There are more than 52 thousand people in Ukraine who have the hepatitis C virus, according to the official data from Ministry of Health in Ukraine. However, the number of people who do not know their diagnosis is very high.
EQUIP-Right to Care started a demonstration project for the testing and treatment of hepatitis C in Ukraine with financial support of the USAID. Participation in this project includes testing and free treatment, if the diagnosis will be confirmed.
“Ukrainian Interest” decided to talk about the project with Charles Chasela — Doctor of Philosophy and Head of the EQUIP Research Department in the South Africa. The project manager in Ukraine is Tatiana Barnard. They came to the editorial office of «Ukrainian Interest» to tell about their work, contribution to the treatment of hepatitis C and prospects for the future.
The Head Office of EQUIP is located in South Africa, why did you decide to cooperate with Ukraine?
According to the World Health Organization (WHO), more than 5% of Ukrainians are infected with hepatitis C, this is about 2 million persons. Due to their low socio-economic status, a certain part of the population has no possibility to do a test and start their treatment. For example, people who inject drugs have a fairly high risk of infection with viral hepatitis C and most of the time this group do not have access to testing because of a fear of stigma and discrimination against them. Also, laboratory diagnostics is quite expensive as well as treatment.
Therefore, we decided to start a demonstration project to help these people. Also, this project will help Ukrainian doctors to get the necessary experience of using new antiviral drugs for effective treatment of patients. The government can develop effective programs to increase access to the treatment of those who need it.
Why choose hepatitis C? There are problems with other diseases in Ukraine. For example, tuberculosis.
This is true, the number of patients with tuberculosis is very high. But in Ukraine, many organizations work on it — treat and provide access to prevention. With hepatitis C the picture is completely different. Many people do not even know about their status. If we do not consider those who have hepatitis C, then the disease will progress to the final stage of liver damage and will cause death of those people.
Have you already worked in Ukraine?
This is the first project within the framework of cooperation between EQUIP and Ukraine. We have several partners here that help us to implement the project. There are the Alliance of Public Health and the All-Ukrainian Network of People Living with HIV «100% of Life». Our strategic partner from your Ministry of Health is the Public Health Center. The administrative support for the office of Equip-Right to Care Ukraine provides the Charity Foundation “Future Development Agency».
On our own, as an organization or as a Ministry, we cannot counteract the epidemics separately from each other. Together, we can succeed if we will firmly support partnerships between all interested parties.
What does it mean that it is a “demonstration project”?
This is the research project. We try to develop, implement and evaluate the simplified hepatitis C testing, treatment and care model integrated with HIV testing and treatment initiation. There are three methods of diagnosing hepatitis C virus in our project. Also we reduce the number of visits to the doctor to a minimum. So at the end of the project, we will make his financial assessment and we will prepare kind of a package for the Ukrainian MOH where you can show that such testing and treatment method is effective and that it contains such a set of services.
Is participation for Ukrainians free in this project?
Yes, it is free. The project was allocated to 1.5 million dollars. So, patients do not pay for laboratory diagnostics and HCV drugs.
Can you get sick a second time on hepatitis C?
Yes, if a person continues a risky behavior and does not follow preventive norms. Such person can re-receive the hepatitis C virus. There is no immunity from it.
What if woman has finished her treatment and then gave a birth to a child — will a baby be healthy?
Yes, because she does not have a virus, so she cannot transfer it further. In general, the transfer of the virus from mother to child is minimal. If HIV is transmitted in this way, then hepatitis is mainly transmitted through blood: scratches, cuts. But the risk still exists.
As you know, newborn children in the maternity house are getting vaccines from hepatitis B. Is it necessary for the child who did not have contacts with sick people?
Such vaccination is necessary for prevention. No matter whether if there was contact or not. We cannot know this. It is better if baby will be protected in advance. The situation with hepatitis B is different than with hepatitis C — there are no medications against hepatitis B. It is better to prevent it with vaccination. This is the only effective method there is. According to the recommendations of the World Health Organization, the first vaccination of Hepatitis B has to be done to a child in the first day of life. The second and the third in future months. In general, there are a lot of kind of hepatitis: A, B, C, D and others. They all affect a liver, but the ways of infection are different.
How are you finding it here in Ukraine?
It is very friendly. People with such admiration and dedication are working on projects. We are very pleased with our partners. For example, thanks to the Public Health Center, we have a connection with the Ministry of Health, which shows how it is transformed into a state policy. Such commitments to the project and the support of the MOH for project implementation are positively evaluated by international donors.
In your opinion, what should the Ukrainian interest be?
I think you should to increase the interest to a new diagnostic model of hepatitis C and access to testing and treatment for hepatitis C.
Is it possible to do tests only in Kyiv according to your project?
Today our project is being implemented in two healthcare institutions: Kyiv Clinical City Hospital №5 and the Institute of Epidemiology and Infectious Diseases of L.V.Gromashevskiy (Department of Viral Hepatitis and AIDS). Our partner organizations are providing rapid testing for HCV. Key populations from other regions in Ukraine also have an opportunity to enter the project, but they will need to confirm their HCV diagnosis in Kyiv. There is has already been assigned a special laboratory analysis. If it is positive, then a person undergoes further examinations, followed by HCV treatment. Three months after the treatment is complete, participant need to take a test to make sure that the person really has recovered. In fact, the treatment lasts for three months, and then you need to make sure that it has been successful.
How exactly is the treatment is happening?
Medications given to a project participant in several doses. So usually a person has 4-5 visits to the treatment facility during the project. During such a visit, there is a consultation with a doctor to see if patient is tolerating treatment, if he/she has any complaints etc. We pay significant attention to treatment safety especially during the early weeks of treatment.
Treatment under the project is free of charge. But how much do cure for hepatitis C cost?
These are new technologies and new drugs that are being used globaly. They are expensive in th most of the Western, developed countries. According to the World Bank criteria, Ukraine refers to low-middle income countries. Therefore, the one of the manufactures offers a special price of 300USD per bottle. So, for three months of treatment it is $900. At the Ministry of Health of Ukraine say that prices can be further reduced.
How long your project in Ukraine will last?
It began in October 2017. We have more than 500 patients on HCV treatment currently. Most of them have co-infection, so they have been diagnosed with HIV and viral hepatitis C. We have already supplied HCV drugs for 866 patients in healthcare facilities.
Among 500 recruited in the project some have already completed treatment, some are still continuing with their treatment. 164 people completed treatment and they are waiting for another three months to have the test and finally make sure that they have been cured.
The number of patients we treat is quite small comparing to the national scale. The need for the treatment in Ukraine is much higher than we can cover within the project resources. But there are other projects implemented by partner organizations and the Ministry of Health are also plan to provide HCV treatment to more patients in 2019.
The fight against the virus continues…
Daria Panchenko, «Ukrainian Interest”