Introduction

Community heathy center is established in Rawalpindi to create awareness of different diseases in community which are preventable if the community is educated about these diseases in an organize manner. There are different project which are run by University, the important one is hepatitis-C free Rawalpindi initiative.Thousands of patients are living health education regarding the risk factors of hepatitis-C transmission

In Pakistan, more than 10 million population are suffering from Hepatitis C Virus (HCV) with high morbidity and mortality. Presently, the prevalence of HCV is 6.7% and Hepatitis B is 2.5-3% respectively1,2. Local data suggests that most affected age group involves patients from 20-50 years. Every 3rd or 4th death in hospital is related to Hepatitis C infection and hepatocellular carcinoma is the 4th commonest malignancy in Pakistan. At present more than 01 lac people need liver transplant in the country and there is no national liver transplant program in Pakistan except one center in private sector. Hepatitis B and C is 100% preventable by controlling the risk factors like, injudicious use of therapeutic injections, used syringes, unscreened blood transfusions, unsterilized surgical, delivery and dental equipment.

With the advent of new Direct Acting Antivirals (DAAs) the whole scenario of hepatitis C had changed. By using DAAs and with effective prevention strategies hepatitis C can be 100% eradicated. 

Aims and Objectives of Program:

      Awareness and Prevention in community and health professionals.

      To make Rawalpindi 1st Hepatitis free city of Pakistan.

      Moving from hepatitis C cure to elimination. 

Operational Plan:

  • Firstly community screening camps will be organized ward wise.
  • The population will be screened by using kit method for hepatitis B and C.
  • The anti HCV patients will have their PCR done.
  • Patient’s history and examination will be performed by doctors/nurses/consultants.
  • Appropriate laboratory tests will be performed including CBC, LFTs, PT, APTT, etc and Ultrasound Abdomen in patients who require treatment.
  • Free /subsidized treatment will be provided to all patients.
  • Regular follow-up of patients with PCR at the end of treatment and 3 months post treatment will be performed.

Operational Plan:

  • Firstly community screening camps will be organized ward wise.
  • The population will be screened by using kit method for hepatitis B and C.
  • The anti HCV patients will have their PCR done.
  • Patient’s history and examination will be performed by doctors/nurses/consultants.
  • Appropriate laboratory tests will be performed including CBC, LFTs, PT, APTT, etc and Ultrasound Abdomen in patients who require treatment.
  • Free /subsidized treatment will be provided to all patients.
  • Regular follow-up of patients with PCR at the end of treatment and 3 months post treatment will be performed.

    Awareness Campaign:

    • As this program will be ineffective without the public awareness, education of society and stake holders regarding HCV treatment, transmission and prevention, following measures will be taken :
    • Involvement of primary physicians of area
    • Education of dispensers, nurses, lady health workers, quacks and other health care workers
    • Awareness amongst barbers, beauticians and the people involved in tattooing and ear, nose piercing etc.
    • Focused group discussions with local community/political workers and religious leader.
    • The health awareness campaign will be simultaneously initiated regarding hepatitis control and treatment.

     

    Project Time Line:

    • 46 months from the date of launch.

     

     

    Demographic Data of Rawalpindi City

     

    Total Population of Rawalpindi District                      5405633

    Total Population of Rawalpindi City:                          2098231

    Implementation Strategy

    Population between 20 – 50 year people                 944203

    (per Ist phase screening protocol):

    Total Cases to be screened:                                          944203

    Total UC of Rawalpindi                                               46

    Approximate population of each UC                           20,526 

    Total number of wards of each UC                              6 wards

    Approximate population of each ward                         3421

    Each camp target                                                         2 wards (6,842)

    Patient to be screened                                                  20,526 (every month)

    Total Project time line                                                 4 years

    Approximate Cost of the Project

    1. Screening Cost

    Option 1

    1. Population to be screened             1 million
    2. Lab cost including, banners,

    hand bills, screening tests, PCR

    (Per patient)                                                       Rs. 150

    Total                Rs. 141.63 million

    (Our project adopted option I)

    Option 2

    1. Lab cost including banners,

    hand bills, screening, PCR, CP/USG/SVR/LFTs 300

    1. Per patient total cost 300

                                                    Total                Rs. 283.26 million

    1. Treatment Cost

    Approximate number of patients to be treated                  56652

    (Prevalence 5-6%)

    Treatment cost per patient (Subsidized)                            Rs. 5000/-

    Estimated cost                                                               Rs. 283.62 million

    1. Total Cost expected for eradication 424.89 million (Option 1)

    Rs. 566.52 million (Option 2)

     

     

     

     

    Contributors/Implementation:

    For this initiative, the funds will be raised by involving multiple societies/NGOs and philanthropists:

