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Strategies for Removal of Barriers to Hepatitis C Elimination in Sub-Saharan Africa
Justine Umutesi1, Ming-Lung Yu2,3, Olufunmilayo Lesi4
1IHDPC Rwanda Biomedical Centre, Kigali, Rwanda.
Insights
Hepatitis C virus (HCV) elimination is achievable, with countries showing progress despite challenges in testing and drug affordability. Lessons from HIV programs offer a framework for comprehensive HCV services in Africa.
Area of Science:
- Hepatology and Viral Diseases
- Global Public Health
- Infectious Disease Control
Background:
- Hepatitis C virus (HCV) remains a significant global health concern, causing liver cirrhosis and cancer, with millions of new infections annually.
- Despite global efforts, HCV was the sixth leading cause of death in 2017, highlighting the urgent need for effective elimination strategies.
- Political will and successful country-led initiatives offer hope for achieving the 2030 HCV elimination goals.
Purpose of the Study:
- To present strategies employed by African nations in their pursuit of HCV elimination.
- To detail the specific challenges encountered during the implementation of HCV programs in Africa.
- To propose practical and realistic solutions to overcome these obstacles and advance HCV elimination.
Main Methods:
- Review of country-specific HCV elimination strategies in Africa.
- Analysis of challenges related to diagnostic platforms and direct-acting antiviral (DAA) accessibility.
- Exploration of leveraging existing human immunodeficiency virus (HIV) program frameworks.
Main Results:
- Several African countries are actively implementing HCV elimination programs, demonstrating progress.
- Significant challenges persist, including the high cost of testing and direct-acting antivirals (DAAs), hindering accessibility.
- The integration of lessons learned from scaling up HIV services is crucial for comprehensive HCV care delivery.
Conclusions:
- HCV elimination is a feasible goal, but requires addressing economic and logistical barriers in Africa.
- Adapting successful HIV program models can facilitate the delivery of integrated HCV services.
- Sustained political commitment and innovative funding mechanisms are essential for achieving global HCV elimination targets.
Abstract:
Hepatitis C virus (HCV) infection is a major global health threat, with serious consequences including liver cirrhosis and cancer. Despite efforts to combat HCV, an estimated 1.5 million new infections occur each year and HCV was the sixth leading cause of death in 2017. Nevertheless, political leaders are increasingly interested in the fight against HCV, and the achievements of countries such as Rwanda, Egypt, India, Mongolia, Pakistan, Georgia, and Ukraine have given hope that the elimination plan to reduce new infections to 90% and mortality to 65% by 2030 is possible. It is true that some African countries can attest to the difficulty of operationalizing the HCV program with expensive testing platforms and HCV drugs that few could afford in the past, let alone the logistics involved, given that active case detection is an asset for HCV elimination. The inability to add direct-acting antivirals (DAAs) to the national essential drug list and negotiate DAA cost subsidies remains a major challenge in Africa. The lessons learned from implementing and scaling up the human immunodeficiency virus program can provide a strong framework to deliver comprehensive HCV services. We present the strategies used by some African countries to move toward HCV elimination, describe the challenges they have faced, and suggest realistic solutions.
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