A global campaign for providing low-cost HCV care rolls out
by Larry Buhl
[dropcap]L[/dropcap]ast year UNITAID funded two grants to increase access to new treatments for the hepatitis C virus (HCV) for HCV and HIV coinfected patients in low- and middle-income countries.
Up to $15 million was granted to Médecins Sans Frontières (MSF), also known as Doctors Without Borders. The MSF grant will cover patient screening, diagnosis, and treatment in ten sites across India, Iran, Kenya, Mozambique, Myanmar, Uganda and Ukraine.
Another grant of up to $5.2 million was committed to French NGO Coalition Internationale Sida to work with partners in Brazil, China, Ecuador, Egypt, Georgia, Indonesia, Malaysia, Morocco, South Africa, Thailand, and Ukraine.
Both grants aim to provide a model for simple, low-cost care for people with HCV living in low-resource areas. Most people infected with HCV in these areas, as is the case in higher-resource countries, are unaware of their status. Testing and monitoring for HCV is complicated and expensive and require a set of initial and confirmatory tests. An RNA test is needed to confirm diagnosis and to re-confirm a cure twelve weeks after treatment with direct-acting antivirals (DAAs).
I spoke with Dr. Isabelle Andrieux-Meyer, the viral hepatitis medical advisor and team lead for the MSF Access campaign, after she returned from Myanmar, where she oversaw the implementation of new viral hepatitis screening and testing procedures at a clinic. That Myanmar site, as well as the other nine sites identified for testing and treatment as part of the UNITAID grant will, she says, be a model for bringing affordable hepatitis care to parts of the world where the cost of treatment is far beyond most people’s ability to pay.
Larry Buhl: Why was Myanmar chosen as one of the sites?
Isabelle Andrieux-Meyer: We opened this clinic in Myanmar ten years ago to treat people infected with HIV. There are four huge HIV cohorts in Myanmar and more than 40,000 people in care. In the north there is the burden of HIV/HCV coinfection of between twenty-five and thirty percent, which is huge. This means, at the country level, there is a serious health problem that hasn’t been addressed. We are trying to understand the magnitude of the problem and design programs that are adequate for the people and respond to their needs.
What are the procedures for screening and testing there?
The initial screening test tells you if the patients have been in contact with the virus but doesn’t tell you they have an active hep C infection. The next step is to find out who has an active infection. You look at medical files and see who has liver disease and prioritize to go to HCV viral load testing. It is $100 per test, and the genotype test is also $100.
We are assisting all people who seem to be coinfected to prioritize for viral load and genotype and starting to prepare them for treatment. In the future there will also be fibroscans to see how advanced the liver disease is.
You’re prioritizing who will be treated?
Right now it’s only the most advanced cases of liver disease that we can treat. The program will not function at full speed from the beginning. Globally it raises the issue of the cost and availability of the drugs.
What will the treatment regimen be?
This year it will be sofosbuvir-based combinations using ribavirin as soon as we get agreement from the ministry of health in Myanmar and receive the drugs bought from Gilead. In future we want a generic option for a lower price. We need quality control over generic manufacturers. We encourage them to pre-qualify through the WHO process.
Will there be prevention and follow-up?
Yes, we need to be comprehensive. If you consider drug use with limited access to needle exchange programs and criminalization and limited methadone, the risk of reinfection can’t be ignored. We need to design the package of care, pre and post treatment to allow a person to remain healthy. There are many risk factors that need to be understood so that we can come up with a good treatment solution for the people.
Do the countries you’ve selected to work in have any national hepatitis programs?
No, but we encourage them to start. Without national commitment it is hard to move forward.
In one year what do you hope you will have achieved?
We would like access to as much of the DAAs as we need at affordable price and screening strategies for not only people beyond our cohorts. The challenge will be powerful financing mechanisms to allow each country to scale up and establish national hepatitis programs. Some funding mechanisms like The Global Fund will have a role to play in management of coinfected people.
Click here for more information about all of the MSF Access campaigns.
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.