Globally, it is estimated that there are approximately 135 million people living with chronic hepatitis C virus (HCV) – every year nearly 500,000 people die from HCV- related complications. HCV infection, if left untreated, can progress to cirrhosis of the liver, hepatocellular carcinoma and end-stage liver disease. Indeed, HCV and Hepatitis B infection combined account for nearly 50% of all hepatocellular carcinoma cases globally and HCV has overtaken HIV as a cause of death in many countries including the United States where in 2014, HCV caused more deaths than HIV, Hepatitis B and tuberculosis combined.
Hepatitis C virus can be cured. However, until two to three years ago, it was difficult to treat HCV infection because treatment required weekly injections of interferon and daily doses of ribavirin for 24–48 weeks. These medicines were not only cumbersome to take, but were also associated with severe side effects including depression and suicidal ideation and had cure rates that were sub-optimal (only ~50%). However, over the past few years new all-oral agents (e.g., sofosbuvir, daclatasvir, ledipasvir) have been developed. These new agents can be delivered in combination, require only a 12 week course and are associated with high cure rates (>90%) and almost no side effects. The availability of these new curative therapies has prompted global discussions on the elimination and even potentially eradication of HCV. While some cities and even countries have developed plans towards elimination, to date, no city has eliminated HCV.
In Chennai, the general population prevalence of HCV is estimated to be approximately 1%; however, in the slums, prevalence may be as high as 2.5%. With a population of nearly 8 million persons, this translates to nearly 80,000 persons living with HCV in Chennai. One of the primary barriers to treating HCV is extremely low levels of awareness of HCV – in a study among drug using populations across India, we identified that less than 5% of HCV-infected drug users were aware of their status. In part, this is because HCV infection is asymptomatic until late stages of disease when the risk of complications is very high and the probability of achieving cure from treatment lower. While there are no data on awareness among the general population, it is not anticipated that awareness will be much higher.
We launched the Hepatitis C Free Chennai Campaign on July 28, 2016. The campaign includes a comprehensive strategy to improve awareness of hepatitis C across all communities in Chennai, reduce stigma associated with diagnosis, universal screening with access to confidential testing for all, prompt linkage to HCV care and curative treatment alongside counseling to reduce the risk of reinfection in high risk populations. We believe that the way to start this is through demonstration projects within individual organizations employing large numbers of individuals.
At YRGCARE, the YRGCARE hepatitis C free campaign offers free screening to all our employees and their immediate family for hepatitis C. All those who test positive for chronic infection will be offered free treatment. We expect that YRGCARE will be hepatitis C free within one year. Several other organizations including corporates have expressed interest and TT Group, SPI Cinemas and First Flight Couriers will be initiating similar programs in their organizations while also helping spread awareness and support testing programs in low-income areas in the city. We hope this project will prompt other institutions to establish similar programs for their employees. And if this does happen, we hope that Chennai can establish a public-private partnership model for HCV elimination that not only other cities in India, but the rest of the world to follow!
First Flight Couriers
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