The Southeast Asia Region, meanwhile, has made notable progress in hepatitis prevention in line with the Regional Action Plan for Viral Hepatitis 2016-2021. For instance, nine of the region’s 11 Member States have achieved coverage of more than 90% of the third dose of hepatitis B vaccine. Four countries – Bangladesh, Bhutan, Nepal, and Thailand – have reached the hepatitis B control targets. However, during the seventy forth session of the WHO regional committee adopted a decision to develop an integrated action Plan for viral hepatitis, HIV and sexually transmitted infections for 2022 -2026 (I-RAP) to bring together common strategies, actions and specific targets across health systems to promote synergies in the effective prevention, diagnosis and treatment of three communicable diseases including Hepatitis in a patient -centered approach. This I- RAP attempts to bring the gap between previous regional action plan (2016-2021) and the SDG 2030.
Five core strategic directions are set to achieve the targets of hepatitis by each member states. The WHO, which closely monitors the progress across this plan, commits to advocate and provide technical support to national programmes to achieve the national targets.
1. Deliver high quality, evidence -informed people centered services
3. Generate and use data to drive decisions for actions
4. Engage empowered communities and civil society
5. Foster innovations for the impact
With the introduction of a safe and effective vaccine in 1982 globally, immunization against hepatitis B became the major prevention strategy. Immunization resulted in prevalence rates of chronic infection among children falling to very less numbers. Sri Lanka, however, is reportedly a hepatitis B low-prevalent country. Hepatitis B vaccination was introduced to Sri Lanka’s Expanded Programme of Immunization (EPI) schedule in 2003. Since then, all infants in Sri Lanka are receiving three doses of hepatitis B vaccines. Data reported to the Epidemiology Unit of the Ministry of Health and district-level immunization coverage surveys indicate very high level of immunization coverage, with the pentavalent vaccine which includes hepatitis B had a coverage of 99% in 2019(2) This achievement is remarkable for a lower-middle income country like Sri Lanka.
In line with the global initiative to eliminate viral hepatitis by 2030, Sri Lanka aimed to achieve the 2020 hepatitis B control target and to ascertain the prevalence of hepatitis B among pregnant mothers as a proxy for the prevalence among the general population. To achieve these objectives, with the support of WHO Sri Lanka, a nationwide survey was carried out in 2022 as per WHO protocol using 1266 pregnant mothers and 2528 five-year-old children. None of the participants were found to be positive for hepatitis B. It demonstrated the low prevalence of hepatitis B in the country which was highlighted by the sample surveys carried out among high-risk groups. However, hepatitis C prevalence is around 40% among those who inject drugs in Sri Lanka, primarily in the urban capital of Colombo. the National STD/AIDS Control programme with the support of WHO initiated a community-based intervention targeting people who inject drugs under one roof. This include the delivery of evidence-based harm reduction services, such as Safe Needle Programme, Needle Syringe Exchange Services, safer drug use education, testing for HIV, hepatitis B, C, and syphilis, counseling services and hepatitis treatment services that are provided within the close neighborhood of people who inject drugs. With these initiatives, the Ministry of Health is planning to reach hepatitis elimination targets earlier than the stipulated time.
The Government of Sri Lanka has reaffirmed its commitment to reducing new hepatitis infections and accelerating hepatitis testing and treatment services with the integration with HIV and STI services and WHO stands ready to support the government in its efforts.