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Hepatitis is an inflammation of the liver — a condition that can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hence its diagnosis becomes all important.
Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. And amongst the viruses, hepatitis C virus (HCV) infection can cause both acute and chronic hepatitis, ranging from a mild illness lasting a few weeks to a serious, life-threatening illness if not treated.
Since the infection remains asymptomatic, and for a long time, early diagnosis becomes particularly challenging. Worse, the disease does not manifest itself through any specific symptoms. Vulnerable populations (such as people who inject drugs, patients on haemodialysis, geriatric patients, healthcare workers, people engaging with multiple sexual partners, those in close contact with an HCV-infected patient, having body piercing and tattoos, etc) need to be routinely tested for HCV.
Naturally, it becomes important to create awareness about HCV and its modes of infection, transmission, prevention and treatment and to set up systems to pick up early warning signals.
Diagnosis is central to HCV treatment because symptoms may only become evident when the patient is in the advanced stages of liver disease, which might be too late, or too complicated to treat. Its treatment has become simpler, safer, shorter and while the prices have come down significantly over the last few years, they still remain expensive and out of reach of the common man in the private sector.
But new Direct Acting Antiviral (DAA) oral drugs have changed the landscape of HCV care, with cure rates of up to 95 per cent within a span of 12-24 weeks. Patients continue to lack access to HCV treatment because diagnosis remains a major barrier, being expensive for the patients and ambiguous for the healthcare professionals in the absence of established diagnostic algorithms.
A positive move
The Indian government took a step towards tackling the challenges when it launched the National Viral Hepatitis Control Programme on July 28, 2018, with an aim to control viral hepatitis, provide free-of-charge screening, diagnosis, treatment and counselling services to all, including vulnerable groups.
It is still early days, but a successful programme requires building a patient-centred, integrated, efficient and sustainable public health response to HCV. This would also require bringing new, simpler and affordable HCV tests to the market and making them available and accessible. And that’s where innovative, community-focussed models for screening and treatment of HIV/HCV co-infected people are required, by tapping into existing diagnostic platforms and introducing other technologies as they become available for use.
Recent advances in diagnostics have made it possible to diagnose people carrying viral hepatitis infections through point-of-care rapid diagnostic tests. Several new technologies and platforms are also now available for conducting screening and confirmatory tests.
In fact, global non-profit organisation FIND is implementing a UNITAID-supported Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) project in six countries, including India. As part of the project, FIND works to improve HCV diagnosis by making it more affordable and widely available to those in need, with a focus on serving people co-infected with HIV.
The HEAD-Start project is designed to inform global implementation guidelines and national policies that are conducive to scaling up HCV management in support of the WHO elimination targets for 2030.
In India, FIND is working in three States; Delhi, Manipur and Punjab in partnership with Institute of Liver and Biliary Sciences, YRG Care and Directorate General of Health Services (Punjab), besides community-based efforts to spread the word on HCV infection and its risk factors, in both general and among vulnerable populations.
The writer heads FIND India, a subsidiary of the global non-profit organisation FIND, involved with accelerating the development, evaluation and delivery of diagnostic tests for poverty-related diseases
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