Rawalpindi : Having one of the highest prevalence rate of hepatitis-C in the world, Pakistan needs to work religiously both for treatment of patients and for screening of people if we want to eliminate the disease by 2030 as has been pledged by the World Health Assembly of which Pakistan is a signatory.
With nearly five per cent population suffering from hepatitis, over eight million patients and less than five per cent of the patients getting treatment, Pakistan needs to screen 25 million people every year to diagnose 900,000 hepatitis-C infections and at least 700,000 patients would need treatment per year.
This capacity target, representing a 4-fold increase in treatment and 24-fold increase in diagnosis compared with the current rates needs urgent steps to accelerate the diagnosis of hepatitis-C infection and identify the missing millions of individuals.
President Pakistan Society for the Study of Liver Diseases and Pakistan Society of Gastroenterology and G I Endoscopy Professor of Medicine Hepatologist Brigadier (r) Dr. Masood Siddiq expressed this while talking to ‘The News’ on what is needed to make Pakistan hepatitis free country.
Although Hepatitis C testing and treatment scaled-up, the treatment uptake is happening at a faster rate than testing. Several Hepatitis C micro elimination projects are under way, and these projects play an important role in identifying infected individuals and linking them to treatment, he said.
He, however, added the elimination of Hepatitis C will require screening of the general population. This is challenging but could be optimized through first targeting subpopulations with higher prevalence and improving their linkage to treatment. The lessons learned from these initial efforts can then be extended to other subgroups with intermediate prevalence, he suggested.
Of course, increasing the diagnosis and treatment capacity would require an initial investment but such strategy could be cost saving in the long term, he said while responding to a query.
He believes that using a point-of-care test for antibody screening and hepatitis C core antigen/GeneXpert for confirmation of cure may reduce the overall cost of hepatitis C elimination by 21 per cent. Although Hepatitis C elimination may be ambitious, we believe that strong support from the government and strategic planning can make elimination a reality, said Professor Masood.
He said the foundation of scaling up testing and treatment has already been set up through Pakistan’s Hepatitis Prevention and Treatment Program. “Efforts should be focused on establishing a national policy for screening the general population for hepatitis C infection.”
Setting screening and testing targets for local health facilities, skill building of health care workers, increasing availability of low-cost diagnostics and treatment, simplifying diagnosis and treatment and expanding the infrastructure for tele-health system may help controlling spread of hepatitis and ultimately eliminating it, he said.
In addition, innovative financing mechanisms could be explored to raise money needed to scale up hepatitis C screening and treatment. It is believed that the WHO targets regarding elimination of hepatitis will not be met unless there is a strong political will and focused effort at both the public and the private levels, concluded Professor Masood.
Muhammad QASIM, Urgent steps needed to accelerate diagnosis of hepatitis-C, Rawalpindi, Pakistan, The News, May 27, 2019.