Ukraine on the edge of fight against hepatitis C

By Andriy Klepikov, Executive Director of Alliance for Public Health

Viral hepatitis nowadays is one of the biggest global health threats, still rarely being in focus of the media. World Hepatitis Day traditionally marked on 28th of July is the major date to increase public awareness on hepatitis, as without finding of undiagnosed people millions of lives will be lost. While internationally 9 out of 10 people living with viral hepatitis do not know their status, Ukraine makes no exception. Moreover, Ukraine is the only European country appeared on the WHO alarming list of 28 countries accounting for 70% of the viral hepatitis burden in the world.

More than 300 million of people in the world are suffering from viral hepatitis, and 1.3 million die each year of its complications. Ukrainian data is even more shocking – according to the latest national estimates up to 5% of Ukrainians have viral hepatitis C, in absolute figures this means that up to 2 million Ukrainians have Hepatitis C virus.

Globally, an estimated 71 million people have chronic hepatitis C infection. Getting into the human body Hepatitis C begins its devastating work by destroying the liver with no symptoms at all. It is transmitted mainly through blood specifically through unsafe injection practices, unsafe health care, transfusion of unscreened blood, and occasionally via sexual intercourse, through unprotected manipulations in beauty and tattoo saloons. In 80% of cases it becomes chronic. Imagine how dangerous it is, as people may only find out about the disease when they finally diagnosed with fibrosis, cirrhosis or even liver cancer. Approximately 399 000 people die each year from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma.

National statistics of testing results is very disappointing. For example, findings of 2016 World Hepatitis Day testing showed 8.5% of positive cases in 3800 randomly tested persons. In July 2015, a sample of 4500 thousand police officers, National Guard staff and other representatives of Ukrainian law enforcement servants has shown 4% of positive results in those tested within Ministry of Defence establishments. 2018 shows not much difference from the previous years.

These numbers bring even more evidence that up to two million people in Ukraine potentially carrying a deadly virus. This means a fairly high risk for virtually everyone, which is why access to quick testing for all is pivotal.

Not every health care facility is offering the hepatitis diagnostics, at the same time some pharmacies offer affordable rapid diagnostic tests for a price of 2-5 euro, whereas national and local non-governmental organizations, involved in HIV prevention, provide HCV and HBV testing for key groups of population for free.

The most serious challenge for Ukraine is development of national strategy aimed at viral hepatitis elimination, including awareness campaign for the population, national-wide screening program, affordable up-to-date HCV diagnostic and scaled-up access to modern HCV treatment with direct active antiviral (DAA) medications.

Have been initiating several campaigns, including global ‘Unite to Eliminate’, we joining the 2018 campaign against hepatitis focusing in widening access to diagnostic and treatment. We were the first brought up-to-date treatment to Ukraine and made it available to the most severe patients. We achieved the amazing results with 95% cure rate of patients treated with direct-acting antiviral (DAA) medications. Unlike years ago, viral hepatitis C with short DAA 12 weeks treatment course is curable today. The cure rate is so high and no or low side effects, it should be a strong motivation for people to get tested.

In 2016 – 2018 Ministry of Health of Ukraine has included some DAAs into the national treatment protocol and state budget procurement list. The initial procurement done by Alliance with funding from the Global Fund brought the prices for DAAs in Ukraine as low as 1% from the US price. Moreover, recently the DAA price was further dropped down due to generic competition, so government is procuring more and more courses of DAA medicines. This means that more patients will receive HCV treatment for free whereas presently access to it is dramatically limited.

We must admit publicly that viral hepatitis C is a serious problem that needs to be tackled urgently on a national level. And the government can’t do it alone – all stakeholders must get together.

In an effort to bring best practices of healthcare available on a city level, Alliance for Public Health brings a network of individuals and organisations engaged in the study of and response to structural health issues to Odessa on 13-14th of September, 2018. Together with our partners from AFEW International (the Netherlands), City of Odessa (Ukraine) and Knowledge Action Change (United Kingdom) we host a conference — City Health International 2018. More than 300 delegates from around the world will gather to examine how, in the increased urbanisation of society, cities respond to changing populations, economic and environmental pressures and health behaviours. It is a fantastic opportunity for us to facilitate local governments with solutions for city healthcare in Odessa and internationally.

We welcome everyone in Odessa.

Program of the event: https://cityhealthinternational.org/2018/programme/programme
List of speakers: https://cityhealthinternational.org/2018/programme/speakers-bios/david-wilson
Registration for participants: https://cityhealthinternational.org/go2018/
Registration for press: https://goo.gl/forms/i5sJac3Em99GAJLh2

Alliance for Public Health is the International charitable foundation founded in 2000 in Ukraine. It became a leading non-governmental professional organization making a significant impact on the epidemics of HIV/AIDS, tuberculosis, viral hepatitis and other socially dangerous diseases in Ukraine. In cooperation with state partners and civil society organizations, it provides financial and technical support to programs, serving over 250,000 representatives of most vulnerable populations: the highest such coverage indicator in Europe. For more information on Alliance please visit http://aph.org.ua/en/about-alliance/.

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