Interventions for Chronic Liver Disease(Cirrhosis)

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Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health promotion and education programmes to reduce alcohol consumption, excessive weight, and diabetes Community engagement [community sensitization on transmission and prevention for hepatitis B and C, including ingestion of native herbs, practices, sharing of sharp objects, tattoos, IV drug use and needle	Complete abstinence from alcohol Avoidance of excessive herbal ingestions and over-the-counter painkillers and other hepatotoxic drugs Healthy diet, physical activity, weight management, and tobacco use Safe sex practices	Recognition of liver disease signs and symptoms	Immediate transfer of suspected cases to a higher-level health care facility	Home-based support for complete abstinence from alcohol	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Primary Care
Health promotion and education programmes to reduce alcohol consumption, excessive weight and vaccination	Regular clinical check-ups for abdominal masses. Safe blood transfusion Safe injection practice Eliminate unnecessary and unsafe injections Early identification and treatment of schistosomiasis Vaccination: Hepatitis B Screening for hepatitis B and hepatitis C	History and Physical examination Viral hepatitis B and C serology Point of care Viral load testing Complete blood count Liver function tests	Counselling on avoidance of exacerbating factors Immediate transfer of suspected cases to a higher-level health care facility	Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care
Referral Facility: General
Health promotion and education programmes to reduce alcohol consumption, excessive weight and vaccination	Safe blood transfusion Safe injection practice including eliminating unnecessary and unsafe injections Post-exposure prophylaxis Regular screening for hepatitis B and hepatitis C	History Physical examination Viral hepatitis B and C serology PCR (quantitative and qualitative) with genotype Complete blood count Liver function tests Coagulation factors, including PTT, PT, and INR Serum iron, ferritin and TIBC test Alpha 1 antitrypsin test Ultrasonography Transient elastography (TE) Upper GI endoscopy	Counselling on avoidance of exacerbating factors Antivirals for viral hepatitis B Pan genotypic direct-acting antivirals (DAA) for viral hepatitis C IV Fluid Blood transfusion Therapeutic paracentesis Diuretics Lactulose	Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care*
Referral Facility: Specialist
Health promotion and education programmes to reduce alcohol consumption, excessive weight and vaccination	Safe blood transfusion Safe injection practice including eliminating unnecessary and unsafe injections Post-exposure prophylaxis Regular screening for hepatitis B and hepatitis C	History Physical examination Viral hepatitis B and C serology PCR (quantitative and qualitative) with genotype Complete blood count Liver function tests Coagulation factors, including PTT, PT, and INR Serum iron, ferritin and TIBC test Alpha 1 antitrypsin test Ultrasonography Transient elastography (TE) Upper GI endoscopy Liver biopsy Computed tomography (CT) Electroencephalography (EEG)	Counselling on avoidance of exacerbating factors Antivirals for viral hepatitis B Pan genotypic direct-acting antivirals (DAA) for viral hepatitis C IV Fluid Endoscopic band ligation Injection sclerotherapy Blood transfusion Therapeutic paracentesis Diuretics Lactulose Liver transplant	Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health promotion and education programmes to reduce alcohol consumption, excessive weight, and diabetes Community engagement [community sensitization on transmission and prevention for hepatitis B and C, including ingestion of native herbs, practices, sharing of sharp objects, tattoos, IV drug use and needle	Complete abstinence from alcohol Avoidance of excessive herbal ingestions and over-the-counter painkillers and other hepatotoxic drugs Healthy diet, physical activity, weight management, and tobacco use Safe sex practices	Recognition of liver disease signs and symptoms	Immediate transfer of suspected cases to a higher-level health care facility	Home-based support for complete abstinence from alcohol	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Primary Care
Health promotion and education programmes to reduce alcohol consumption, excessive weight	Regular clinical check-ups for abdominal masses. Safe blood transfusion Safe injection practice Eliminate unnecessary and unsafe injections Early identification and treatment of schistosomiasis Vaccination: Hepatitis B Screening for hepatitis B and hepatitis C	History and Physical examination Viral hepatitis B and C serology Point of care Viral load testing Complete blood count Liver function tests	Counselling on avoidance of exacerbating factors Immediate transfer of suspected cases to a higher-level health care facility	Counselling and support for complete abstinence from alcohol	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care*
Referral Facility: General
