28 July is World Hepatitis Day. This date was officially recognised in 2011 when the World Health Organisation (WHO) added it to its calendar. World Hepatitis Day is celebrated in more than 100 countries around the world. The vast majority of people with chronic hepatitis C live in low- and middle-income countries, where access to hepatitis C treatment remains extremely limited.
Thanks to the development of new generations of drugs, HCV treatment is becoming increasingly effective, but high prices are one of the main barriers to treatment accessibility, and people who inject drugs (PWID) and other vulnerable groups are systematically excluded from public treatment programmes in most countries in the region.
In June 2016, a group of experts from the Public Health Alliance and ITPCru prepared a report on the epidemic and response measures for viral hepatitis C in EECA countries. Analysing the situation over the past year in EECA countries, the authors of the study came to the following conclusions:
– Limited data on the prevalence and incidence of HCV among the general population and key populations in most countries in the EECA region. In Georgia, Ukraine and Russia, non-governmental organisations have begun to systematically collect data in recent years.
– According to available data, people who inject drugs and people living with HIV continue to be the most vulnerable groups affected by viral hepatitis. According to estimates, the prevalence of viral hepatitis C (HCV) among drug users in different EECA countries ranges from 22% to 95%. Repressive drug policies are the main structural driver of the spread of viral hepatitis among IDUs. At the same time, the report notes that the number of patients receiving treatment under public programmes is disproportionately low compared to the estimated number of people living with HCV. According to the study, treatment coverage is only about 1% of the estimated number of people living with HCV, or even less.
- Experts note that the situation with the registration of drugs for the treatment of HCV in ECA countries has improved significantly compared to 2015, but there are still countries where access is limited. Second-generation drugs (sofosbuvir, etc.) are registered and used in countries in the region where hepatitis C treatment programmes have been implemented in one form or another, or where patients are actively involved in the implementation of such programmes, for example in Kyrgyzstan. However, in countries such as Moldova, Armenia, Tajikistan, Uzbekistan and Azerbaijan, work on registering these drugs is still ongoing.
- Prices for officially registered drugs for the treatment of HCV remain too high in relation to the average income level in EECA countries. Thanks to the introduction of generic drugs, the prices of anti-hepatitis therapy in a number of countries have fallen significantly compared to previous years. Thanks to active cooperation between non-governmental organisations and authorities in Ukraine and Georgia, state programmes for the treatment of viral hepatitis have been adopted, and in Kyrgyzstan, active work is underway to initiate a similar programme.
The report also notes that in Ukraine and Kazakhstan, HCV treatment guidelines are approaching the recommendations of the WHO, the European Association for the Study of Liver Diseases, and the American Association for the Study of Liver Diseases regarding HCV treatment regimens.
As for the situation in Russia, in the latest report on government procurement of HCV treatment drugs for 2015, experts from ITPCru note that the number of people living with HCV in Russia is approaching 6 million, of whom approximately 2 million may need treatment now. At the same time, according to monitoring data from 2013, less than 1% of the total number of people in need receive therapy.
Highly effective direct-acting antiviral drugs are registered in Russia, but the existing regulatory framework does not allow these drugs to be purchased with federal budget funds. The number of people who received treatment with highly effective HCV drugs in 2015 was about 1,000, according to the ITPCru report.
In his video blog, Alexei Kurmanaevsky, a Russian activist with the Eurasian Network of People Who Use Drugs (ENPUD), talks about his personal experience of treating viral hepatitis C with sofosbuvir and ledipasvir. Alexei discusses his health after 30 days of taking the drugs and notes the effectiveness of the treatment and the absence of side effects.
Comments from experts on advocacy and treatment of viral hepatitis on the situation in their countries:
Aibar Sultangaziev, Partner Network, Kyrgyzstan:
“Accessibility is determined by several factors, including physical and economic accessibility. At present, the physical availability of drugs for the treatment of hepatitis C has improved significantly. Sofosbuvir manufactured in India and Egypt is available on the market. The registration of daclatasvir and sofosbuvir/ledipasvir will begin in the near future, and then virtually the entire range of the latest drugs will be registered in the country. And compared to many countries, the price is relatively low. At the same time, the state does not allocate funds for the purchase of these drugs, especially for vulnerable groups, including PLHIV, medical professionals and children. The process of developing a state programme and clinical protocol that includes new drugs has now been stepped up, and we hope that in 2017-2018, the citizens of Kyrgyzstan will begin to receive affordable treatment.”
Mari Chokheli, Open Society Foundation, Georgia:
“The second phase of the hepatitis C eradication programme in Georgia is scheduled to begin in the second half of June 2016, providing access to treatment for approximately 20,000 patients annually over a period of 10 years. Partial funding for diagnostics in several regions of Georgia is also planned. Compared to 2010, the situation with access to treatment has changed dramatically for the better. The plan to eliminate hepatitis C in Georgia can become a reality if several important steps are taken: implementing effective prevention measures, including expanding support for harm reduction programmes, improving drug policy to increase the detection of new cases, and expanding funding for the diagnosis and monitoring of hepatitis C treatment in Georgia.
Anahit Harutyunyan, Armenian Network of Positive People, Armenia:
Pegylated interferon and ribavirin are registered in Armenia. New-generation drugs are not registered. They are available on the market, imported illegally by individuals, mainly Indian generics. In terms of cost, pegylated interferons remain expensive, while generics are more affordable. It is very important for the country to take certain steps. To date, there is no national hepatitis programme. Epidemiological surveillance needs to be strengthened and joint actions developed to reduce the burden of the disease. It cannot be said that people in Armenia do not receive treatment, but the availability of drugs is not fully ensured. The state must commit to providing treatment for the population.
Sergey Biryukov, AGEP’C (ANTIGEPAPTIT’C) Public Organisation, Kazakhstan:
Unfortunately, the situation with access to HCV treatment in the country leaves much to be desired. Thousands of people are diagnosed, but only a thousand are treated; there are almost 40,000 people on the waiting list for treatment. What needs to be done to improve the situation? Comprehensive screening is necessary. A long-term national programme to combat viral hepatitis C should be developed with clear indicators for achieving the goal. Negotiations should be started with leading manufacturers of original medicines to reduce the cost of medicines for the country within the framework of the developed national programme. Georgia’s experience in this area shows that this is possible. At the same time, allow and begin registering generic forms of drugs used to treat HCV in the country.
Lyudmila Maistat, Public Health Alliance, Ukraine:
“The eradication of hepatitis C in ECA countries is impossible without ensuring access to diagnosis and treatment for vulnerable groups, as injecting drug use is the driving force behind the epidemic. Implementing the recommendations of the WHO and the European Association for the Study of the Liver means that representatives of vulnerable groups must be included in HCV testing and treatment programmes. This is important to consider when developing national plans and programmes aimed at overcoming the epidemic. The The Public Health Alliance, in partnership with the Ukrainian Ministry of Health, provides treatment for the most vulnerable groups, pilots effective models, and lays the groundwork for significantly expanding access to diagnosis and treatment for all who need it. It also works to reduce the cost of diagnosis and medication, raises public awareness, and conducts regular training for doctors and social workers. The successful experience of implementing the Alliance’s treatment programme was taken into account in the development of the WHO Global Strategy on Viral Hepatitis. It is also worth noting that, provided there is sufficient funding, a reduction in the price of direct-acting drugs, and access to high-quality generic drugs, the countries of the EECA region have a serious chance of successfully implementing this strategy, dramatically increasing the availability of modern treatment and, as a result, stopping the hepatitis C epidemic in the region.”
Video blog by ESUN activist Alexei Kurmanaevsky about his experience of treating hepatitis C
