The National Viral Hepatitis Control Programme (NVHCP) implementation at Chandel District Hospital, Manipur was severely impacted, much like how the recent COVID-19 pandemic forced other illnesses to take a back seat.
However, despite it being crippled by issues with inadequate staff and equipment, the hospital has now begun concentrating on providing NVCHP in full swing as the district is reportedly facing an increasing number of drug users in recent years.
It may be mentioned that Hepatitis B and C are common co-infectious diseases among injecting drug users (IDU), especially those who share syringes, needles, and other dosage-fixing equipment.
Manipur, one of the states with high rate of IDUs in India, rolled out NVHCP way back in 2019 with the target of Hepatitis elimination by 2030. But viewing the implementation momentum of the programme, achieving this target appears a farfetched dream.
There is a need for constant mobilization of the NVHCP programme to scale up awareness level to push up the test and treatment of Hepatitis B and C in the state.
When Imphal Free Press visited the district recently to cover the situation firsthand, many drug users from the district told this reporter that the drug problem had gotten worse even after the state government declared a war on drugs. However, church leaders and community organisations from the district had stepped in to help control the situation.
In an interaction with the drug users, it was found that most of them were aware that the NVHCP was launched at Chandel District Hospital, but due to the lack of proactive health behaviours, they did not make much of an effort to get tested.
District Nodal Officer of NVHCP, Chandel District Hospital, Deben Laishram told the Imphal Free Press that NVHCP was rolled out in Chandel District Hospital in January 2020 but due to recent COVID-19 pandemic, the hospital was unable to implement it properly for nearly two years. But as everything comes to normal and with installation of viral load testing kits in the hospital, they are now able to deliver NVHCP better than before, he said.
Hepatitis B and C viral load test has been conducted every Friday since this September (2022). At least five to six viral load tests can be performed in a single day, Laishram said. He said that the use of viral load testing tools is crucial to determining who is eligible for hepatitis treatment after receiving a positive Hepatitis B or C test. Many people with Hepatitis B and Hepatitis C had previously been unable to receive treatment after testing positive due to the lack of this equipment.
Testing and treatment for Hepatitis C started in the hospital from 2020 onwards, he said. So far, as many as 10 people have been treated and four are under treatment. For Hepatitis B, service for only screening was provided. But, hospitals can start giving treatment for uncomplicated patients. But not a single person is eligible to begin treatment yet, according to a viral load test.
Mentioning about Hepatitis screening conducted so far, he said that in the context of Manipur, Hepatitis C cases are usually higher than that of Hepatitis B.
Mass screening campaign was carried out at Chandel District Hospital last August 31. In the camp, as many as 54 people turned up for testing. Of it, 10 people tested positive for Hepatitis C and the number of Hepatitis B reactive was five.
In 2020-2021, 623 people were screened for Hepatitis B from the general population and out of it, 26 of them tested positive, he said, adding that the number of people screened for Hepatitis C was 630 and 24 of them tested positive.
The number of pregnant women tested for Hepatitis B was 81. Of them, four tested positive, he said. In the case of Hepatitis C, it was 74 and out of it, one tested positive, he added.
In 2021-2022 (till April), 81 people were screened for Hepatitis B from the general population and out of it, 30 of them tested positive. For Hepatitis C, the number of people screened from the general population was 1077 and out of them, 44 tested positive, Deben said.
In the case of pregnant women, 89 women were screened for Hepatitis B and out of them, six tested positive. Whereas for Hepatitis C, 87 women were screened and two of them are tested positive, he added.
He said, as these screening was done during COVID-19, maximum of them did not come for viral load testing. This is why not a single eligible person has been found to begin Hepatitis B treatment yet.
Hospital authorities are aware that those who could not follow up for treatment are vulnerable to spread virus. However, they are facing difficulties in tracing them down for resumption of treatment as their contact numbers usually do not work, he added.
Free vaccination for Hepatitis B is provided only to healthcare workers. Since the launching of the programme in 2020 till August 2022, as many as 174 healthcare workers have been vaccinated with the first dose, 101 with second dose and 60 with third dose.
In an interaction with Jina (name changed), one of the female injecting drug users from Chandel, said that she gets to know about the vulnerability of Hepatitis B Virus to IDUs from her peer group. However, her understanding of HBV is not thorough, which was the reason for the delay in her getting HBV vaccination.
Jina, who is currently pursuing Bachelor of Science in third semester, said that she started using drugs in the last three years due to the influence of male friends.
When she first started abusing drugs, she paid little attention to blood diseases like HIV/AIDS, Hepatitis B and C, etc. that are primarily spread by IDUs. She began to get tested for the majority of infectious and co-infectious diseases that are spread through the sharing of needles, syringes, and other items while setting doses, but she later regretted becoming a drug addict.
“I have tested HIV and AIDS negative. Some months ago, I tested for Hepatitis C and then Hepatitis B. The results of these both tests also came negative. Though I have become a drug addict, I always try to take a fixed dose with enough care so that I don’t get infected by any diseases from others or vice versa,” she said.
She said she was already aware of the National Viral Hepatitis Control Program's implementation in Chandel district hospital. But she never visited the hospital despite being curious about her HCV and HBV status.
Both tests are done during a mass testing campaign carried out by a community-based organisation, she said. “Because of discomfort, I hesitated to get tested in hospital. So, I always try to get support from CBOs,” she added.
Another client, with more than 10 years of drug addiction, said that he knew about NVHCP clearly and its implementation in Chandel District Hospital as well. Suspicion of Hepatitis B and Hepatitis C infection made him to screen for both infections when NVHCP was launched in the district hospital. He was relieved that both the results came negative.
The IDU further said he had tested a second time for Hepatitis B and Hepatitis C recently in one of the testing and vaccination campaigns organised by some NGOs. In that testing, the result for Hepatitis C came positive though and Hepatitis B was negative. To prevent getting infected with Hepatitis B virus, he had administered Hepatitis B vaccine during the camp, he said, adding that he was not aware about the significance of the vaccine earlier.
He said that drug menace in the district has been increasing gradually. Children below 18 years of age have started directly using injecting drugs to get euphoria, he added.
Observing the prevailing scenario of drug issues in the district, there is a need for strengthening NVHCP implementation as many drug users in the district are still not aware about it.