Access for all: How the Indian state of Punjab is honing in on hepatitis

WHO/India

Bhajan Singh* is a happy man. The 52-year-old from Punjab, India, is now clear of the hepatitis C infection he once suffered and which could have threatened his life if left untreated. Significantly for Bhajan and his family, he has also been spared the crippling financial burden often associated with hepatitis treatment – an outcome he credits to a new treatment fund implemented by Punjab’s state government.

“Before the start of the Mukha Mantri (Chief Minister’s) Hepatitis-C Relief Fund I was paying for treatment from my own pocket – about INR 15 000 (USD 228) per month,” he explains. “But after the scheme started I was provided all medicines free of cost. Though my family and I were earlier worried, today we are happy. I am disease-free.”

Bhajan is one of many to benefit from the Fund. Since it was established in June 2016, over 33 000 patients have started free hepatitis treatment and care via a decentralized network of over 22 district hospitals and three government medical colleges. As per the Fund’s service model, patients are systematically registered, monitored and issued a certificate on successful treatment and elimination of the hepatitis C virus. Over 19 000 of the Fund’s patients have now completed treatment, with a cure rate of more than 92%.

Dr Gagandeep Grover, State Programme Officer, explains the state’s objective: “The goal is to eliminate hepatitis C from Punjab in 12 years, which would help save thousands of lives. It is an excellent service delivery model.”

He has a point. Though an estimated 325 million people worldwide live with chronic hepatitis B or hepatitis C infection, the large majority of them lack access to life-saving testing and treatment. This risks a slow progression to chronic liver disease, cancer and death. In India, around 40 million people are infected with hepatitis B and at least 6 million people with hepatitis C. About 176 000 people die each year of hepatitis B- and C-related complications – two times the estimated annual number of HIV and malaria deaths together.

While Punjab’s approach to hepatitis is multi-faceted, and includes enhancing the skills of health workers to detect and treat viral hepatitis C, its ability to overcome price barriers to cutting-edge treatments like sofosbuvir has established it as a global leader.

Since they came to market in 2013, sofosbuvir , daclastavir and other directly-acting antivirals (DAAs) that have a cure rate above 90% have been out of reach to consumers in both developed and developing countries, largely as a result of their price. With India now producing generic DAAs, this is changing, as evidenced by the Fund.

WHO Representative to India Dr Henk Bekedam says the impact – if appropriately harnessed – could be dramatic.

“Hepatitis C treatment is now affordable, both at the individual level in Punjab and also for the governments,” he says. “The implications are significant. As Punjab has demonstrated, price barriers can now be overcome, and hepatitis treatment made available to all. This could save the lives of hundreds of thousands of people across the country,” he says. “That is a public health victory that will help advance the SDG agenda.”

Nevertheless, as Dr Bekedam emphasizes, treatment alone is not enough; prevention is also vital. To this end, he says, Punjab is collaborating with WHO Country Office for India in WHO’s injection safety project, making India one of three countries globally where this project is being implemented. Among other things, the project aims to increase awareness and adoption of re-use prevention (RUP) syringes. Six Indian companies now manufacture this technology; enhanced production capacity will further boost the ‘Make in India’ initiative.

Punjab and India’s efforts to tackle hepatitis are part of a Region-wide push to eliminate the disease as a public health threat by 2030. As part of this, in 2017 WHO South-East Asia Region intensified the battle against hepatitis and appointed Indian film star Amitabh Bachchan WHO Goodwill Ambassador for the disease.

According to Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia, accelerating progress requires greater awareness at all levels.

“The public needs to be aware of how to prevent hepatitis, as well as the need to get tested. Health workers need to be aware of how to detect hepatitis, as well as the treatment options available. And political leaders at the highest levels need to be aware of the full extent of hepatitis’ burden, and the social and economic cost it represents,” she says. “We now have the tools needed to eliminate hepatitis as a public health threat; we just need to mobilize them effectively.”

For Bhajan Singh and others in Punjab now hepatitis-free, that sentiment would be apt. As the Mukh Mantri Hepatitis-C Relief Fund demonstrates, where there’s a will to eliminate hepatitis, there is indeed a way.

*name changed

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