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Hepatitis C Virus

  • Writer: Polelo Mawela
    Polelo Mawela
  • Aug 3, 2022
  • 4 min read

Updated: Aug 5, 2022

Improving Access and Quality of Treatment Services.

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World Hepatitis Day was commemorated on the 28th of July 2022 under the theme "I can't wait", this theme emphasises the need to eliminate waiting times and increase access to hepatitis testing and treatment. This article echoes the same call by looking at barriers and recommendations that could help South Africa fight Hepatitis C Virus (HCV). We will also look at relevant literature on cost-effective tactics to improve screening and treatment (1).


An estimated 10.15 million people in the Sub-Saharan Africa are infected with chronic Hepatitis. As of February 2020, about 600 000 people in South Africa were estimated to be suffering from Hepatitis C; among these are high-risk groups such as people who inject drugs (PWID), men who have sex with men (MSM), the prison population and people living with HIV (6) (7).



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The recommended treatment for hepatitis C includes Direct-Acting Antivirals (DAA) which have an excellent tolerance rate and a cure rate of up to 95%. This treatment is able to achieve a higher sustained viral response after a short treatment regimen (2). If treatment exists, why is HCV still challenging for the healthcare system? Some of the contributory factors include low awareness, lack of screening programs, loss of follow-up and high reinfection rates in high-risk populations. A study published in the harm reduction journal 2020 looked further into the motivations and barriers to seeking Hepatitis C treatment among the PWID community in South Africa. The study found that most participants were willing to attend treatment appointments even if they knew they would experience stigmatisation by the healthcare system. The main motivations for getting treatments were the desire to be cured and the fear of dying. The barriers for service attendance were stigmatisation by the healthcare system, experiencing drug withdrawal symptoms, lack of money and urgency (3). As the study indicates, it is essential for health practitioners to not stigmatise communities affected by Hepatitis.


Health practitioners can help optimise DAA treatment by monitoring patients for hepatocellular carcinoma and hepatic decompensation every six months. They can closely monitor extrahepatic complications like lymphoma, cardiovascular diseases and conduct yearly screening for HCV reinfection in high-risk communities (4)(5).


Due to the economic state of South Africa, any recommendation to scale up screening and treatment will have to be cost-effective. This is why we are referring to a study conducted in South Korea comparing the estimated cost-effective impact (in terms of decreasing the mortality rate as well as the infection rate) of different screening policies in the long term (from 2017 to 2050). The best cost-effective results for women were attained in the age groups of 50-59 and 60-69; for men, the best outcome was reached in the age group of 40-49 (6). The best policies are the ones that will increase screening starting from age 40 for men and age 50 for women, as well as high-risk groups such as people living with HIV, PWID and MSM (6).


The recommended approach to reducing hepatitis C cases involves contributions from both the government and health practitioners. Policies should focus on high-risk populations for the best economic outcome. Barriers such as stigmatisation or lack of awareness should be addressed to allow easier access to treatment and screening.


In the South African context, a high prevalence of HIV is a significant driver for HCV infections. It is therefore crucial to have an integrated approach to screening, diagnosis and management of both medical conditions. The Clinical Care Platform offers a wide range of HIV and related disease management programs that empower and enhance skills of healthcare professionals with current clinical guidelines, furthermore strengthening the ability of our healthcare system to eradicate various diseases. We recommend you visit the clinical library “clinLib” and explore available continuous professional development(CPD) courses.

References:

  1. World Hepatitis Day: Hepatitis Can't Wait [Internet]. World Hepatitis Day. 2022 [cited 1 August 2022]. Available from: https://www.worldhepatitisday.org/

  2. Asselah T, Boyer N, Saadoun D, Martinot-Peignoux M, Marcellin P. Direct-acting antivirals for the treatment of hepatitis C virus infection: optimising current IFN-free treatment and future perspectives. Liver International [Internet]. 2016 [cited 1 August 2022];36:47-57. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218370/

  3. Versfeld A, McBride A, Scheibe A, Spearman C. Motivations, facilitators and barriers to accessing hepatitis C treatment among people who inject drugs in two South African cities. Harm Reduction Journal [Internet]. 2020;17(1). Available from: http://file:///C:/Users/User/Downloads/12836-57794-1-PB%20(1).pdf

  4. Huang CF, Dai CY, Yeh ML, Huang CI, Lee HC, Lai WT, Liang PC, Lin YH, Hsieh MY, Hou NJ, Lin ZY, Chen SC, Huang JF, Chuang WL, Yu ML. Cure or curd: Modification of lipid profiles and cardio-cerebrovascular events after hepatitis C virus eradication. Kaohsiung J Med Sci. 2020;36:920–928. [PubMed] [Google Scholar]

  5. Muzica CM, Stanciu C, Huiban L, Singeap AM, Sfarti C, Zenovia S, Cojocariu C, Trifan A. Hepatocellular carcinoma after direct-acting antiviral hepatitis C virus therapy: A debate near the end. World J Gastroenterol. 2020;26:6770–6781. [PMC free article] [PubMed] [Google Scholar]

  6. Kim J, Haacker M, Keshavjee S, Atun R. Cost-effectiveness of scaling up of hepatitis C screening and treatment: a modelling study in South Korea. BMJ Global Health [Internet]. 2019;4(3):e001441. Available from: https://gh.bmj.com/content/4/3/e00144

  7. Sonderup, M., Gogela, N., Nordien, R., Smuts, H., Korsman, S., Hardie, D. and Spearman, C., 2020. Direct-acting antiviral therapy for hepatitis C: The initial experience of the University of Cape Town/Groote Schuur Hospital Liver Clinic, South Africa. South African Medical Journal, [online] 110(2), p.112. Available at: <http://file:///C:/Users/Lucie/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/12836-57794-1-PB%20(1).pdf>

 
 
 

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