Dr Sanjay Sarin, Head, FIND India reveals that 4 out of 5 people with hepatitis C are unaware of it and suggests treatment measures to overcome this chronic disease
India is one of the fastest growing economies in the world today. Addressing our healthcare challenges is critical, both for our people individually, and for our country’s development. Hepatitis C, a disease affecting the liver, is a particular concern. Estimates suggest that, in India, anywhere between 6 and 12 million people are infected with the hepatitis C virus (HCV) – with 71 million people affected worldwide.
It is an urgent problem to address: 4 out of 5 people who are infected with HCV don’t know it, which means that transmission is only increasing as people are not seeking treatment. The virus is contracted through exposure to infected blood, most commonly via unsafe healthcare practices such as poor injection hygiene or the transfusion of unscreened blood and blood products, or as a result of injection drug use. As many as 5–20 per cent people who are chronically infected may develop serious conditions including liver cirrhosis or liver cancer.
However, hepatitis C is fully curable. In recent years, the introduction of highly effective direct acting antiviral (DAA) drugs has enabled cure rates of up to 95 per cent within a span of 12–24 weeks. While these drugs are increasingly affordable and available, people need to be diagnosed before they can access the treatment they need.
HCV diagnosis – where do we stand today?
Strategies and technological advances must be in place for early detection of HCV infection, but R&D of HCV diagnostics has not kept pace with drug development. Current diagnostic strategies start with screening – a test to identify antibodies that would be present in the blood if a person has ever been exposed to HCV, even if the infection has subsequently been cleared spontaneously or cured through therapy. If the screening test is positive, a confirmatory (HCV RNA) test is needed to establish if the person is still infected with the virus.
Various rapid diagnostic tests (RDTs) have been developed and given the green light by the World Health Organisation (WHO) for HCV screening at the “point-of-care” – where patients first seek medical attention. This type of test is particularly appropriate for low-resource settings, where testing laboratories and trained personnel may be scarce. Resembling a pregnancy test, an RDT does not require hospital facilities or electricity, and can be performed by health workers with limited training. The test gives an HCV antibody result within 20 minutes.
How can we improve access to diagnosis so more patients can be treated?
The Indian government has committed to mounting a patient-centred, integrated, efficient and sustainable public health response to HCV. This includes scaling up use of both RDTs in community settings, and HCV RNA tests in laboratories. FIND is working with the governments of four countries, including India, to implement a Unitaid-funded project called HEAD-Start – Hepatitis C Elimination through Access to Diagnostics. The HEAD-Start project will develop urgently needed new tools, and build the evidence base that will drive a change in global implementation guidelines and national policies needed to support scale up of HCV management. The project includes work to improve HCV diagnosis by making it more affordable and widely available to those in need, with a focus on vulnerable populations including people co-infected with HIV.
We are working in three Indian states: Delhi, Manipur and Punjab, in partnership with Institute of Liver and Biliary Sciences, YRG Care and the Directorate General of Health Services (Punjab), alongside community-based efforts to spread the word on HCV infection and its risk factors.
In Punjab, we are working to integrate HIV/HCV co-infection management into public health settings, while in Manipur, we are implementing community-centric HCV interventions for vulnerable populations such as people who inject drugs and their sexual partners. In Delhi, we are managing a demonstration study for point-of-care HCV screening using RDTs, confirmatory RNA testing, and linkage to treatment services, with minimal turnaround time in secondary and tertiary healthcare settings. RDTs are being used in all three project sites. These initiatives are designed to pave the way for HCV elimination in our country.
This World Liver Day, we remember that meeting the WHO 2030 elimination targets for HCV – and defeating this disease – is only possible if we can diagnose the 4 out of 5 people who don’t know they are infected, so that everyone can be linked to the treatment and care they need.