As we recognize World Hepatitis Day this year, there is hope for millions of people living with chronic hepatitis around the world. New, directly acting antiviral (DAA) medications are providing a cure to people infected with the disease.
In Vietnam, one of the countries with highest rates of hepatitis C (HCV) infection in the world, the Clinton Health Access Initiative (CHAI) is helping to increase access to these new medications through its Quick Start program.
In Hai Duong Province, south-west of Ha Noi, around 20 people with chronic HCV will form the first cohort to receive this new treatment at Hai Duong Provincial HIV/AIDS Center, one of five health centers receiving support through the program around the country.
Under Quick Start, 2,000 patients will receive (free-of-charge) a new, highly effective drug, called daclatasvir, from Bristol-Myers Squibb (BMS). The program will also support patients to purchase another required directly-acting antiviral medicine (sofosbuvir) at a reduced price, negotiated by CHAI.
For patients coming to the Hai Duong Provincial HIV/AIDS Center, these new medications are truly a lifesaver. Patients selected to begin treatment through the program began arriving at dawn. Many of these patients have been waiting months or even years for treatment.
Previously, it was difficult for those living with HIV to afford HCV medication. Earlier treatments had significant side effects and were often poorly tolerated. In addition, they had less than a 50 percent chance of sustained virologic response (a proxy for cure) after one year of treatment.
The launch of safe and effective DAA medications in 2013 has made it feasible for a lower-middle income country like Vietnam to begin widespread screening and treatment. This is especially critical for Vietnam, with over 1 million people estimated to be chronically infected. Vulnerable groups are particularly affected, with high prevalence among people who inject drugs and who are co-infected with HIV. Liver cancer is now one of the top five causes of cancer deaths in the country.
While the vigorous efforts and investments in expanding antiretroviral therapy services nationwide have contributed to improved survival of HIV patients, the high rate of HCV/HIV co-infection has continued to accelerate disease progression and contribute to high mortality, impeding the national progress in combating HIV and HCV. Due to the previously prohibitive high costs, the health infrastructure for diagnosing and treating HCV in Vietnam is woefully inadequate. Even though many kinds of DAAs are now available to purchase in Vietnam, HCV treatment is only provided in tertiary hospitals and a select few provincial health facilities.
CHAI’s Quick Start program aims to strengthen Vietnam’s viral hepatitis control by increasing the number of people accessing affordable diagnosis and treatment and demonstrating that treatment is feasible and affordable at lower levels of the health care system. In addition, CHAI, together with the National Hospital of Tropical Diseases in Vietnam, aims to improve the capacity of health care workers in the provinces on viral hepatitis care and treatment.
“I feel very lucky for Hai Duong Province to be part of this project. I would never think that our patients, while most of them are on either ART [antiretroviral therapy] or MMT [methadone maintenance treatment], to have enough money to pay for HCV treatment, even with new DAAs introduced in Vietnam. Most of them were injecting drug users, they are now very poor. I have witnessed a patient of mine, who had to sell his house two years ago for a lengthy HCV treatment course. But now, with CHAI’s support, patients can pay only 50% of the normal price for treatment. I think their dream of HCV-free can become true now”, said Dr Hai, Director of Hai Duong Provincial AIDS Center.
CHAI will continue to work with the National Hospital of Tropical Diseases, Ministry of Health and other partners to address the key barriers to HCV diagnosis and treatment and to ensure that the lessons learned from the Quick Start program in 3 provinces in Vietnam will shape HCV policy in years to come and ensure that Quick Start leads to smart scale-up and ultimately elimination of this disease. On this third World Hepatitis Day since the launch of the Quick Start program at CHAI, countries like Vietnam have the building blocks in place and are poised to launch ambitious efforts to tackle this disease.
