By Faranak Bakhtiari

Free hepatitis care on agenda, end of disease by 2030

July 25, 2020 - 18:2

TEHRAN – Iran is planning to provide free diagnosis and treatment services to people who are suffering from hepatitis and eradicate the disease by 2030.

“By 2030, if we could reduce the incidence of hepatitis by up to 90 percent and decrease mortality by 65 percent, we would have implemented the elimination program as planned by the World Health Organization,” Rashid Ramezani, head of the hepatitis of the infectious diseases management department of the Ministry of Health, explained.

“Some 1.5 million Iranians are diagnosed with hepatitis B and less than 200,000 people with hepatitis C; nearly 3,000 people are infected with hepatitis C each year,” he stated, IRNA reported on Saturday.

World Hepatitis Day, July 28, is an opportunity to step up national and international efforts on hepatitis, encourage actions and engagement by individuals, partners and the public and highlight the need for a greater global response as outlined in the WHO's Global hepatitis report of 2017.

The date was chosen because it is the birthday of Nobel-prize winning scientist Dr. Baruch Blumberg, who discovered the hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus. 

Low coverage of testing and treatment is the most important gap to be addressed in order to achieve global elimination goals by 2030.

“Following the vaccination plan and blood transfusion safety, we have vaccinated 300,000 blood donors last year, he noted, adding, 400,000 prisoners were also vaccinated and in total, 35 million Iranians under the age of 30 were immune by vaccination.”

He went on to say that “to remove hepatitis, we need medicine and a quick diagnosis kit because patients do not have the financial means to treat themselves.”

Pointing out that treating hepatitis is investing and conserving resources, he said that every dollar spent on hepatitis C eradication can lead to$18 cost reduction for the countries.

Ramezani continued “Every hepatitis C patient can infect 12 people a year, so we must treat them to stop the transmission cycle.”

He pointed to the elimination of malaria and said that AIDS is also under control in the country and the eradication of malaria is our achievement, but the hepatitis death rate is increasing and we need national determination and the help of authorities to control and eliminate it.

So far, 124 countries in the world have put the hepatitis elimination program on the agenda; Iran is also committed to taking steps in this regard, he noted. 

Lamenting that many patients are not aware of their disease, Ramezani said that the disease is asymptomatic, especially in the elderly, and If the virus stays in the body for 6 months, it becomes chronic. 

Only 10 percent of patients are aware of their disease, which increases the importance of awareness and diagnostic programs, he said, regretting, 1.4 million deaths per year are caused by hepatitis.

WHO goals of controlling hepatitis C

An estimated 325 million people worldwide live with hepatitis B and/or C, and for most, testing and treatment remain beyond reach.

Some types of hepatitis are preventable through vaccination. A WHO study found that an estimated 4.5 million premature deaths could be prevented in low- and middle-income countries by 2030 through vaccination, diagnostic tests, medicines, and education campaigns. WHO’s global hepatitis strategy, endorsed by all WHO the Member States, aims to reduce new hepatitis infections by 90 percent and deaths by 65 percent between 2016 and 2030.

The World Health Organization is focusing on full control of hepatitis C by 2030. Statistics also show that the number of people living with infectious diseases in the world is currently declining, but the number of people infected with hepatitis C is rising; Therefore, the WHO, while inviting all countries in the world to fully control hepatitis, has set guidelines in this regard.

According to WHO’s three goals of controlling hepatitis C, the incidence of new cases of hepatitis C infection should be reduced by 90 percent, 80 percent of infected people should be treated, and hepatitis C mortality should be reduced by 65 percent. With these goals in mind, the world now has high hopes for opening new doors to reduce the number of sufferers, especially with the developments that have taken place in the field of diagnosis and treatment of hepatitis and making them completely controllable.

According to the WHO, 12 countries will achieve the goals in complete control of hepatitis C by 2030. Iran, which has a 30 percent reduction in new hepatitis cases and a 10 percent reduction in hepatitis deaths by 2021, is now one of 17 countries working to achieve the goal of full hepatitis control.

Domestically-made medicine raise hope to cure hepatitis 

A study, on 1,361 patients with hepatitis C with a mean age of 50 years in 46 treatment centers treated with new domestic medicine, showed that Iranian-made medicine has been effective on all hepatitis C genotypes and has shown 98 percent success in treating patients, deputy health minister Reza Malekzadeh has said.

With the help of this medicine, hepatitis C can now be treated in 8 to 12 weeks, and the study showed that it has no side effects; however, treatment with previous medicines caused numerous side effects and made the treatment of hepatitis C difficult and tedious.

Malekzadeh also pointed to the cheap price of domestic drugs compared to very expensive foreign ones and said “it will reduce the cost of complete treatment of hepatitis C d to one hundred dollars.”

It will also reduce the number of patients with liver cancer that are added to the transplantation list each day, he added.

Simple diagnostic test the most important step in hepatitis control

Referring to Iran's important measures in controlling hepatitis C, he said that the most advanced public health policy to reduce drug harm in the region by establishing more than 4,000 methadone treatment clinics, and 700 harm reduction centers. 

Implementing national plans such as “free control and treatment of prisoners and addicts with hepatitis C”, “plan on improving liver health”, the pilot city-to-city plan for hepatitis C, the plan to identify hepatitis C patients in the target population of HIV patients were among the major measures taken in this regard, he highlighted.

Just as Iran has succeeded in producing generic drugs for the definitive treatment of hepatitis C under U.S. sanctions, it is now considering eliminating the costly hepatitis C test by researching to develop a simple, low-cost blood test. The project has begun and is in the process of being tested on samples.

He estimated the credit needed for this project at 500 million rials (nearly $11,000 at an official rate of 42,000 rials) and said that but its foreign currency savings are tens of million dollars. 

Iran's challenges in full elimination of hepatitis C

Complete control of hepatitis C in Iran with the global “point elimination” strategy needs to address several key challenges. One of these challenges is the lack of accurate statistics on people at high risk for hepatitis C, Amir Ali Sohrabpour, the head of the Iranian Hepatitis Network said.

While it is necessary to identify 20,000 patients with hepatitis C in Iran annually, only 10 percent of hepatitis C patients have been identified; Therefore, it seems that the challenge of identifying and accurate statistics of high-risk groups in Iran needs a more immediate solution, he added. 

On the other hand, the provinces with high hepatitis C prevalence have not yet been fully identified but is planned to be done, and the country's medical universities can play an important role, while the prison organization can also help hepatitis network by identifying patients to determine how many prisoners are infected with hepatitis C, he emphasized.

There are 1.5 million drug users in Iran, 300,000 of whom are injecting drugs, but one of the challenges is the need for a full treatment of these high-risk groups, including adequate funding for diagnostic tests and distribution of free medicine, he stated.

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