HIV and Hepatitis C Co-infection (HIV/HCV) is a key programmatic service of the EQUIP programme. HIV/AIDS not only enables opportunistic pathogens that otherwise rarely infect human beings to cause illness, it can also substantially worsen the manifestations of other pathogens— infections with hepatitis B and hepatitis C viruses, for example, are more likely to rapidly lead to liver damage.
A look at HIV and Viral Hepatitis, Globally
Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. However, the number of deaths due to viral hepatitis is increasing over time, while mortality caused by tuberculosis and HIV is declining. Most viral hepatitis deaths in 2015 were due to chronic liver disease (720 000 deaths due to cirrhosis) and primary liver cancer (470 000 deaths due to hepatocellular carcinoma). Globally, in 2015, an estimated 257 million people were living with chronic HBV infection, and 71 million people with chronic HCV infection. (WHO report 2017).
For the population of people who inject drugs (PWIDs) and former PWIDs in Europe, the prevalence of HCV is high, with 11 of the 16 countries with recent data reporting national estimates of over 40% . Harm reduction programmes, especially those combining needle and syringe programmes (NSP) and opioid substitution treatment of people who inject opioids, as well as more recently, treatment with the new direct-acting antiviral drugs, may have the potential to contribute considerably to reducing transmission in many countries. In spite of this, prevalence rates found in national and subnational seroprevalence studies among PWID in most EU/EEA countries are high (> 50%) , including among young and new injectors . Reports suggest that only a small proportion of those infected with HBV or HCV are aware of their infection [2,12]. Among PWIDs, the proportion of those undiagnosed for HCV is likely to be very high, with estimates ranging from 24% to 76% . This highlights a clear need to extend existing testing programmes. (WHO Report 2017)
In Ukraine, an EQUIP supported country
Eastern Europe bears one of the greatest population burdens for hepatitis C. In Ukraine, WHO estimates that over 5% of people are infected with the hepatitis C virus (HCV) accounting for more than 2 million people and 84,000 deaths per year from Hepatitis C-related liver cancer and cirrhosis. For certain populations, this rate is much higher with reported infection rates of 55.8% among people who inject drugs, 15% among commercial sex workers and 4% among men who have sex with men (Alliance, 2015, Ukraine). Among those infected with HCV, 10.54% were found to be co-infected with HIV, while of those newly diagnosed with HIV 28,8% testing antibody positive for HCV in 2016.
EQUIP Hepatitis C project in Ukraine
To address the challenge of HCV and HIV in Ukraine, a USAID-funded EQUIP project, in partnership with the Ministry of Health of Ukraine, U.S. office of USAID and local implementing partners is conducting a Hepatitis C demonstration project with the aim of implementing and evaluating a simplified HCV testing, treatment and care model integrated with HIV testing and treatment initiation.
Specifically, the USAID-funded project involving up to 4000 patients across PEPFAR regions in Ukraine aims to:
- Implement simplified testing and treatment strategy in HCV infected individuals with fixed-dose combination of Direct Acting Antivirals ledipasvir and sofosbuvir
- Analyse the cost outcome of simplified HCV screening and cost per successfully treated patient for HCV mono and HCV/HIV coinfected participants
- Evaluate simplified testing and treatment strategy in HIV/HCV co-infected individuals
Project title: «Demonstration project on assessment of simplified antiviral treatment strategy for Hepatitis C in Ukraine»
Project populations: representatives of key populations (People Who Inject Drugs (PWID), Men having Sex with Men (MSM), Commercial Sex Workers (CSW)).
Four thousand (4 000) participants will be divided into two phases:
- Phase I (n=800)
- Phase II (n=3200)
Treatment regimens and follow up duration:
The treatment regimen of choice is fixed-dose combination of Sofosbuvir/Ledipasvir for 12 weeks. Before and after completion of the treatment course viral load assessments will be undertaken using low-cost laboratory monitoring. Total duration up to 24 weeks: 12 weeks of treatment and 12 weeks of post-treatment follow up.
Project regions: PEPFAR regions: Dnipropetrovsk, Odesa, Kherson, Kyiv City, Kyiv Oblast, Zaporizhzhya, Cherkasy, Poltava, Chernihiv, and Kirovohrad.
Project Executing Organization
EQUIP – Right to Care in partnership with MOH of Ukraine and together with local implementing partners in Ukraine.
Project donors and funding:
US Agency for International Development (USAID) within cooperative agreement between Right to Care NPC South Africa and USAID. Funding for 2016 -2017: Two million five hundred (2 500 000) USD
Gilead Science Inc.: donation of SOF/LDV (HARVONI) for eight hundred (800) patients in Phase I of the Project.