A large investment of at least US$3.9 billion needed to meet the World Health Organization’s (WHO) target for the elimination of Hepatitis C virus (HCV) in Pakistan could deliver huge benefits in terms of lives saved and reduced ill health, according to University of Bristol led research published in The Lancet Global Health.

Pakistan has one of the highest rates of Hepatitis C infection in the world, accounting for over 10% of the global HCV infections, so reducing new infections to meet the WHO target is a public health priority. New direct-acting antivirals, or DAAs, are highly effective at curing HCV infection, resulting in WHO recently developing the first Global Health Sector Strategy to eliminate HCV by 2030. Targets have been set to reduce global incidence by 80% and mortality by 65%. However, there is a lack of guidance on how to achieve the WHO elimination targets in low- and middle-income countries (LMICs), and there are no estimates on how much it could cost.

The study, a collaboration between the University of Bristol, Médecins Sans Frontières, the Pakistan HCV Task Force, US Centers for Disease Control and Prevention, Aga Khan University, and the Pakistan Kidney and Liver Institute, used mathematical modelling to provide the first country-level estimates of the screening and treatment needed for achieving the WHO elimination targets for HCV incidence in Pakistan, and the possible the costs of doing so.

The study found that to achieve elimination by 2030, around 36 million people will need to be screened or re-screened annually, and around 660,000 will need to be treated each year. Regular re-screening will also be needed to identify new infections or re-infections, and efforts will need to be made to re-engage individuals lost to follow-up. Success will also depend on achieving high referral rates to ensure that at least 90% of people diagnosed receive treatment.

Achieving the WHO elimination target for incidence could mean preventing 5.8 million new infections and 390,000 HCV-associated deaths that might otherwise occur by 2030. The estimated US$3.9 billion cost – the equivalent of around 9.0% of the current health expenditure of Pakistan or an investment of US$1.50 per person per year – is dependent on using the cheapest drugs and tests, and using a simple testing and treatment algorithm. 

Dr Aaron Lim, infectious disease mathematical modeller and lead author from the National Institute for Health Research Health Protection Research Unit at the University of Bristol, said: “Our modelling suggests that Pakistan’s HCV epidemic is on the rise, with around 700,000 new infections occurring each year, rapidly adding to the current 7.5 million people, or about 4% of the population, who are chronically infected by HCV. The situation is expected to get worse if interventions are not scaled up. With fewer than 14% of infected people aware of their infection status, and even fewer having been treated, it is clear that any global HCV elimination effort will need to seriously address Pakistan’s large epidemic.”

Read the full Research Paper: Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: A modelling analysis by Aaron G. Lim et al. Published in The Lancet Global Health. 19 February 2020.

Read the full Article here at http://www.bristol.ac.uk/news/2020/february/hepatitis-c.html

Image: https://vizhub.healthdata.org/gbd-compare, The institute for Health Metrics and Evaluation (IHME)