The journey from detection to protection: inside South Africa’s hepatitis testing gaps

In South Africa, we’ve made enormous progress in testing and treatment for diseases like HIV, HPV and TB. But there is a small group of viruses that don’t make the headlines as much. In fact, most people who carry these viruses don’t even know they have them. 

Hepatitis A, B, C, D and E — and particularly hepatitis B and C — cause about 1.3-million deaths globally in a year, including more than 2,000 in South Africa. This is because certain strains can lead to deadly liver diseases. The good news is, if we can get more South Africans talking about hepatitis, we can stop it. All it takes is one test, and hepatitis can be treated, or in the case of hepatitis C, even cured.

A simple blood test — the kind that can be done in minutes, using equipment we already have in our clinics — is the first step towards stopping hepatitis in its tracks. However, hepatitis testing isn’t always standard practice, and it isn’t always routinely requested by patients. The solutions we need are within reach. All we need to do is break the silence — ask to be tested. Get vaccinated or, if necessary, get treated.

We already have integrated diagnostic platforms in place — many originally rolled out for HIV, TB or Covid-19. These same machines can test for hepatitis B and C. In other words, we don’t need to reinvent our systems. We need to expand our view of what public health integration can look like.

A simple blood test — the kind that can be done in minutes, using equipment we already have in our clinics – is the first step towards stopping hepatitis in its tracks.

Egypt showed the world what’s possible. Their national hepatitis C programme screened more than 60-million people and treated more than four million — all within five years. This was the result of a public health campaign that brought public and private partners together to inspire a nationwide commitment to eliminating the silent killer. South Africa has the tools, the partnerships and the healthcare workforce to do the same.

So why haven’t we?

Part of the answer lies in awareness. In a recent survey, most South Africans said they didn’t know hepatitis was a serious disease. Many had never been offered a test. The virus doesn’t always present symptoms early, so it slips beneath the surface — undiagnosed, untreated and unspoken.

But another part of the answer lies in how we design our health priorities.

Testing for hepatitis still isn’t fully integrated into existing services. For example, we’ve done critical work to normalise HIV testing — it’s part of antenatal visits, school programmes, even workplace health drives. Hepatitis should be just as visible. It should be part of every antenatal screening, every STI check-up, every blood drive. Testing for one virus shouldn’t mean ignoring others.

There’s also a missed opportunity in our corporate and community health environments. The burden of hepatitis doesn’t stop at the clinic door. Chronic liver disease affects productivity, health budgets and family stability. While specific cost data is limited in South Africa, international evidence is clear: investing in integrated testing and early diagnosis reduces healthcare costs and improves lives.

The World Health Organisation has set a goal: eliminate hepatitis as a public health threat by 2030. To get there, South Africa must do three things:

• Normalise integrated testing for hepatitis B and C.
• Expand public education to match the scale of the risk.
• Mobilise partnerships between government, private sector, and civil society to scale up access.

Hepatitis isn’t rare. It isn’t untreatable. And it isn’t too late.

But every day we wait, we lose lives that could have been saved with a test. Let’s not let silence stand in the way of protection. Let’s make this the decade where South Africa turns detection into action — and action into health.

Everyone deserves to get tested.

Steenkamp is general manager of Southern Africa Multi-Country Network at Roche Diagnostics