The Diagnosis and Treatment of Hepatitis C: A Technical Landscape

Opportunities to Revolutionise Care in Developing Countries

This report provides an overview on the current state of play and a framework for action with regards to hepatitis C diagnostics and treatment in resource-poor settings.

SUMMARY AND STATEMENT OF PRIORITY

Hepatitis C (HCV) has been a silent killer among people living in low- and middle-income countries. Factors including lack of epidemiologic data, poorly tolerated treatment with low success rates, and cost and complexity of care have all contributed to a vicious cycle of neglect that has allowed a growing epidemic of HCV to blossom unchecked.

But recent advances in both diagnosis and treatment, as well as new data on prevalence in low- and middle-income countries, provides an unprecedented opportunity to take the lead in turning back the growing tide of HCV and dramatically improve the wellbeing of people infected with HCV. New all-oral regimens offer the potential of being robust, well-tolerated and pan-genotypic.

Thus, not only improving cure rates, but also simplifying diagnosis and management requirements. Advances in and scale up of molecular testing in low-resource environments facilitates diagnosis and monitoring of HCV.

Taken together, these new tools open the door to managing this deadly coinfection in low- and middle-income countries. The simplified package of care may also enable decentralization of diagnosis and treatment as well as pave the way for eventual task-shifting to less specialized cadres of health workers. However, several key interventions are required in order to spark this revolution in HCV care:

• Proactive normative guidelines at the WHO and at country level are needed
• Regular screening of patients at high risk for HCV, including those infected with HIV, is critical
• Access to appropriate diagnostics, including molecular tests, is of utmost importance and can be facilitated by utilizing the same platforms currently being rolled out for HIV
• Prices of both interferon-based therapy as well as new all-oral therapy must be appropriate to facilitate scale up in low- and middle-income countries, and biosimilar and generic competition is required in order to reach a fair price.
• Access to new oral therapies depends not only on price but also on registering of these new medications in key countries, as well as the WHO or other normative bodies signaling their importance by inclusion in the model Essential Medicines List.

There is no time like the present to rapidly address this hidden and ignored epidemic. The benefits of new tools and data will not be realised without key market interventions as well as prioritisation of this disease at the WHO and at country level. But if the choice is made to invest now in the tools needed to fight HCV in low- and middle-income countries, the potential benefits are vast.

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