By Ethan Covey
The first Hepatitis Delta Global Landscape Survey, produced by the World Hepatitis Alliance (WHA), has found that significant knowledge gaps, inequities and systemic barriers are impeding the global fight against hepatitis delta virus (HDV).
HDV, which occurs in people with hepatitis B, affects an estimated 12 million worldwide; leads to faster disease progression; and greatly increases the risk for liver cancer and death.
The survey includes responses from 583 individuals in 102 countries and included perspectives from healthcare providers (HCPs), community-based organizations and policymakers.
The Unknowns
Lack of knowledge regarding HDV was the most commonly reported barrier to both testing and treatment. Although 31.8% of respondents said they were “moderately familiar” with HDV, 20.2% reported being “not familiar at all,” and another 18.2% reported being “slightly familiar.”
HCPs were the most familiar with HDV. However, 1 in 6 HCPs said they were “not at all familiar” with the virus. More than one-third of policymakers reported being “slightly or not at all familiar” with HDV, as did nearly one-half (49.1%) of community-based organizations.
Testing Access Denied
Confusion regarding HDV testing was widespread. More than 40% of survey respondents indicated that they had problems accessing testing: 13.9% said testing was not available in their country, and 27.3% did not know whether it was available.
Only 39.3% of respondents who said testing for HDV was available in their country reported that it was easily accessible. This inequity varied significantly, with only 21.5% in Africa and the Middle East indicating that testing was easily accessible (the lowest percentage), compared with 55.7% in Europe and Central Asia (the highest percentage).
A general lack of knowledge regarding HDV was the primary reason given as a barrier to testing for the virus (60.9%), followed by concerns about direct costs to individuals, such as testing, treatment and professional fees (32.4%).
Access to treatment for HDV is also severely lacking, with only 19.6% of those who participated in the survey stating that treatment was both available and accessible. Thirty-one percent noted that treatment for HDV was available in their country but only accessible in specific areas or cities. The most commonly indicated barriers to treatment were lack of knowledge (54.2%), direct costs (38.7%), lack of specialists providing HDV treatment (27.6%), lack of knowledge among HCPs (27.3%) and lack of public health policies (26.3%).
‘An Urgent Need’
Overall, the specifics regarding testing and treatment were not commonly understood. Of note, 1 in 3 survey respondents said they weren’t sufficiently informed to identify barriers to either HDV testing or treatment.
These knowledge gaps, the authors of the report said, highlight the need for culturally competent awareness campaigns aimed at informing individuals living with hepatitis B of the need to test for HDV.
Addressing these barriers will necessitate coordinated efforts to address education and training for HCPs, awareness for both community members and individuals with hepatitis B, and adopting policies to meet WHO recommendations on reflex testing for HDV.
“These findings highlight an urgent need for coordinated action to scale up hepatitis delta education, diagnosis and care,” said Cary James, the CEO of WHA. “Without informed providers, empowered communities and accessible health services, millions will remain undiagnosed and untreated.”
Mr. James reported no relevant financial disclosures beyond his stated employment.