Health promotion and education programmes to reduce alcohol consumption, excessive weight	Safe blood transfusion Safe injection practice including eliminating unnecessary and unsafe injections Post-exposure prophylaxis Regular screening for hepatitis B and hepatitis C	History Physical examination Viral hepatitis B and C serology PCR (quantitative and qualitative) with genotype Complete blood count Liver function tests Coagulation factors, including PTT, PT, and INR Serum iron, ferritin and TIBC test Alpha 1 antitrypsin test Ultrasonography	Counselling on avoidance of exacerbating factors Antivirals for viral hepatitis B Pan genotypic direct-acting antivirals (DAA) for viral hepatitis C IV Fluid Blood transfusion Therapeutic paracentesis Diuretics Lactulose	Counselling and support for complete abstinence from alcohol Nutritional management Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care*
Referral Facility: Specialist
Health promotion and education programmes to reduce alcohol consumption, excessive weight	Safe blood transfusion Safe injection practice including eliminating unnecessary and unsafe injections Post-exposure prophylaxis Regular screening for hepatitis B and hepatitis C	History Physical examination Viral hepatitis B and C serology PCR (quantitative and qualitative) with genotype Complete blood count Liver function tests Coagulation factors, including PTT, PT, and INR Serum iron, ferritin and TIBC test Alpha 1 antitrypsin test Ultrasonography	Counselling on avoidance of exacerbating factors Antivirals for viral hepatitis B Pan genotypic direct-acting antivirals (DAA) for viral hepatitis C IV Fluid Endoscopic band ligation Injection sclerotherapy Blood transfusion Therapeutic paracentesis Diuretics Lactulose Liver transplant	Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care*

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health promotion and education programmes to reduce alcohol consumption, excessive weight, and diabetes Community engagement [community sensitization on transmission and prevention for hepatitis B and C, including ingestion of native herbs, practices, sharing of sharp objects, tattoos, IV drug use and needle	Avoidance of excessive herbal ingestions and over-the-counter painkillers and other hepatotoxic drugs Healthy diet, physical activity, weight management, and alcohol and tobacco use Safe sex practices	Recognition of chronic liver disease signs and symptoms	Immediate transfer of suspected cases to a higher-level health care facility	Home-based support for complete abstinence from alcohol	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Primary Care
Health promotion and education programmes to reduce alcohol consumption, excessive weight	Regular clinical check-ups for abdominal masses. Safe blood transfusion Safe injection practice Eliminate unnecessary and unsafe injections Early identification and treatment of schistosomiasis Vaccination: Hepatitis B for individuals, families of carriers Regular screening for hepatitis B and hepatitis C	History and Physical examination Viral hepatitis B and C serology Point of care Viral load testing Complete blood count Liver function tests	Counselling on avoidance of exacerbating factors Immediate transfer of suspected cases to a higher-level health care facility	Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care
Referral Facility: General
Safe blood transfusion Safe injection practice including eliminating unnecessary and unsafe injections Post-exposure prophylaxis Regular screening for hepatitis B and hepatitis C	History Physical examination Viral hepatitis B and C serology PCR (quantitative and qualitative) with genotype Complete blood count Liver function tests Coagulation factors, including PTT, PT, and INR Serum iron, ferritin and TIBC test Alpha 1 antitrypsin test Ultrasonography Transient elastography (TE) Upper GI endoscopy Liver biopsy Computed tomography (CT) scan Electroencephalography (EEG)	Counselling on avoidance of exacerbating factors Antivirals for viral hepatitis B Pan genotypic direct-acting antivirals (DAA) for viral hepatitis C IV Fluid Endoscopic band ligation Injection sclerotherapy Blood transfusion Therapeutic paracentesis Diuretics Lactulose Liver tran		Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care
Referral Facility: Specialist
Safe blood transfusion Safe injection practice including eliminating unnecessary and unsafe injections Post-exposure prophylaxis Regular screening for hepatitis B and hepatitis C		History Physical examination Viral hepatitis B and C serology PCR (quantitative and qualitative) with genotype Complete blood count Liver function tests Coagulation factors, including PTT, PT, and INR Serum iron, ferritin and TIBC test Alpha 1 antitrypsin test Ultrasonography	Counselling on avoidance of exacerbating factors Antivirals for viral hepatitis B Pan genotypic direct-acting antivirals (DAA) for viral hepatitis C IV Fluid Blood transfusion Therapeutic paracentesis Diuretics Lactulose	Counselling and support for complete abstinence from alcohol Nutritional management	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families End-of-life care