Viral Hepatitis Control Program

Country Model Ukraine

Zahedul Islam

Director: Treatment, Procurement & Supply

Alliance for Public Health Ukraine

www.aph.org.ua

Catalyst for Change

Alliance for Public Health

“Alliance for Public Health” is an international non-governmental professional organization working in the area of HIV/AIDS, tuberculosis, viral hepatitis and other harmful diseases in Ukraine and the EECA region. APH operates in partnership with the government and civil society organizations to deliver its programs

APH is also partners with 30 Linking Organizations of International HIV/AIDS Alliance, UK worldwide

www.aph.org.ua

www.aph.org.ua

➢ Population: 42 078 492 as of August 1st, 2018

➢ Estimated 3% HCV prevalence in Ukraine (1 280 000)

➢ More than 52 000 registered cases of HCV-infection in 2017

➢ 21.5% were detected with Viral Hepatitis C Markers among new HIV cases

➢ 30 826 persons were co-infected with HIV/HVC as of January 1st, 2017

➢ 21.9% HIV prevalence among 346 000 estimated number of PWID

➢ HCV prevalence among PWID in Ukraine exceeds overall average, reaching 63.9%

(2017-2018, Alliance bio-behavioral research)

➢ 240 000 persons living with HIV

Epidemiological Background (HPV)

Alliance Key Interventions in Viral Hepatitis www.aph.org.ua

Awareness and Advocacy

Prevention

Diagnostics, treatment and care

Capacity building

Testing, Diagnostics and HCV Treatment in the Penitentiary Sector of Ukraine

December 2017- July 2018 www.aph.org.ua

In 2017 in close cooperation with the Ministry of JusticeAlliance was the first to launch HCV testing, diagnostics and treatment with DAAs in the Penitentiary sector of Ukraine

226

1000 HIV+ patients tested

for HCV

98 % treatment success attained

www.aph.org.ua

139 HIV+ prisoners were laboratorydiagnosed for HCV

84% HCVconfirmed

50 HIV+ persons received HCV treatment

74% HCV+results

“Scaling up Accessible and Effective HCV Treatment through Community-Based Treatment Model for Key Populations

in Resource Constrained Ukraine” 2015-2018 www.aph.org.ua

Key populations: PWID, OST patients, SW, MSM, PWID partners, war veterans

Enrollment criteria: Fibrosis≥ F2 (priority F3, F4), METAVIR

Project key objectives:

Implementation of community-supported DAAs-based HCV treatment model for key populations

Access to laboratory diagnostics (treatment monitoring and follow-up)

Operational research “Effectiveness of HCV Treatment Program for MARPs”

Model: community-supported HCV treatmentwww.aph.org.ua

Step 1. Sharing information on

the Project via NGOs,

communities and medical staff;

referrals to HCV diagnostic

Step 2. Case-manager informs

potential patients about

enrollment criteria and refers

patients to a doctor Step 3. A doctor

advices a list of

examinations required

to take enrollment

decision

Step 5. Doctor

selects the

treatment

regimen for

enrolled patients

Step 6. Social support

provided by a case

manager;

3 sessions on re-

infection prevention

Step 7.

Laboratory

monitoring of

treatment

END of

TREATMEN

T

MDT

Step 8. Treatment

success evaluation

(SVR12)

Dia

gn

ostic

s

Step 4.Multi-disciplinary

team consisting of a

doctor, a nurse and a

social worker takes joint

decision on patients

enrollment (MDT)

Multidisciplinary Approach to Patient Oriented Integrated Services

Consultations

Diagnostics

Administering treatment

Dispensing medicines

Clinical monitoring

Laboratory monitoring

Re-directing to TB and HIV services

Counseling

Scheduling visits to doctors

Three sessions on re-

infection prevention

Linking ART and OST

takes joint decision on patients enrollment

Doctor & Nurse Case manager

Multidisciplinary

team (MDT)

Hello, I am your case manager

www.aph.org.ua

Patient-Oriented Activities: Re-infection Prevention Education (3 sessions) www.aph.org.ua

www.aph.org.ua

Treatment Outcomes2015-2018

1907 DAAs-based courses of HCV-infection treatment were provided, 1421 out of them interferon-free – sof/riba and led/sof courses

1873 patients successfully finished full course of treatment

98,2% retention on treatment

34 patients (1,8%) terminated treatment on different reasons, 6 out of them re-started treatment within the Project

1837 patients were diagnosed (PCR RNA HCV) after 12 weeks of treatment (SVR 12)

95% treatment success

81%

8%4% 4% 1%

PWID

PWID partners

SW

MSM

PWID&PWHL Advocates

92%

93%

94%

95%

96%

97%

98%

95%

96%

98%

94%

96%

Treatment Outcomes as per Key Group (n=1837)www.aph.org.ua

SVR12

PWID Treatment Success (n=1479)

94,6%97,4%

92,3% 93,2%96,8%

91,7%

HCV/HIV HCV

SVR 12

PWID in remission Active PWID PWID on OST

781/826 192/208 90/93 227/233 55/59 55/60

www.aph.org.ua

Treatment Success (SVR 12) as per HIV Status (n=1837) www.aph.org.ua

1.360

477

7022

94,8% 95,3%

0%

20%

40%

60%

80%

100%

0

200

400

600

800

1.000

1.200

1.400

1.600

HIV + HIV -

Tested for SVR 12 Reached SWR 12 Treatment success %

Challengeswww.aph.org.ua

• Lack of awareness and knowledge about HCV treatment

• High diagnostic cost was a barrier for enrollment (Alliance provided 50% discount)

• Limited knowledge of medical staff on DAA administration and treatment

• No access to medicines to treat adverse reactions during treatment

Conclusionwww.aph.org.ua

• Significant reduction of HepC treatment cost

• Alliance agreed price (900 USD/12w treatment course) for Sof and Sof/led became a benchmark for the state procurement

• DAAs-based regimens were integrated in National HCV treatment guidelines and in the essential medicine list

• PWID identified as KP in National HCV treatment guidelines

• Model is recognized as the best practice in the national HCV elimination strategy

www.aph.org.ua

Thank you!