted in the Kenya Essential Package of Immunisation schedule. Amid measures set by ministry through NASCOP and partners, use of drugs and substance in the country remains high, risking spread of Hepatitis. Data by the National Authority for the Campaign Against Alcohol and Drug Abuse (Nacada), shows that at least one in every six Kenyans aged 15 and 65 years, representing 4.7 million use at least one drug or substance of abuse. Men are disproportionately affected, with one in every three males actively using drugs, compared to one in every 16 females. The Coast region, where heroin use and needle sharing are prevalent, has among the highest rates of multiple drug use at 10.5 per cent, followed closely by Nairobi and Central regions. The report also indicates alarming increases in the use of cannabis, which has nearly doubled in the last five years, with Nairobi, Nyanza, and Coast recording the highest prevalence. Cannabis use has also increased by 90 per cent in the last five years - with Nairobi leading in usage. Rev Wangai Gachoka, the manager of Miritini Rehabilitation Centre of Excellence and Coastal region coordinator for Nacada says the entity in collaboration with NASCOP and NSCDD, runs a harm reduction program that includes distributing clean needle and syringes, offering methadone, and providing free condoms. The goal of the program is to reduce infections of Hepatitis, HIV among other diseases, in addition to support for recovery of addicts. "A lot of drug addicts like cocaine and alcohol consumers highly acquireh epatitis, but highest contributor to the disease is sharing of needles," says Gachoka. "If someone who is infected with Hepatitis inject drugs and share contaminated needle, they highly transmit the disease". Nacada through Miritini Rehabilitation Centre of Excellence currently supports at least 359 individuals on methadone treatment daily, with some infected with Hepatitis Cm as a result of injecting needles. At the rehabilitation center, recovery addicts receive a wide range of care ranging from treatment of Hepatitis C and B, antiretroviral therapy (ART), PrEP, and treatment for TB and malaria. At the center Naomi Phenny, a compliance officer, working at Miritini Modern Centre of Excellence, Nacada, explains that the most common way of transmission of Hepatitis C among recovery addicts is injection of needles. At the unit, individuals who presents with bruises, fatigue, weight loss, low appetite, and dark or reddish urine colour, abdominal pain, and itchy skin for heroine users are screened for Hepatitis C. The first test they are subjected to is an antibody tests, liver functioning and PCR. Those who test positive after PCR are initiated for Hepatitis C treatment for three months. "If a patient tests positive for antibodies, they are further subjected to PCR, they are then put on treatment," says Phenny. She adds, "Treatment of Hepatitis C takes about 8 to 12 weeks. We keep a patient for about three months before allowing them to go home, because majority default, and risk infecting others," adds penny. Patients are put on Sofasbuvir and Valpatasvir, for three months and a follow-up of PCR tests done. This is to ensure that an individual is free from Hepatitis C. Defaulting on treatment also risks liver chlorosis, more so among alcohol users. With support from Nacada, Ministry of Health and donors, patients access free treatment at the unit. "Treatment of Hepatitis C is expensive-$78,078 (Over Sh10 million, per person for 3 months, charges that majority of drug addicts cannot afford. Luckily, through well wishers, they get free treatment," says the official. Apart from treatment, Ministry, NACADA and donors are distributing free needles and syringes to stop spread of Hepatitis C, and other infectious diseases. Further, the health professional pleads with individuals at risk of Hepatitis C infections to go for Hepatitis C vaccination. At the centre Health and Science meets Brian* Mtwapa in Kilifi District, Mombasa County who carries the weight of a life shaped by early hardship and addiction, but also, today, a life marked by resilience and hope. Brian's battle with heroin addiction began when he was only 10 years old. Forced to drop out of school in Standard Three due to lack of school fees, he started working for drug traffickers, packing heroin smuggled in from a neighbouring country. Curiosity soon led him to try the drug, a decision that spiralled into daily dependence. "I started using heroin when I was about 10," Brian recalls. "Instantly, I got hooked. I injected the drug through veins in my head, hands and legs." For the 46-year-old addiction escalated quickly, with Katana using up to two grams of heroin a day. Aggressive injection practices led to severe vein damage and infections, eventually requiring surgery. Repeatedly sharing needles also exposed him to Hepatitis C infection that he was treated, and recovered. "When you're intoxicated, you don't think about whether the needles are safe," he says. "All I cared about was getting high, but it cost me my health. I ended up contracting Hepatitis B." Now undergoing treatment and rehabilitation, Brian is focused on healing, and on helping others understand the devastating consequences of drug abuse. Anzala notes that all needles are disposable- "used once and discarded". Current syringes and needles he says cannot be sterilised unlike in the past, "they are all plastic, cannot be sterilised for re-use. They have no ability to sterilise". The virologist who has been in virus research however regrets that whereas needles are single use, drug addicts are using them, risking transmission of pathogens carrying Hepatitis C, B and HIV. A number of drug users collect syringes and needles in hospitals waste. To avoid such, hospitals are encouraged to incinerate its waste. "Nobody in any hospital reuses needles the places where. But we are witnessing young men addicted to drugs hiding on streets, injecting themselves," regrets Anzala. "They re-use needlers, enhancing HIV infections, hepatitis b, c and other pathogens found in blood". A person who injects drugs he explains has possibility of transmitting blood that contributes to Hepatitis C transmission. "When you inject yourself with in muscle and remove it, there is blood left in the syringe. It is direct exposure to infections. The needle might be caring blood," explains Prof Anzala.

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