See one, do one, teach one

Dr Jerome Liwakala Siyambu was a medical officer at Maina Soko, a referral hospital in Lusaka within the Zambian Defense Force (ZDF). ZDF serves about 20,000 active members of the military and another 100,000 dependents in Zambia. As a medical officer, Dr Siyambu cared for many patients with hepatitis B; however, he had never received any formal training in that area; instead, he relied on Medscape, Uptodate, and any pocket medical handbook he could find. Even within Maina Soko, there was no local expert in hepatitis to turn to consult. In 2021, he learned about the ACCELERATE programme, and got in touch with its directors, who invited him to begin to attend weekly hepatitis clinics at UTH and period lectures. He became a regular at  the “Hep Clinic”, where he took care of 5-8 patients living with hepatitis B or C each week. After collecting the history, reviewing the file, and performing a physical examination, Dr Siyambu discussed each case with his supervisor, an hepatitis expert.

 Through 20-30 patients, he learned about the challenges implementing WHO HBV guidelines, the tension of not knowing if an HBV-positive pregnant had a high viral load or not (the strongest predictor of transmission to the baby), and the importance of assessing hepatitis comorbidities like diabetes and alcohol use, which can accelerate liver disease in people with HBV. In between hepatitis clinics, back at Maina Soko, Dr. Siyambu obtained permission to start a new HBV clinic there. Maina Soko is uniquely prepared to fight hepatitis as it has additional resources to procure testing kits, which limit other facilities in the country.

Dr Siyambu is now planning a campaign to screen all clients at Maina Soko for HBV, as they come to seek other services, and positives will be channeled to a new clinic that he will oversee. Dr Siyambu will also oversee training of hundreds of other health workers. As this unfolds, the ACCELERATE programme will also dispatch hepatitis experts to provide support. In addition, leadership of the Zambian Health Defenses, several top generals, have become aware of viral hepatitis and Dr Siyambu’s efforts, and have reached out on a high level to one of their donors, PEPFAR, to support them in these efforts. This story describes the catalytic nature of the Accelerate programme in Zambia. By developing a core group of experts, we had a wide impact in this area.

Accelerating the Hepatitis B response in Zambia (ACCELERATE)

Grantee: Hospital HIV AIDS Programme (UTH-HAP)

(UTH-HAP) started a “training of trainers” programme on hepatitis as Zambia had very few public health or clinical leaders prepared to train other health workers on viral hepatitis.  At the end of this project, 31 doctors were certified as hepatitis expert trainers. Before this programme, there were only five doctor experts in hepatitis in Zambia, making it virtually impossible to treat all the people in need.

UTH-HAP has also worked with hospital leadership to ensure the decentralization of testing to various points and the orientation of nurses to offering tests. More service delivery points, such as antenatal, sexually transmitted infection (STI) and antiretroviral therapy (ART) clinics and sites doing HIV testing, are now integrating hepatitis into their routine services. When kits are available, hepatitis testing can now be offered at any service delivery point by a trained provider.