    • Provincial Government Pakistan
    • Center for Liver and GI Diseases Holy Family Hospital, Rawalpindi
    • Pakistan Society of Hepatology, Rawalpindi/Islamabad Chapter
    • Advanced Liver and GI Center, Commercial Center, Satellite Town, Rawalpindi
    • Tehzeeb Bakers
    • Pharmaceuticals
    • Rawalpindi Chamber of Commerce and Industry
    • Lions Club International
    • Rotary Club
    • Philanthropists
    • Haji Feroze Khan Trust
    • VFAHT
    • Shifa4u

    Logistics – Human Resource

    Following Human Resource required for each camp

    • Doctor 5
    • Medical Students 8
    • Nurse 1
    • Technician 8
    • Community Worker 6
    • Computer Operator with Computer 1

    Project Proposal:

    • This project will be done in 3 phases, with the help of six teams comprising of 6 people in each team: two dispensers, two nurses, one community worker and 5 doctors.
    • Approximately 100,000 patients from age group 20-50 years will be screened for Hepatitis B and Hepatitis C during phase I. As per study by PMRC2 the prevalence of Hepatitis C patients is 5%, so approximately 5000 patients will need PCR for HCV. Patients with positive PCR will be offered treatment according to their affordability.
      • A0 Totally Non-Affording
      • A1 Partially Affording
      • A2 Affording

Pilot Project Activity Report (UC-1 Ratta Amral Rawalpindi)

  • Pre-screening meeting was done on 4th Feb 2019 with chairman UC-1 Mr. Umar Mushtaq and ward chairman and councilors regarding launching of the training program and sensitization of the community.
  • Second meeting was done on 1st March 2019 in the community hall of UC-1 in which following attended the meeting.
    1. Bushra Khaar
    2. Arshad Ali Sabir
    3. Zahid Mahmood Minhas
    4. Sarfraz Ahmad DDHO Rawalpindi
    5. Naveed DDHO Rawalpindi
    6. Umar Mushtaq Chairman UC-1
    7. Haji Arshad Ward No. 1
    8. Shahid Rahila Lab
    9. Other members of UC-1 and Health Team.
  • Following decisions were made:
    1. Camp will start from 8th – 10th March 2019 in Jinazgah which is the central point of Ward 1 UC-1 from 9am – 3pm.
    2. Pre camps different activities like focus group discussions, hand bills, posters, school visits and announcements during Jumma Prayer.
  • On 5th March 2019 all women of the ward-1 were gathered in community hall of UC-1 and Faculty of Community Medicine of RMU motivated all women of ward-1 to take part of the screening for active participation of the family members i.e. husband, children’s and also neighbors.
  • On 6th March 2019 team visited the schools of ward-1 and gave awareness to the children about the hepatitis and were asked to motivate there family members to come for screening in hepatitis free camp.
  • On 6th March 2019 banners of hepatitis camp were placed at three important sides of ward and hand bills containing awareness campaign and prevention strategies with camp site date and time.
  • The camp was successfully completed with help of Society of Therapeutic Endoscopy Pakistan (STEP), Centre for Liver and Digestive Diseases (CLD), Medical Unit-1, Community Medicine Department RMU, VHAFT and local efforts of local councilors.

References:

  1. Gower E, Estes C, Shearer KR, Razavi H, Global Epidemiology and genotype distribution of the hepatitis C virus infection, J Heptol, 2014 Vol 61J S45-S57
  1. Qureshi H, Bile KM, Jooma R, Alam SE, Afridi HUR, Prevalence of hepatitis B C viral infection in Pakistan, Findings of a national survey appealing for effective prevention and control measures, East Mediterr Health J 2010;16 Suppl S15-23

 

 

First pre-screening Awareness Campaign. (1st – 7th March 2019).

A  community awareness move focusing prevention of Hep-C, availability of a Curative treatment against Hep-C, opportunity of getting free treatment of Hep-C disease through screening , and schedule of screening camps in the area was done. For rapid spread of information community groups, high risk groups, school teachers & senior students  and women groups were targeted. Banners & specifically designed awareness handbills were also used. Team of CHC was instrumental behind this work.

Hep-C Free Community Project Awareness Campaign (1st to 7th March 2019) Ratta Amral UC-I (ward-1)

Hep-C Free Rawalpindi Screening Camps Report

Camp was successfully completed under the supervision of Prof. Muhammad Umar, Prof. BushraKhaar and Dr. ZahidMahmood Minhas. Team of Centre for Liver and Digestive Diseases, Medical Unit-1, Medical Unit-2, Community Medicine Department RMU, Students of Rawalpindi Medical University students organization, Volunteer Force Against Hepatitis Transmission (VFAHT) and research society of Rawalpindi Medical University were present for three days from 9am to 3pm throughout the camp and participated both registering and screening work.