The entire world is now battling to contain COVID-19 and, six months into it, the fight is far from over. But even as health workers continue to treat patients and medical research races to find a vaccine, it does not mean that health risks from other viruses have disappeared.
Before the COVID-19 global outbreak was declared, the World Health Organization Philippines was already supporting the Department of Health (DOH) in implementing its Hepatitis program. Starting August and up until November 2019, six Hepatitis B demonstration sites were established in Central Luzon and National Capital Region by DOH with support from WHO. By the end of 2019, DOH had expanded its services in these treatment facilities from testing to offer eligibility screening for free antiviral therapy.
As of July 26, 2020, the Philippines has a total of 82,558 confirmed COVID-19 cases. But as early as March, the government had already imposed community lockdowns to contain the spread of the virus. When the Enhanced Community Quarantine (ECQ) was declared, clinical testing services and distribution of medicine supplies were at the very least delayed or at most halted in demonstration sites and other healthcare facilities nationwide.
Most of the local healthcare workers in the demonstration sites had been reassigned to the COVID-19 response. This resulted in a significant delay in report submission as well as difficulties in communication between national and regional counterparts. A more concerning outcome of the quarantine was the general drop in patient volume, with the exception of pregnant women, for which HBsAg screening is mandatory.
Taguig City Hepatitis Coordinator Dr. Liezl Ramos adds, “The challenge we encountered at the start of the pandemic is the decrease of patient visits for check-up and blood monitoring because of anxiety and fear of contracting the COVID virus. There was also limited options for transportation going to and from the health centers.”
Despite all these, the program was still able to successfully conduct testing of over 33,000 individuals in Bataan, San Fernando and Angeles (Pampanga), Nueva Ecija and Taguig City. All treatment-eligible patients were able to start their antiviral therapy. To ensure that the therapy was uninterrupted, patients in Central Luzon and Taguig City received a 2-month supply of medicines, with the arrangement to deliver refills via courier services.
Coping with Pandemic Restrictions
In an interview with WHO, Bataan Governor Albert Garcia gives a powerful reminder to local governments and health service institutions implementing the pandemic response.
“Because a lot of our efforts are focused on COVID-19, sometimes we neglect other health concerns and responses to other illnesses, such as our Hepatitis program. It is important to still implement these, as efficiently as possible,” he said.
Bataan has 25 Screening, Assessment, and Treatment Facilities (SATF) with all staff nurses, doctors, medical technologists and midwives trained to provide full cascade of hepatitis B services. Most of them were trained before the COVID-19 quarantine but the same cannot be said for the rest of the country.
To address limited mobility and face to face consultations at this time, online platforms have been used in the interface between the World Health Organization and the Hepatology Society of the Philippines (HSP). Contacts in community-based civil society organizations have remained in close contact with government hepatitis coordinators to ensure access of their members to treatment.
Bataan, according to Governor Garcia, uses social media to raise awareness on Hepatitis. It also has telemedicine consultations available for Hepatitis patients. Dr. Ramos of Taguig shares that they do door-to-door delivery and provide transportation for patients requiring blood monitoring.
In the National Capital Region and Davao Region, HSP established a referral system to private facilities for patients to obtain free antiviral therapy. The HSP link to the private sector also gave DOH the access to data on Hepatitis B patients that would have not been recorded on their database.
The DOH, with WHO input, took advantage of the time afforded by COVID-19 induced interruption to review and revise their guidelines on the Hepatitis B treatment and response.
Scale-up and Onward
The DOH is expanding its Hepatitis B services to all DOH Hospitals, Medical Centers, Sanitaria, Treatment and Rehabilitation Centers, and Treatment Hubs in the country. With the support of WHO, a total of 243, 032 bottles of Tenofovir were redistributed nationwide by June 2020. It is also currently strengthening and increasing the frequency of its capacity building via online training, with assistance from HSP and WHO.
At the moment, DOH is gathering data from demonstration sites to assess and further improve the program, as practiced since 2019 by LGUs in the two regions. This data will inform guidelines that may be distributed to regional centers.
Moving forward, the Hepatitis program is expected to focus on awareness raising on service availability targeting healthcare providers and the public, while it would also give special attention to the COVID-19 response.
DOH and the LGUs will continue to work on providing quality health care even in the midst of a pandemic. WHO Philippines will continue to provide technical support and expertise at national and subnational levels.