A pilot project to increase access to antiviral drug for treating chronic hepatitis C in 2022-2023

Abstract

Chronic hepatitis C is a major cause of liver cirrhosis and liver cancer. In previous implementations, access to screening services has remained limited due to the exclusion of such services from the national benefit package. Furthermore, notable barriers persist that hinder patients’ ability to access appropriate treatment, the Division of AIDS and STIs (DAS) initiated a pilot project to increase access to antiviral drug for treating chronic hepatitis C in 2022. The objective of this initiative is to improve access to hepatitis C virus (HCV) screening and treatment within pilot provincial settings. The project implemented a service delivery model in which trained general practitioners provide both diagnosis and immediate treatment across 3 pilot provinces. DAS provided reagents for hepatitis C viral load testing and antiviral drugs for those with a positive Anti-HCV result. Patients underwent confirmatory testing with HCV Viral Load. Those without complications received antiviral treatment for 12 weeks at community hospitals and monitored their treatment outcomes, administered by trained general practitioners. Local staff collected data from report forms and recorded treatment information in a reporting program and analyzed the data using descriptive statistics. The project results showed that 19,708 individuals in the target population underwent anti-HCV screening, with 2.2 % (425 individuals) testing positive for Anti-HCV. Among these, 96.2% underwent HCV viral load testing, with 87.5 % (358 individuals) testing positive. Of these, 98.6% (353 individuals) patients received treatment at community hospitals (CPH). Five individuals did not receive antiviral therapy: two patients with cirrhosis were referred to medical specialists, while three patients declined treatment due to work-related relocation. A total of 292 patients (82.7%) completed the 12-week antiviral treatment and follow-up, where 278 patients (95.2%) achieved a sustained virological response (SVR), indicating a complete cure. The implementation demonstrated that the target population had access to screening and received immediate and accurate treatment from trained general practitioners. In community hospitals, these physicians were able to manage and prescribe medications for patients without complications, thereby improving the timeliness and accessibility of care. Therefore, this operational model should be expanded to cover all provinces by providing training for doctors in community hospitals and establishing a consultation system with gastroenterologists in referral hospitals. Additionally, the system for recording screening and treatment data should be developed to link data with service units. Laboratory testing for hepatitis C should be integrated into the regular testing system to reduce referral costs from local service units. Finally, guidelines for managing hepatitis C should be developed to enhance understanding and efficiency among provincial staff.