Comprehensive hepatitis B program in Vietnam provides an excellent model for other countries
Doylestown, Pa., Dec. 15, 2022 - Vietnam is among the nations with the heaviest burden of hepatitis B, with at least 8% of people infected, studies have shown.
The prevalence may be closer 10%, according to Doan Y. Dao, MD, a native of Vietnam, and assistant professor at Johns Hopkins University School of Medicine. That means with a population of approximately 100 million, nearly 10 million residents may be living with hepatitis B, which in part is why Dr. Dao went into the field of hepatology and has focused on hepatitis.
“It began with a family, personal reasons,” Dr. Dao said. “Then I decided during medical school to take time and learn more, investigate and study about hepatitis B. When I saw the statistics, I decided to return to where I came from to experience firsthand the disease burden with the patients in Vietnam.”
[Note: You can hear Dr. Dao’s story, in his own words, in a recent episode of B Heppy, the Hepatitis B Foundation’s podcast. Click here.]
Dr. Dao contacted Joan and Tim Block, co-founders of the Hepatitis B Foundation, “for advice and support.” The Blocks were able to provide seed funding from the Foundation to help Dr. Dao launch start the Vietnam Viral Hepatitis Alliance in 2014.
Aimed at reducing the public health burden of hepatitis B and hepatitis C viruses, the Alliance is focused on supporting the design, funding and implementation of research-based awareness, education, screening and access-to-care programs, along with educational programs for individuals in community and health professionals.
Chari A. Cohen, DrPH, MPH, president of the Hepatitis B Foundation says Dr. Dao’s work is “cutting-edge” and he represents “the next generation of clinician-researchers.
“With the initiatives he has developed in Vietnam, Dr. Dao has created an excellent model for eliminating hepatitis B that other countries can use,” Dr. Cohen said. “He’s the future of hepatitis B.Dr. Lily-Trang Pham of the Vietnam Viral Hepatitis Alliance speaking with Foundation Co-founder Joan Block at the 2017 Liver Meeting, the annual meeting of the American Association for the Study of Liver Diseases.
In 2017, the Alliance was granted an international NGO status by Vietnam’s Department of State. Dr. Dao was invited to join the faculty of the Johns Hopkins University School of Medicine in 2020 and the university created its Center of Excellence for Liver Disease in Vietnam, which builds on the Alliance’s foundation and he directs.
The most ambitious joint initiative of the Center and the Alliance is in Ho Chi Minh City. It’s a comprehensive demonstration program to screen and navigate access to care for 20,000 adults throughout Ho Chi Minh City, which has 10 million residents. Dr. Dao says it is Vietnam’s first community-based comprehensive screening and care access program. The result of this program sets the stage for their next provisional program that aims to eliminate hep B and C for 1.1 million residents of the section known as Thu Duc City, a section of Ho Chi Minh City.
The Alliance launched the Hepatitis Evaluation to Amplify Testing and Treatment (HEAT) program in Vietnam in 2020 in collaboration with the Coalition for Global Hepatitis Elimination at the Task Force for Global Health. They also are working with the Division of Viral Hepatitis Laboratory, U.S. Centers for Disease Control and Prevention (CDC), to determine the burden and characterize the molecular epidemiology of hepatitis D in Ho Chi Minh City. Guided by a coalition of local stakeholders, the Alliance has been coordinating the support of expanded hepatitis B and C testing and treatment efforts across Vietnam. The hope to “identify feasible strategies to scale testing and proven models of care” and “develop policy recommendations to inform further program development.”
The ultimate goal is a long-term public-private partnership to implement public health policies that address the burden of viral hepatitis in Vietnam and work towards viral hepatitis elimination by 2030.
For World Hepatitis Day this year, the Alliance conducted screening in Ho Chi Minh City, an annual tradition they call “Healthy Liver, Happy Life,” which began in 2018. The Alliance also sponsored a scientific conference, also an annual July 28 tradition.
"The people of Vietnam understand they have a serious problem with hepatitis B,” Dr. Dao says. However, there are still two major misconceptions in the community that have made progress difficult. One is that treatment will not cure hepatitis B, “So why bother?” The second, he says, is the belief that the indolent or silent phase of the disease does not require treatment.
Also challenging their efforts to combat hepatitis B in Vietnam, Dr. Dao says, are two issues facing probably everyone in the field worldwide: funding and stigma. Still, he remains optimistic.
”We have the testing, the effective vaccines and the effective treatments. If we put it all together, hepatitis B can be controlled and eliminated in the near future.”