Global Hepatitis C Rates Persist Despite Curative Treatments

Despite the availability of curative treatments, hepatitis C virus (HCV) infection rates remain high, particularly in low- and middle-income countries (LMICs). A new study on long-acting (LA) antiviral therapies in Egypt, Ethiopia, and India highlights barriers and facilitators to treatment, focusing on preferences for LA formulations such as injections, implants, and microarray patches (MAPs).¹

The study surveyed 400 respondents and found that 78% were open to receiving injections, 43% were willing to accept implants, and 55% expressed interest in MAPs. Notable differences in willingness were observed between those who had previously undergone HCV treatment and those who had not. Among those never treated, 94% were willing to try injections, 43% were open to implants, and 75% favored MAPs. In contrast, among those already cured by oral treatment, only 61% were willing to accept injections, 40% to implants, and 43% to MAPs.¹

In a previous interview with Danjuma Adda, former president of the World Hepatitis Alliance, he discussed the challenges in addressing viral hepatitis, particularly for HCV, which kills 3,500 people daily. He emphasizes that inadequate funding, low diagnosis rates, and lack of awareness are critical barriers to progress. Adda stresses the urgent need for increased investment in healthcare systems to improve diagnosis, treatment access, and care availability, particularly in LMICs.²

Despite the availability of effective treatments, Adda points out that only a small fraction of those infected are diagnosed or treated. He advocates for stronger national programs for testing and treatment, noting that political will and financial commitment are key to overcoming these challenges.²

Regarding treatment, Adda mentions that the World Health Organization (WHO) recommends pan-genotypic direct-acting antivirals (DAAs) for HCV, which are now more affordable in LMICs. However, by the end of 2022, only 20% of diagnosed patients had received DAAs, highlighting the need to scale up efforts to meet the 2030 goals for HCV elimination: diagnosing 90% of infected individuals, treating 80%, and reducing mortality by 65% and incidence by 90%.²

Adda also addresses misconceptions about HCV, noting that many remain unaware of their infection because the disease is often asymptomatic until it leads to severe liver damage, including cirrhosis and cancer. He advocates for better training for healthcare providers and calls for expanded testing beyond hospital settings to reach more people in need. Ultimately, Adda aims to empower communities, reduce stigma, and improve access to care to alleviate the global burden of HCV.²

Study Limitations and Concerns

The study has limitations, including the fact that the population they surveyed may not accurately reflect global HCV treatment access, as the treatment landscapes in the three countries varied. While 61% of respondents with HCV had received treatment, globally only 20% of diagnosed individuals have received treatment. Additionally, the survey may have attracted individuals particularly interested in LA HCV treatments, potentially leading to an overestimation of their acceptability and feasibility. The sample size was based on convenience, and our analyses may not have been sufficiently powered to detect significant differences in treatment preferences across different respondent characteristics.¹

Investigators from the study noted, “The most common issue for all modalities for which respondents were ‘very concerned’ was that they might not be effective. This result underscores the need for education as part of the rollout strategy for any new LA modality.”¹

Broader Insights on Healthcare Challenges

In previous interviews, clinicians Chad Costley, MD, and Anson K Wurapa, MD, discussed challenges that overlap with those addressed in this study, such as vaccine hesitancy and the importance of tailored treatment protocols for underserved communities. While these conversations were unrelated to HCV, they highlight key factors, including overcoming vaccine hesitancy and prioritizing treatment for marginalized groups, issues that also play a critical role in improving HCV treatment access and reducing global disparities in care.

Costley highlighted that "a significant portion of vaccine hesitancy is due to needle phobia," while Wurapa emphasized, "From the patient standpoint, I think it improves their confidence and trust in what they're being asked to take, knowing that it has actually been looked at in their specific demographic."

Overall, the study findings suggest that LA formulations, paired with point-of-care diagnostic tests, could greatly enhance treatment access in LMICs, simplify HCV care, and support global elimination efforts.

References

1. Furl R, Scarsi KK, Sayles H, et al. Preferences and feasibility of long-acting technologies for the treatment of hepatitis C virus: A survey of patients in diverse low- and middle-income countries. J Viral Hepat. 2024;31(12):1741-1751. Accessed December 6, 2024. doi:10.1111/jvh.14031

2. Addressing Funding Shortfalls and Raising Awareness to Combat Viral Hepatitis. Contagion. August 1, 2024. Accessed December 6, 2024. https://www.contagionlive.com/view/addressing-funding-shortfalls-and-raising-awareness-in-combating-viral-hepatitis