In 2015, after many years of preparatory activities, Alliance for Public Health initiated a free program to treat hepatitis C virus (HCV). A year after, patients representing high-risk populaitons were the first in Ukraine to receive HCV treatment with current direct-acting antivirals (before HCV treatment was based on interferons, with multiple side effects, treatment interruptions and cure rates not exceeding 50%). In 2017, for the first time in our country Alliance initiated HCV screening, testing and treatment services to be provided to the first several dozens of inmates in penal institutions.
HCV treatment success rate in Alliance programs was up to 98%!
In 2019, with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria Alliance procured 3,740 new HCV treatment courses. According to the WHO recommendations, we use generic direct-acting antivirals (DAAs), pangenotypic (universal) treatment regimens and simplified diagnostics approach. Only this year, over one thousand patients successfully completed their treatment, with the adherence to treatment reaching the record level of 99.5%!
Today, our program provides access to HCV treatment to the key population members with HIV/HCV co-infection from all over Ukraine, including temporarily uncontrolled areas as well as inmates in 13 institutions of the State Criminal-Executive Service of Ukraine. Only in 2020, we expanded treatment coverage to include Zakarpattia, Luhansk, Donetsk, Ternopil, Volyn and Chernivtsi regions.
Even with strict restrictions because of the COVID-19 pandemic, project case managers support every client, successfully ensuring uninterrupted therapy and high treatment adherence. The unique experience of preventing reinfections in the time of lockdown and creative approaches to knowledge sharing helped us to develop an awareness-raising brochure, containing answers to the most popular questions, which patients ask when talking to social workers.
In five years of Alliance HCV treatment program implementation:
- 5,000 patients have received or are currently receiving treatment
- There was an evolution of treatment from interferon-based to current pangenotypic/universal regimens
- Treatment and main diagnostics are provided to patients free of charge
- The procurement cost of direct-acting antivirals (provided to patients free of charge) has been reduced from USD 900 to the lowest price for Ukraine – USD 75 per standard 12-week treatment course
- A simplified approach to HCV diagnostics has been introduced
- For the first time, HCV diagnostics is done using GeneXpert systems directly in the treatment facilities of Ukraine
- For the first time, regional laboratory centers of the Ministry of Health are involved in HCV diagnostics
- A model has been introduced to educate patients from the key populations on the routes of HCV transmission, safe behavior, prevention of reinfections and its efficiency has been proven
- A cascade of services is provided by referring prevention program clients with positive results of HCV rapid tests to the treatment program
- Cascade of services is provided to the patients in the penitentiary system
- 100% monitoring of treatment quality is implemented
- For the first time, a study on the rates of HCV reinfection among successfully cured key population members has been carried out
- Sustainability of the program has been ensured with multiple sources of funding
Today, on the World Hepatitis Day, we would like to sincerely thank doctors, case managers and patients for their commitment and participation in the Alliance treatment program and for their invaluable contribution to elimination of viral hepatitis in Ukraine.
Hepatitis treatment program implemented by Alliance has been included in the Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region.
The WHO data show that Ukraine is the only country in the European region, which has been included into the list of 28 countries with the highest hepatitis burden in the world. It is estimated that up to 5% of people in Ukraine are infected with hepatitis C, which totals one to two million Ukrainian citizens who require treatment.
The surveillance system existing in Ukraine as well as the limited access to diagnostics and treatment services do not allow getting accurate cumulative data on the burden of this disease. Meanwhile, there number of people who know about their HCV status is dozens times lower: according to the Public Health Center of the Ministry of Health of Ukraine, in January 2020 the estimated number of people with HCV in Ukraine was 1,342,418 people. Only 87,269 people receive medical follow-up services (6.5% of the estimated number).
As the disease is often asymptomatic (“silent infection”) and left without treatment, chronic hepatitis C is the main driver of hepatic cirrhosis and primary liver cancer. Peculiarities of the clinical HCV progression lead to its late diagnosis, often at the terminal stages of hepatic disease.
In November 2019, Ukraine joined the Global Health Sector Strategy on Viral Hepatitis by approving the National Strategy on HIV/AIDS, Tuberculosis and Hepatitis until 2030. Goals of implementing the National Strategy until 2030:
- 90% of new viral hepatitis cases will be prevented;
- 90% of people with viral hepatitis will be diagnosed and will know about their status;
- up to 90% of patients will receive treatment, which will be effective and will lead to full recovery (for HCV) or effective control of the disease (for HBV).
Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region
Testing is the only possible way to diagnose viral hepatitis.
National Viral Hepatitis Hotline: 0-800-50-33-10
Alliance for Public Health