In the absence of essential services at the district or sub-district level, people are forced to try to come to the two model treatment centres in Imphal for hepatitis-related services. Not only the viral load test and treatment for both hepatitis B and C are available there, but a gastroenterologist is also available whose consultation is needed for managing complicated cases.
When the hepatitis programme has full staffing and support, then all hepatitis-related services should be made available at the district level, which will increase the uptake of the services.
Maximum number of cases of hepatitis B and hepatitis C are among the people who inject drugs. Many times communities of people who inject drugs are marginalized and face financial constraints. This makes it all the more difficult for them to go to Imphal for tests or for follow up tests, which might require an overnight stay too. Viral load testing and other services must be made available at the district level at least.
"Human power is a big constraint for us. We do not have any logistic officer here for medicines and other things, even then we are handling two types of medicines - one for hepatitis B and another one for hepatitis C, and kits. It is a big challenge for us. At the state level there are only two of us - myself and one assistant. At the district level too, even though we have trained staff - but these are transferrable posts of health department - so some of them have gone for post-graduation and some of them have been transferred to another district. Also we are lacking a data manager and/ or data entry operator who can punch the data," explained Dr Rosie.
"As far as human power is concerned it is a challenge for us. Recruitment of four more staff is yet to be done since we started the national viral hepatitis control programme in the state. Since ours is not a vertical programme, but a horizontal one, we have to depend on the existing staff. Many of them say that they are overloaded. Since it is a new programme, even though we have trained them, it is very difficult to get even the reports. Our reporting is through a portal" said Dr Rosie. That is why reports on the portal do not reflect the ground reality as reports are often missing.
"Since many of the people who need hepatitis services come from injecting drug users' communities, we are in touch with Manipur State AIDS Control Society, and very soon we will be starting screening of those who come to partner NGOs for HIV-targeted interventions," said Dr Rosie.
We have already completed hepatitis C treatment for over 1000 people, and currently over 600 are on hepatitis B treatment services.
Manipur has five times higher incidence of HIV in the general population (1.15%) compared to rest of India (0.22%). More alarming is that HIV rates among those who inject drugs is even higher at 7.66%. Government could know this because HIV data was segregated as per key populations too. But hepatitis data is yet to be segregated as per key populations.
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