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Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination
With political will, modest financial investment and effective technical assistance, public sector hepatitis C virus (HCV) programmes can be established in low- and middle-income countries as a first step towards elimination. Seven countries, with support from the Clinton Health Access Initiative (C...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745326/ https://www.ncbi.nlm.nih.gov/pubmed/33328200 http://dx.doi.org/10.1136/bmjgh-2020-003767 |
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author | Boeke, Caroline E Adesigbin, Clement Agwuocha, Chukwuemeka Anartati, Atiek Aung, Hlaing Thazin Aung, Khin Sanda Grover, Gagandeep Singh Ngo, Dang Okamoto, Emi Ngwije, Alida Nsanzimana, Sabin Sindhwani, Siddharth Singh, Grace Sun, Ly Penh Kinh, Nguyen Van Waworuntu, Wiendra McClure, Craig |
author_facet | Boeke, Caroline E Adesigbin, Clement Agwuocha, Chukwuemeka Anartati, Atiek Aung, Hlaing Thazin Aung, Khin Sanda Grover, Gagandeep Singh Ngo, Dang Okamoto, Emi Ngwije, Alida Nsanzimana, Sabin Sindhwani, Siddharth Singh, Grace Sun, Ly Penh Kinh, Nguyen Van Waworuntu, Wiendra McClure, Craig |
author_sort | Boeke, Caroline E |
collection | PubMed |
description | With political will, modest financial investment and effective technical assistance, public sector hepatitis C virus (HCV) programmes can be established in low- and middle-income countries as a first step towards elimination. Seven countries, with support from the Clinton Health Access Initiative (CHAI) and partners, have expanded access to HCV treatment by combining programme simplification with market shaping to reduce commodity prices. CHAI has supported a multipronged approach to HCV programme launch in Cambodia, India, Indonesia, Myanmar, Nigeria, Rwanda and Vietnam including pricing negotiations with suppliers, policy development, fast-track registrations of quality-assured generics, financing advocacy and strengthened service delivery. Governments are leading programme implementation, leveraging HIV programme infrastructure/financing and focusing on higher-HCV prevalence populations like people living with HIV, people who inject drugs and prisoners. This manuscript aims to describe programme structure and strategies, highlight current commodity costs and outline testing and treatment volumes across these countries. Across countries, commodity costs have fallen from >US$100 per diagnostic test and US$750–US$900 per 12-week pan-genotypic direct-acting antiviral regimen to as low as US$80 per-cure commodity package, including WHO-prequalified generic drugs (sofosbuvir + daclatasvir). As of December 2019, 5900+ healthcare workers were trained, 2 209 209 patients were screened, and 120 522 patients initiated treatment. The cure (SVR12) rate was >90%, including at lower-tier facilities. Programmes are successfully implementing simplified, decentralised public health approaches. Combined with political will and affordable pricing, these efforts can translate into commitments to achieve global targets. However, to achieve elimination, additional investment in scale-up is required. |
format | Online Article Text |
id | pubmed-7745326 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-77453262020-12-28 Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination Boeke, Caroline E Adesigbin, Clement Agwuocha, Chukwuemeka Anartati, Atiek Aung, Hlaing Thazin Aung, Khin Sanda Grover, Gagandeep Singh Ngo, Dang Okamoto, Emi Ngwije, Alida Nsanzimana, Sabin Sindhwani, Siddharth Singh, Grace Sun, Ly Penh Kinh, Nguyen Van Waworuntu, Wiendra McClure, Craig BMJ Glob Health Practice With political will, modest financial investment and effective technical assistance, public sector hepatitis C virus (HCV) programmes can be established in low- and middle-income countries as a first step towards elimination. Seven countries, with support from the Clinton Health Access Initiative (CHAI) and partners, have expanded access to HCV treatment by combining programme simplification with market shaping to reduce commodity prices. CHAI has supported a multipronged approach to HCV programme launch in Cambodia, India, Indonesia, Myanmar, Nigeria, Rwanda and Vietnam including pricing negotiations with suppliers, policy development, fast-track registrations of quality-assured generics, financing advocacy and strengthened service delivery. Governments are leading programme implementation, leveraging HIV programme infrastructure/financing and focusing on higher-HCV prevalence populations like people living with HIV, people who inject drugs and prisoners. This manuscript aims to describe programme structure and strategies, highlight current commodity costs and outline testing and treatment volumes across these countries. Across countries, commodity costs have fallen from >US$100 per diagnostic test and US$750–US$900 per 12-week pan-genotypic direct-acting antiviral regimen to as low as US$80 per-cure commodity package, including WHO-prequalified generic drugs (sofosbuvir + daclatasvir). As of December 2019, 5900+ healthcare workers were trained, 2 209 209 patients were screened, and 120 522 patients initiated treatment. The cure (SVR12) rate was >90%, including at lower-tier facilities. Programmes are successfully implementing simplified, decentralised public health approaches. Combined with political will and affordable pricing, these efforts can translate into commitments to achieve global targets. However, to achieve elimination, additional investment in scale-up is required. BMJ Publishing Group 2020-12-15 /pmc/articles/PMC7745326/ /pubmed/33328200 http://dx.doi.org/10.1136/bmjgh-2020-003767 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Practice Boeke, Caroline E Adesigbin, Clement Agwuocha, Chukwuemeka Anartati, Atiek Aung, Hlaing Thazin Aung, Khin Sanda Grover, Gagandeep Singh Ngo, Dang Okamoto, Emi Ngwije, Alida Nsanzimana, Sabin Sindhwani, Siddharth Singh, Grace Sun, Ly Penh Kinh, Nguyen Van Waworuntu, Wiendra McClure, Craig Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination |
title | Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination |
title_full | Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination |
title_fullStr | Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination |
title_full_unstemmed | Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination |
title_short | Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination |
title_sort | initial success from a public health approach to hepatitis c testing, treatment and cure in seven countries: the road to elimination |
topic | Practice |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745326/ https://www.ncbi.nlm.nih.gov/pubmed/33328200 http://dx.doi.org/10.1136/bmjgh-2020-003767 |
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