Have a Heart, Save My Liver! Why Hepatitis C Virus Care Remains Inaccessible

Available evidence suggests that by 2040, viral hepatitis deaths will outnumber HIV, tuberculosis, and malaria deaths combined if viral hepatitis is not appropriately addressed. In the absence of proactive national strategies to raise awareness, actively engage with communities to scale up hepatitis C virus (HCV) screening uptake, and decentralize HCV care to make it more accessible, particularly among key populations with the highest HCV burden, countries will not be able to find the missing millions of people living with HCV.

Seven years into the Global Health sectors strategy on HIV, viral hepatitis, and STIs for 2016–2021, in which the World Health Organization (WHO) set out a strategy to eliminate viral hepatitis by 2030, only 21% of the 58 million people estimated to be living with HCV have been diagnosed, and about 400,000 people die from the disease each year. Low- and middle-income countries account for about 75% of the global HCV burden, with India, Pakistan, Nigeria, and China alone being home to over 50% of people living with HCV.

HCV is the only chronic infectious disease that can be cured with 8–12 weeks of treatment.

As a result, the disease can be controlled and eliminated with appropriate national strategies that address stigma and prioritize key populations for diagnostics and treatment with all-oral pangenotypic direct-acting antivirals (DAAs). Generic versions of DAAs are commercially available, and cost less than $100 in a few countries.

However, based on Polaris Observatory studies, only 11 countries (Australia, Canada, Denmark, Egypt, Finland, France, the country of Georgia, Japan, Norway, Spain, and the United Kingdom) are on track to achieving the HCV elimination goals by 2030. An additional 22 countries are expected to meet these goals between 2031 and 2050.

This policy brief, developed by Treatment Action Group (TAG), presents online survey data from 23 countries on some of the key HCV diagnostics and policy barriers that inhibit access to HCV care in low- and middle-income countries (LMICs).

As the target year for viral hepatitis elimination, 2030, approaches, the policy brief demands that:

The global community and national governments work together to raise funding for HCV elimination, to find the missing millions of people living with HCV, and to scale up HCV diagnostics, especially among high-burden key populations. Having a clear idea about the demand for DAAs would serve as a leverage to re-engage with generic manufacturers and negotiate more affordable prices for health systems and patients.
Given that HCV remains asymptomatic for several decades while causing avoidable liver damage, national hepatitis programs should continuously raise awareness about HCV, subsidize HCV screening programs to encourage more people to screen, with a particular focus on key populations.
Countries adopt WHO recommendations on decentralization of care to lower-level health facilities accessible to all; integrate HCV care into primary care, harm reduction programs, prisons, and HIV services; and task sharing through delivery of HCV testing, care, and treatment by appropriately trained non-specialist doctors and nurses.
Countries review HCV diagnostics algorithms to include POC HCV RNA viral load and reflex HCV RNA viral load testing, eliminate requirements for HCV genotype testing, and to initiate treatment at the same site and during a single visit.
Countries put in place systems to record epidemiological data regarding HCV diagnosis, treatment, and care to track and guide policies and allow communities to understand and advocate for the best care.
National regulatory authorities review and amend policies that prevent registration of generic daclatasvir, even if the originator drug is not registered, by relying on its registration in other countries. This will ensure that all approved generic DAAs are available on the market, promote competition and drive down treatment costs.