Inadequate infrastructure is posing a challenge to effective implementation of the National Viral Hepatitis Control Programme (NVHCP) in Kangpokpi hill district of Manipur. The programme was launched in all districts of the state in 2020.
NVHCP was launched by the Government of India across the country with the objective to address the viral hepatitis problem which is considered as one of the major public health concerns.
The World Health Organisation (WHO) also set a target to eliminate the virus by 2030 for which it stated that “test and treat” is the only way to achieve it.
The NVHCP health service, however, is not easily accessible in Kangpokpi district, which is hampering the smooth implementation of the programme in the area.
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The number of people who inject drugs (PWID) in the district is reportedly rising but only a few of them are aware about the national health programme. This observation was made based on the opinion shared by PWID during the one-day HBV screening camp and vaccination camp held in Kangpokpi.
In a bid to reach out and raise awareness among the PWID, the camp was organised by the Community Network for Empowerment in association with NVHCP under the sponsorship of GILEAD Sciences on October 21 at the Primary Health Centre, Motbung.
As many as 31 PWID were screened for HBV in the camp and out of them, only one person was tested HBV positive.
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It was also observed that a majority of them had done the screening for the first time as they were not aware that screening for HBV is done free of cost.
In an interaction with NVHCP district nodal officer, District Hospital Kangpokpi, Lhingboi Haokip said that NVHCP was started in the district in September 2020, but the treatment of infected persons was yet to begin.
“Only screening for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) and treatment of uncritical HCV is provided so far. Treatment for HBV is yet to begin,” Haokip told the Imphal Free Press.
The nodal health official said that since 2020 till date, as many as 2,500 people had been screened for viral hepatitis B and C in Kangpokpi district. Of them, 15 people tested HBV positive and as many as 30 per cent of them tested positive for HCV.
According to the viral load count, only two of the 15 people who tested positive for HBV are eligible for treatment.
“As District Hospital Kangpokpi does not have treatment facilities for HBV and critical HCV, the hospital authority has linked those two patients to the Model Treatment Centre of Jawaharlal Nehru Institute of Medical Sciences,” Lhingboi Haokip added.
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When asked, Lhingboi explained that due to absence of adequate infrastructure and manpower, treatment service for HBV and HCV could not be started in the District Hospital Kangpokpi. This has led to the poor implementation of NVHCP in the district, she said.
“Test and treat is the key to eliminating viral hepatitis. But unfortunately in the district hospital, only screening service is provided and for treatment, patients have to go to other hospitals where they could access such service. Such kind of service often results in the patient quitting and leaving the treatment incomplete,” the nodal officer said.
Stating the futility of conducting testing and screening of PWID without following up with proper treatment, she said, “A majority of PWID come from economically weak background and are usually unable to afford their travelling cost to other districts or to capital Imphal for treatment. Hence, the programme would be more effective if there is a treatment service in Kangpokpi district hospital and is easily accessible”.
The nodal officer further said that driven away by the fear of stigma and discrimination, PWID hardly come for screening voluntarily.
She informed that there are four screening centres for viral hepatitis in Kangpokpi, excluding the district hospital. They are Primary Health Centre Motbung, Primary Health Centre Kalapahar, Primary Health Centre Gamphazol and Community Health Centre Saikul, she said.
The screening service will also begin in some other health and wellness centres in Kangpokpi district soon, she added.
“Kangpokpi district is one of the districts in Manipur that has a high number of PWID. There is an urgent need to provide infrastructure required for efficient implementation of NVHCP in the district,” she suggested.
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One of the PWID, who came for HBV screening at PHC Motbung, named Tomba (name changed) revealed in an interaction with the Imphal Free Press that he has been consuming drugs for almost 10 years and is aware of all diseases associated with it and which most IDU suffer from. However it is his first time going for Hepatitis B screening, he said, citing negligence on his part that kept him deferring it.
“I started indulging in drug abuse in 2012 through the influence of peer and unable to quit till date. Through friends and families, I learnt that the likelihood of contacting HBV is high among PWID who share contaminated needles (syringe). Owing to lack of health-seeking behaviour, I did not go for screening of HBV earlier,” he added.
Another PWID, who is in his forties and took part in the health camp, also revealed that he did not have any knowledge about NVHCP and the significance of Hepatitis B vaccination earlier.
“This is my first time undergoing a test for HBV and I feel lucky to be part of this free HBV screening camp. I came to know about this camp through my friends. There is a need to scale up the awareness programme on NVHCP in the district,” he suggested.
He said that he has been hooked to drugs for more than 15 years and the problem of drug menace is gradually rising in the district. Many young children starting from 15-16 years are seen using psychotropic substances, he said.
“There must be many IDUs in Kangpokpi district like me, who might not be aware about NVHCP and the importance of early detection of HBV and HCV,” he said.
According to the WHO, hepatitis is a viral infection that attacks the liver and can cause both acute and chronic diseases. The WHO report estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year. Majority of the population do not know their hepatitis status as the symptoms usually reveal when the infection gets acute.
Opting for early testing, vaccination and treatment is the only way to stop further spreading of the infectious virus. This year, WHO observed World Hepatitis Day 2022 with the message of providing easy accessible viral hepatitis screening and treatment service.
Considering the ineffective implementation of NVHCP in Kangpokpi district with inadequate infrastructure, many infected people might have been left out for treatment and many might not be aware of their Hepatitis status till today.
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