Nigeria’s hepatitis fight falters amid low testing, high costs

International Day: Nigeria’s hepatitis war falters amid low testing, high treatment costs, ignorance

• Over N500,000 hepatitis C bill shocks patients as country lacks 100 liver specialists
• 50,000-plus die yearly; states lack budget lines, actionable elimination plans
• 2030 elimination goal wavering without urgent action, Okinedo warns
• Experts propose integration into HIV/AIDS framework to curb epidemic
• Aloh advocates scale-up of vaccination, free screening, awareness

As Nigeria joins the global community to mark World Hepatitis Day 2025 today, experts have sounded the alarm over a worsening crisis. Millions remain undiagnosed, treatment costs are skyrocketing, and testing rates are dangerously low.

With hepatitis B and C claiming over 50,000 lives yearly, stakeholders warn that unless urgent action is taken, Nigeria will miss its 2030 elimination goal, leaving myriads of citizens at risk of liver failure, cancer, and preventable deaths.

Viral hepatitis, an inflammation of the liver, remains a major public health concern in Nigeria. If not properly treated, it can lead to serious complications, including liver fibrosis, cirrhosis, and liver cancer.

While hepatitis is often caused by viral infections, it can also result from non-infectious factors such as excessive alcohol consumption or certain medications. The disease can range from a mild, short-term illness to a severe, chronic condition that causes permanent liver damage.

About 21 million people in Nigeria are estimated to be infected with hepatitis. Of this figure, 18.2 million have the hepatitis B virus, while 2.5 million are infected with the hepatitis C virus.

According to the Centre for Disease Analysis Foundation (Polaris Observatory), 55,998 people die of the hepatitis B virus yearly in Nigeria, while hepatitis C accounts for 5,954 deaths each year.

The Nigerian National Hepatitis Elimination Profile (N-HEP) estimates that 14.3 million Nigerians live with hepatitis B. However, as of 2022, only 299,334 had been diagnosed, and less than one per cent received care between 2015 and 2022.

In the case of hepatitis C, where an estimated 27,596 new infections were recorded, only 265 individuals were initiated on treatment in 2022.

The World Health Organisation (WHO) observatory reported that in 2022 alone, Nigeria recorded 46,144 deaths attributed to hepatitis B; a mortality rate of 20.7 per 100,000 people.

Hepatitis C caused an additional 5,652 deaths, with a mortality rate of 2.5 per 100,000. The report also noted that over 90 per cent of people living with hepatitis C in Nigeria lacked access to essential care.

Although WHO recommends a vaccination coverage of 90 per cent, the N-HEP report showed that only 52 per cent of Nigerian newborns received the hepatitis B birth dose, while 62 per cent of infants completed the third dose in 2023: both figures falling short of the target.

The report attributes the low coverage to high rates of home births, limited vaccine availability in rural areas, and inadequate public awareness.

While Nasarawa State has made significant progress, screening over 85,000 people and treating 1,300 cases using a N40 million seed fund, most other states lack hepatitis-specific budget lines and actionable elimination plans. The report also noted that Nigeria does not currently operate a national monitoring system to track hepatitis diagnosis and treatment outcomes.

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Findings by The Guardian revealed that although it costs between N1,000 and N3,000 to screen for hepatitis B or C, respectively, a person who tests positive requires confirmatory testing to determine viral load, a key indicator of the risk of long-term liver damage. The cost of viral load testing in Nigeria ranges from N25,000 to N35,000.

In addition, patients require further assessments such as liver function tests, ultrasound scans, serum alpha-fetoprotein, full blood count, electrolyte panels, creatinine, and kidney function tests to assess the extent of liver damage.

These tests are also necessary for preparing treatment, as hepatitis medications are long-term and may affect vital organs. The total cost of these investigations ranges from N100,000 to N150,000 per patient.

The Guardian inquiry also revealed the high cost of treatment. A one-month supply of Tenofovir, the frontline drug for hepatitis B, costs around N18,000. For hepatitis C, the financial burden is far greater: curative treatment costs approximately N500,000 for a three-month course, excluding essential diagnostics such as viral load tests and liver imaging.

The treatment landscape is further constrained by a severe shortage of liver specialists—fewer than 100 nationwide—resulting in care being largely concentrated in urban tertiary hospitals, while rural communities remain underserved.

STAKEHOLDERS are calling for urgent action, including the establishment of a federal budget line for hepatitis, expansion of community awareness programmes, increased testing through multiple strategies, and making all testing and treatment services free for patients.

President of the Society for Gastroenterology and Hepatology in Nigeria, Prof. Abdulfatai Olokoba, told The Guardian that Nigeria belongs to the hyper-endemic region for hepatitis B, with a prevalence rate of about eight to 15 per cent.

However, the country falls within the low endemicity region for hepatitis C, with a burden of between one and three per cent.

He urged the federal government to address the increasing prevalence of viral hepatitis and liver cancer in the country, along with the associated impacts on the health and socioeconomic well-being of Nigerians.

Olokoba noted that access to care is limited, as it has become expensive to screen, diagnose, and treat viral hepatitis. He added that, because of the devaluation of the naira, the cost of test kits and drugs for treating viral hepatitis “has gone up astronomically”.

He observed that, due to the unavailability of liver transplantation services in Nigeria and the prohibitive costs associated with accessing such services abroad, the diagnosis, treatment, and management of viral hepatitis and liver cancer in Nigeria should be subsidised.

Olokoba stated that the treatment of hepatitis C in the past “used to be injection with Interferon and Ribavirin”, noting that a combination of Daclatasvir and Sofosbuvir is now being used to treat hepatitis C.

According to him, this combination drug “cost on average of about N80,000 to N90,000 for a bottle, which is for 28 days, and the patient is expected to take it for between six months and one year”, thereby bringing the cost of the drug to N540,000 for a six-month regimen and over N1 million for a one-year course per patient.

Olokoba explained that there is no cure for hepatitis B, even though “the drug is cheaper”, stressing that for hepatitis B, “an average cost of the drug, which will last for one month, is about N18,000 to N25,000 for a bottle”.

He said, “If you look at that cost, you agree with me that it may be beyond the reach of the average Nigerian, especially when you consider a country with a minimum wage of N70,000. But the good thing is that apart from the cost of treatment for hepatitis C, there is a cure for hepatitis C now.”

Olokoba pointed out that the treatment for hepatitis B is readily available, but it has to start with breaking vertical transmission from mother to child by identifying pregnant women who have either hepatitis B or C.

He observed that antenatal screening now includes screening for HIV, hepatitis C, and hepatitis B, and that “offers the opportunity to be able to break the vertical transmission from mother to child”, while “the horizontal transmission is still there”.

He highlighted that “ignorance, stigmatisation and discrimination, cost of screening, diagnosis, and treatment” constitute barriers to hepatitis care in the country.

He added that “pre-marriage screening should be seen as an opportunity to identify those who have the disease and link them to care and treatment”.

Olokoba emphasised the need for Nigeria to integrate viral hepatitis response into the HIV/AIDS management framework, which helped reduce the burden of HIV/AIDS in the country. He noted that the mode of transmission is similar across the diseases.

 

 

 

 

 

 

 

 

 

 

 

Content Credit | Olaoluwa Ayomide

Image Credit | guardian.ng