Expanding Access to Treatment for Hepatitis C in Resource-Limited Settings: Lessons From HIV/AIDS

Abstract

The need to improve access to care and treatment for chronic hepatitis C virus (HCV) infection in resource-limited settings is receiving increasing attention. Key priorities for scaling up HCV treatment and care include reducing the cost of current and future treatment; simplifying the package of care; identifying opportunities to shift specific tasks to nonspecialists to overcome human resource constraints; service integration with human immunodeficiency virus (HIV) clinics, prison health services, and needle syringe and oral substitution therapy programs; improving surveillance, monitoring, and research; encouraging patient and community engagement; focusing specifically on the needs of vulnerable groups; and increasing financial and political commitment. Many of these obstacles have been addressed in rolling out treatment for human immunodeficiency virus during the last decade, and a number of lessons can be drawn to help improve access to HCV care.

Generic Direct Acting Antiviral Treatment: The First Step Towards Elimination of Hepatitis C in Iran

“…Reduced prices can be obtained through manufacturing generic formulations of the drugs. Over the past decade, generic competition has resulted in a progressive price reduction of HIV antiretroviral therapy from US$ 10,000 to US$60 per patient per year which was a major enabler for expanding access to treatment in the resource-limited settings (4). Generic DAAs are manufactured in several countries such as Iran, Egypt, India, Pakistan, Bangladesh, China, Brazil and Morocco, either under the voluntary license agreement of the patent holder companies or using compulsory licensing (5,6).…”

Pathway to affordable, quality-assured sources of pegylated interferon alpha for treating hepatitis C

“…These countries and NGOs therefore need to rely on international evaluation frameworks to access safe, quality-assured pegylated interferon, for example, via a WHO pre-qualifi cation system for biological/biosimilar drugs that enables member states to access to safe and effective pegylated interferon alpha and other essential biological medicines. The WHO pre-qualifi cation system for HIV medicines had a huge impact in securing quality-assured generic antiretroviral medicines, it allows for competition in the market space and decrease prices tremendously and therefore to allow scale up of treatment in developing countries [10].…”

“…WHO has included pegylated interferon alpha in the WHO Model List of Essential Medicines released in July 2013 [9], but other steps are needed to secure access to the current recommended treatment -steps that could draw on lessons learned from treatment scale-up in other epidemics, such as HIV [10].…”

Rational design and adaptive management of combination therapies for Hepatitis C virus infection

“…Because of the high intrinsic mutation rate of HCV [14,15] and the resulting high viral diversity [1,16,17], combined with the reality of suboptimal treatment adherence [18,19], viral resistance is still a clinical and public health concern [13,20]. This is especially true for high-risk groups such as patients with psychiatric disorders or depression [21], and in resource-limited settings where patients have limited access to clinical cares and cannot afford the expensive pan-genotypic DAAs with high genetic barriers [22,23].If treatment is not properly managed, resistance could quickly develop to combination therapies and render these new DAAs useless, as observed for other antimicrobial treatments, squandering the potential health gains from these recent breakthroughs [24][25][26].…”