The Society on Liver Disease in Africa (SOLDA), established in 2022, has already created a large community, with more than 1500 members from both scientific and civil society representing 37 African countries across the continent. SOLDA has been developed to support the education, training and research landscape in the field of hepatology in Africa. Africa needs more efforts to create data platforms for liver disease while exploring tailored models for diagnosis, prevention and treatment including expansion in clinical trials. This can only be achieved through large-scale continental and intercontinental collaborations that could be critical in achieving research and intervention goals that can influence the outcome of liver disease in Africa.

Although Africa has a high burden of liver disease, only a small proportion of liver disease patients are receiving diagnosis and treatment. This is despite of advancements in the field of hepatology worldwide and major strides made by the African continent in the field of infectious disease. It also highlights the essential need for intervention and improvement in health-care services for liver diseases in Africa.

The recent WHO Global hepatitis 2024 report was a sobering reflection of where the WHO Africa Region stands in the fight against viral hepatitis.

Despite access to preventative Hepatitis B vaccines, effective nucleoside therapy against Hepatitis B and curative Direct-acting antiviral therapy for Hepatitis C, the WHO Africa region accounts for 63% of new viral hepatitis Infections (66% of Hepatitis B and 51% of Hepatitis C infections).

The prevalence of Hepatitis B in Africa reflects a failure of maternal and child health services to identify HBsAg positive pregnant women, link them to care and initiate prevention of mother-to-child transmission interventions with maternal tenofovir and timeous Hepatitis B birth dose vaccination. Despite Hepatitis B vaccination being a safe and effective cancer-preventing vaccine, only 15 African countries have implemented HB Birth dose vaccine with only 18% having timeous administration. Although Gavi’s recommitment to assisting low-income countries initiate implementation of the Hepatitis B birth dose vaccination will have an impact in the reducing the HBsAg prevalence in under 5-year-olds, this must be sustainable.

Successful elimination programmes will require decentralisation with task-shifting to primary care level and integration into existing infectious disease and non-communicable disease programmes with associated dedicated domestic funding. Challenges to elimination include the cost of diagnostics particularly molecular diagnostics and lack of access to point-of-care diagnostics, affordable and simplified treatment regimens, and out-of-pocket expenditure.

The cost of antiviral therapy varies considerably across Africa with the lowest reported price of a public sector procurement of a generic 30-tablet Tenofovir supply varies between US$ 2.20 in South Africa and US$ 26.70 in the Democratic Republic of Congo. Similarly, for  

Hepatitis C, the lowest reported price for the procurement of a 12-week supply of generic Sofosbuvir and Daclatasvir varies between USD$ 60.0 in Nigeria and US$ 491.40 in Cameroon.

We need to learn from the Champion Countries in Africa, Egypt and Rwanda who are leading the charge towards the WHO 2030 viral hepatitis elimination goals.

Egypt through its nationwide screening and treatment campaign (100 Million Healthy Lives) in 2018-19, screened nearly 63 million individuals for anti-Hepatitis C antibodies and were able to treat 4.1 million people living with Hepatitis C. This led to the WHO awarded Egypt gold tier status on the path to HCV elimination on 29 October 2023.

Rwanda is on track to eliminate Hepatitis C by 2024 with 7 million people ≥15 years having been tested for HCV and 60 000 treated, thereby reducing the prevalence of hepatitis C infection to <1% In addition, HBV: 5 million people have been tested for hepatitis B, 7000 are on lifelong nucleoside treatment and 7 million people vaccinated against hepatitis B.

Of note, Egypt’s campaign was supported by US$250 M in financing from the World Bank, as a part of the US$530 M Transforming Egypt’s Health Systems project, emphasising the importance of political will and dedicated funding with the development of national investment cases to achieve the viral hepatitis elimination goals.

Another silent liver disease is Metabolic dysfunction-associated steatotic liver (MASLD) associated with the rising prevalence of obesity and diabetes mellitus across Africa and an estimated prevalence of 13.5%. MASLD encompasses the spectrum of simple steatosis, steatohepatitis (MASH), advanced fibrosis and cirrhosis. MASLD is independently associated with the risk of developing extra-hepatic diseases, including cardiovascular disease, the leading cause of death in people living with MASLD, type 2 diabetes, chronic kidney disease and extra-hepatic malignancies (gastric, colorectal, pancreatic, biliary duct, thyroid, urinary system, breast, skin and female genital cancer), with the risk advancing with the severity of MASLD. This further emphasizes the need to promote a holistic approach to liver health beginning at community and primary care level.

Education of the public and healthcare workers at all levels of care about the silent but preventable and treatable burden of liver diseases associated with viral hepatitis and MASLD is essential to break cycles of infection and prevent the complications of cirrhosis and hepatocellular carcinoma.

SOLDA will communicate with its community through a monthly newsletter, distributed by its board members who represent different regions of Africa. The newsletters will include advances in the field, innovative initiatives on the African continent, educational articles, and information about new collaborations.