Hepatitis C Elimination. Are we on course for 2030?

vaccination and contact tracing. Last, but not the least, is the global implementation


Introduction
H epatitis C is a major public health problem in Pakistan.
At present, Pakistan has the highest disease burden 1 due to chronic hepatitis C (CHC) virus infection.HCV prevalence in Pakistan was studied at the national level in 2008.This sero-survey was conducted by the Pakistan Medical 2 Research Council (PMRC) and the prevalence of Hepatitis C antibodies was estimated to be approximately 5% (8 million).However, recently, other prevalence studies done in Pakistan have shown an increasing trend in chronic hepatitis C (CHC) plus Velpatasvir.In the current scenario, the bottleneck remains that very few people are aware of their disease due to the asymptomatic nature and therefore the unaware patients do not seek active testing and treatment, thereby creating a large pool of untreated and undiagnosed people in the community.
Taking notice of this high burden of disease yet the ease to eliminate the hepatitis C virus, virtually within a few weeks of treatment, the Prime Minister (PM) of Pakistan, has agreed to launch a hepatitis C virus elimination programme to be 13 implemented over the next 5 years (till 2030), which has also received endorsement by the President of Pakistan.The salient features of the PM Programme are that all patients above the age of 12 years will be screened using rapid HCV testing.It is assumed that 10% of the population will be positive (17 million) for chronic hepatitis C. Following this, these 17 million HCV-positive patients will undergo PCR testing and if this hypothesis is correct then 60% may have the virus and thus would need treatment, we are looking at treating 15 million people free of cost.This scientific modeling/mathematics needed the support of the modelers.Therefore, Homie Razavi from the Center of Disease Analysis (CDA) was requested by the Federal government to undertake the modeling for Pakistan.Likewise new data on hepatitis C released by the Polaris Observatory, also shows that 9 countries Australia, Brazil, Egypt, Georgia, Germany, Iceland, Japan, Netherlands, and Qatar are on track to meet the WHO target of eliminating 22 hepatitis C with the UK not far behind.In Pakistan, the PM Programme is being launched as a support program to the already existing provincial hepatitis programs.The PM program shall procure the commodities i.e rapid tests, PCR and the treatment and shall pass on to the provinces on their need/demand base.Monitoring of the utilization of these commodities shall be done by the provinces and the federal government.The federal health ministry shall be the custodian of the project.Provinces will enhance their capacity to screen, test and treat more patients and strengthen infection prevention i.e safe blood, safe injections and infection control in the health care settings.The plan is to screen all population over 12 years of age using health facility-based screening along with community screening.All those who are found to be reactive on the rapid test shall have their blood collected immediately (reflex testing) for HCVRNA, CBC and AST> CBC and AST shall be used to calculate the APIR score for deciding the duration of therapy (APRI <1.5 receive 12 weeks treatment and those with >1,5 receive 24 weeks treatment.Private sector engagement along with engaging other stake holders like department of education, religious affairs, water and sanitation, NGOs, corporate sector, airlines, railways, army will help in making this huge possible.Hence, by adhering to this plan we can achieve elimination by 2030.

Conclusion
In conclusion, the 2030 hepatitis elimination targets seem difficult to be achieved in Pakistan, especially at the current pace.However combining the PM's programme for hepatitis C elimination with other similar stakeholders such as the provincial hepatitis programmes, harm reduction, blood safety and infectious disease control services can bring a huge change in the current momentum.In the PM programme alone, screening, testing and treatment will be increased 8 times to that of the present figures and new infections will thereby be reduced by 5 times.
Hence, abiding by this hypothesis of a combined annotation approach, (one-time mass screening plus follow through with active treatment) we should be successful in toppling the hepatitis C (HCV) virus infection dominos.This in turn should be able to achieve an almost 80% reduction in the incidence and 65% reduction in liver related mortality secondary to chronic hepatitis C infection by year 2030, placing us more closer to our target .

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WHO), HCV elimination targets by 2030.The model estimates that each year Pakistan has to treat 1 million cases to achieve the 2030 elimination targets.Similarly, new cases of HCV must be reduced by enhancing efforts 10 times the 21 present rate.
SVR 12.The cost of 12 weeks of therapy with Sofosbuvir and Daclatasvir is relatively lower than that of Sofosbuvir