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Peers' experiences key in hepatitis interventions for high-risk groups

The peer-led model is important for the success of initiatives to eradicate hepatitis in populations with high-risk behaviours.

At a round table discussion of representatives from government, clinicians and people living with hepatitis from Kenya and South Africa, the inclusion of the people from key populations who engage in high-risk behaviour for contracting the disease was identified as key to the success of eradicating it.

South Africa has one of the highest hepatitis C prevalence globally with at least 600,000 persons affected in general population, a concentrated HCV epidemics among People Who Inject Drugs (PWID) in major metropolitan areas, with HCV viraemic prevalence ranging from 28% in Durban to 93% in Pretoria, according to studies done in 2017. In 2016, the World Health Assembly endorsed the elimination of hepatitis as a public health threat by 2030. South Africa committed to the WHO 2030 targets by developing and approving the national clinical guidelines and Action plan for Viral hepatitis in 2018.

The guidelines also call for the expansion of access to screening, diagnosis, and treatment of Hepatitis in PWID, including needle and syringe services for people who inject drugs (PWID). In South Africa and in Kenya, organisations that provide harm reduction services, opioid substitution therapy and fresh needles, to people who use drugs have employed a peer-led model in their initiatives to slow down the transmission of hepatitis in this population. The model trains people from the community with shared lived experiences on how to educate others to avoid the disease and assist them manage their treatment, with their first-hand knowledge for having been through it.

These organisations have found that peers are better placed to reach out to people in their own communities, to build trust and provide support that these people may not always get when seeking treatment, which undermines their adherence to treatment. Richard, a peer educator from Kenya, found that he was able to connect with people from the community because “as a person who has undergone treatment, I use my own story to educate and encourage them to seek hepatitis services. I use my own experiences to sensitise them to modes of transmission, the risk factors associated with sharing injecting paraphernalia”. He suggested that other peers can “use their own stories to breakdown the myths and misconceptions that surround hepatitis C. By speaking out they’ll encourage the others to come out from the closet and to start living positively”.

The success of the peer led model needs the support and respect of clinicians as Koketso Mokubane, a community linkage officer for the South African Network of People Who Use Drugs (SANPUD), who also has lived experiences with using drugs and going through hepatitis treatment in Pretoria has found. He says “if clinicians have been trained and sensitised to not just treat the community as key population, the number of us who seek treatment would increase. At the moment, we find that because they just treat us as key populations, so not many of us are seeking health care services on a primary level, because we know, we get stigmatised, we get discriminated, because no one understands us, no one understands where we come from”.

Over and above providing information about the disease, clinicians can also provide a safe space to encourage disclosure and for people to share stories which can be a way of supporting community engagement and advocacy. Dr Wanda Abuelhassan, gastroenterologist, Johannesburg, South Africa, suggested that clinicians should allow time for people to tell their stories; it helps to alleviate their fears and some of the stigma. “When we first started treating hepatitis, we were treating people with medication that had a multitude of side effects. It was a small clinic and patients used to sit in a lounge and share some of their stories, creating a support group among themselves. They would come and tell us “so and so doesn’t look like himself today or so and so didn’t come”.

In Mombasa, clinicians have found that community engagement through the peer-led model by the organisations already dealing with people who use drugs has made it easier to reach people who may be infected with hepatitis, and they have seen high rates of adherence to treatment. According to Dr Mohammed Mwakazi, clinical officer and community development expert in Mombasa County, Kenya, “the methadone clinics actually do their engagement in the community, and we work very close with them to ensure that we can reach the client, sensitising them on hepatitis and treatment. This has really assisted with the collaboration within the clinic and the community, and we have seen those clients already on the treatment are starting to recommend it to others”.

Issued to mark World Hepatitis Day (28 July), commemorated by the International Network of Health and Hepatitis Services in Substance Users hosting a round table of government representatives, clinicians and people living with hepatitis.

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