Peer-Led Action Must Be Central to South Africa’s Hepatitis Response

World Hepatitis Day is not just a campaign moment. It is a call to confront systems that delay, exclude, and overlook the people most affected by hepatitis and other sexually transmitted infections. If South Africa is committed to eliminating STIs by 2030, it must actively support the organisations whose daily work demonstrates credibility, urgency, and measurable impact in this response.

Across the country, nonprofit organisations are showing what responsive public health looks like. They are not waiting for policy to filter down or infrastructure to catch up. They are building trust, educating, referring, and following up with the people the system finds hardest to reach. SANPUD is one of those organisations. In 2024, SANPUD provided hepatitis education and health rights outreach across the Western Cape, Gauteng and KwaZulu-Natal, reaching diverse community spaces including shelters, clinics and informal settings.

These were direct engagements, not passive campaigns. We spoke in local languages, we listened, and we answered questions shaped by fear, stigma, and silence. In the Western Cape, activities such as Open Clinic Days at Chapel Street Clinic gave dozens of individuals access to integrated services, including HIV, TB, STI and hepatitis screening. Gauteng-based clinics in Yeoville, Westonaria and Motsamai saw similar uptake, while in KwaZulu-Natal, trained peers conducted monitoring and referrals as part of stakeholder workshops aimed at strengthening the province's hepatitis response. In places where traditional services don’t land, we did.

South Africa carries one of the highest hepatitis burdens globally. An estimated 3.4 million people live with chronic hepatitis B, and hepatitis C presents its challenge. Only 24% of people with hepatitis C have been diagnosed, and just 3% have started treatment. These figures reveal systemic gaps in screening, diagnostics and care. Treatment for hepatitis C remains expensive and difficult to access. International health rights funders and national peer-led organisations are responding to these gaps.

Until recently, a full 12-week course of direct-acting antivirals such as sofosbuvir/velpatasvir cost around R20,000 per patient. Global negotiations led by the Clinton Health Access Initiative and The Hepatitis Fund have helped lower this cost to approximately R3,000 in supported programmes. Sediba Hope Medical Centre, working with the United Nations Office on Drugs and Crime and SANPUD, has pioneered access for people who use drugs in Tshwane. Their approach, rooted in trust, follow-up and peer support, shows what becomes possible when hepatitis treatment is funded, localised and meaningfully integrated into the community.

Beyond education, SANPUD supports care systems. In June 2024, our team worked with TB HIV Care and Sediba Hope Medical Centre to trace people who had defaulted on hepatitis C treatment, verifying data and supporting direct re-engagement. At the same time, 12 peer researchers and community leads were trained through the Unitaid-supported HepC3P programme. Their role is powerful: collect and analyse data from their community of people who use drugs and deepen national evidence while building local ownership and sharing key information with the people Hepatitis directly impacts.

Our international connections have created space for SANPUD to contribute to global research and engage directly with the most recent findings. In 2024, we joined UnitAid’s Global Community Advisory Board, positioning community leadership as central to equitable hepatitis care. We also presented South Africa’s peer-led hepatitis strategy at the International Network on Health and Hepatitis in Substance Users (INHSU) Global Conference in Athens, sharing insights into community advisory board design and harm reduction coordination. In 2025, this same platform will be brought closer to home. INHSU will host its international conference in Cape Town for the first time in our region. The event, taking place from 14 to 17 October, will convene healthcare providers, policymakers, researchers, and people who use drugs to share knowledge, shape strategy, and spotlight African-led models. For many, it will be a first chance to access global research, influence its direction, and engage on equal terms. These engagements are not merely symbolic but place South African realities on the global stage and bring global research back into our local work.

 The Department of Health cannot eradicate STIs by 2030 alone. This is not a criticism, but a reality. Thought leadership must include our voices and reach across sectors and platforms. Frontline nonprofits have developed messaging, referral pathways, and monitoring tools that work and can be easily integrated into provincial rollouts.  SANPUD’s work with Community-Led Monitoring initiatives shows how peer-led systems are accelerating hepatitis access. In 2024, of the 3,202 total health referrals facilitated by Community Monitors, hundreds were for hepatitis screening and treatment. With an 83% linkage success rate, this work reconnected clients lost to care, built trust with facilities, and shifted clinic practices to better serve the marginalised.

We also need to be honest about the policy environment. South Africa has approved a universal birth dose policy for hepatitis B, but it has not yet been implemented. The national hepatitis investment case exists but staffing and data systems remain under-resourced. Routine screening is limited, and rapid diagnostics are not widely available. These are not abstract challenges; they are barriers that civil society is already working to overcome.