Hepatitis C Diagnosis Seen as Biggest Bottleneck in Reaching Global Elimination

Hepatitis C diagnosis is the biggest roadblock to achieving global elimination of the liver-attacking virus by 2030.

Worldwide HCV prevalence in 2017 dropped 2% from 2015 levels to 69.6 million viremic infections, thanks to increased treatment and prevention, according to data collected by research organization Polaris Observatory. That puts global HCV prevalence at 0.9%, according to the Colorado-based organization.

However, to reach the World Health Organization’s Global Health Sector Strategy 2020 interim target, diagnosis and mortality reduction are key. About 1.9 million individuals need to be treated annually between 2018 and 2020 and 4.3 million new patients must be diagnosed annually in those years.

Longer term, 4.5 million patients need to be diagnosed each year from 2020 to 2030 and a little more than 5 million people a year must be treated during that time to reach the final GHSS goal, according to Polaris.

“We need screening to find those who are undiagnosed,” said Homie Razavi, PhD, MBA and founder of the non-profit CDA Foundation, which supports and manages Polaris. “But, more importantly, we need to get those who are already diagnosed to come in and be treated.’’

The WHO has set goals of 90% diagnosis, 90% reduction in new infections and 65% reduction in liver-related deaths as it works to eliminate viral hepatitis by 2030. The organization is focusing on hepatitis B (HBV) and HCV, which account for 96% of all hepatitis deaths.

Eradication requires coordination to prevent new infections while simultaneously curing existing ones, Sarah Blach, MHS, CPH and Polaris’s lead for HCV, said.

Low and low-to-middle income countries face numerous barriers, Blach said.

“The primary roadblock is insufficient laboratory infrastructure, trained staff and cost,” Blach said. “Since the current volume of testing is low, the cost per test is high, making it inefficient to build local capacity.”

In some African nations, samples are shipped abroad for processing, which results in very high diagnostic cost per patient, Blach said.

Also, many poorer countries are still using older standards of care that include multiple tests. Meantime, new recommendations have reduced the amount of testing.

Local, rapid, point of care diagnostic testing could help. However, patients who test positive must then be linked to treatment and follow up.

“Currently, thousands of HCV infections are identified in blood donation centers but, without a registry in place, the governments have no idea who or where these cases reside,” Blach said.

Razavi pointed to high treatment rates in countries including Australia, the US, UK, Spain, Portugal, Egypt, France and Germany.

“Without further screening and linkage to care of those already diagnosed, we will see further decline in the number of treated patients,” Razavi said.

Undiagnosed cases will lead to more advanced liver diseases. Once HCV infected individuals reach the final stages of fibrosis, they must be screened for hepatocellular carcinoma annually even after they are cured, Razavi said.

Razavi cited a program in New Zealand as a potential model to encourage patients diagnosed with HCV to get treated, in which patients are offered financial incentives to receive therapy.

“This is much more cost effective than finding undiagnosed cases and has resulted in a huge increase in the number of treated patients,” Razavi said.

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