The Arkhangai Liver Disease Free Program is a first-of-its-kind collaboration project in Asia and has nearly cured all its screened patients – at no cost to them. In light of the rising hepatitis infections in the world, public and private entities should work together to eliminate viral hepatitis.
World Hepatitis Day takes place on 28 July 2018. This year’s theme is “Find the Missing Millions” – with an emphasis and key message of locating the under- and undiagnosed patients who suffer from viral hepatitis, and steering them towards treatment, care, and cure.
There are 300 million people living with viral hepatitis worldwide unaware that they have the disease – with 55 million people having hepatitis C (HCV).1 In Southeast Asia, 97 per cent of men and women living with viral hepatitis are unaware that they have it.1 The World Health Organization indicates that there were 1.75 million new HCV infections in 2015,2 with potentially even more, as the virus is asymptomatic before serious complications occur. Those who discover that they are infected with the virus may realize it too late, and at an advanced stage, hepatitis is a prime cause of liver cirrhosis and hepatocellular carcinoma, which were responsible for 720,000 deaths and 470,000 deaths respectively in 2015.2
It is timely that the Arkhangai Liver Disease Free Project, a collaboration between Gilead Sciences and the Arkhangai Aimag Health Department in Mongolia, concluded in April after 16 months, right before World Hepatitis Day. The project has shown impressive results of diagnosis, treatment, and post-treatment care for patients infected with HCV in Mongolia. In the landlocked country of over 3 million, very few patients with HCV in the public sector in Mongolia were treated, and no prior public health programs for viral hepatitis were available.
This project was set to screen all individuals in Arkhangai across the ages of 40 to 65. Soon after the screening test was launched in November 2016, 17,594 people were screened thoroughly for the presence of hepatitis B and C. Among them, 1,774 patients were detected with a viral load of hepatitis C – which required treatment. The goals of the project were to identify the number of hepatitis C infections, but during the course of the tests, 36 cases of early stage liver cancer were found and received treatment as well.
Treatment for the 1,774 patients infected with hepatitis C commenced in June 2017. The Family and Soum Health Centre and Arkhangai Aimag General Hospital were extremely instrumental in the treatment process – helping transfer positive samples between locations, attending to patients needs during treatment, and monitoring their statuses and improvement during those months. Because of the dedication and great work of all team members involved, 99.7 per cent of the patients receiving treatment have fully recovered from HCV. The remaining patients are still undergoing treatment and are showing good progress.
This project is a classic example demonstrating public-private partnership. While Gilead provided treatment to the patients, the Arkhangai government took the lead in orchestrating works from patient recruitment, resource allocation, screening, lab testing, to data processing. About 1,500 health workers and consultants from the Health Department of Arkhangai, the Family and Soum Health Centre, and the Arkhangai Aimag General Hospital were mobilized. This will serve as a model to implement similar programs in Asia, whether it is to treat viral hepatitis or other chronic diseases.
Besides improving livelihoods of over 1,700 households in Arkhangai, this project also increased public awareness and knowledge of the risks and symptoms of hepatitis C. During the screening progress, the Arkhangai Aimag Health Department conducted a survey for all patients screened on the risk factors of hepatitis C, and provided input and also academic research for the project. As a result, everyone gained additional knowledge on prevention, shifting behavioral change and mitigation of the diseases, as patients can still relapse.
Great progress has been made in fighting these chronic and life-threatening diseases, but more must be done. The Arkhangai Liver Disease Free Project can be used as a basepoint for other governments, health departments, organizations, and stakeholders, it can be shown that with the right mindset and dedication, we can eradicate diseases such as hepatitis C. It is an urgent need that quickly needs to be addressed and the outstanding results show it all – the Mongolian government is planning to leverage the best practices and learnings from the project into other regions, increasing the screening process to include patients under 40, and to develop infrastructure for future viral hepatitis treatment programs.
Looking to the future, there are many collaboration opportunities in the Asia-Pacific. Similar initiatives have been done in countries such as Egypt, and the former Soviet republic of Georgia. We have to first identify the priority markets, with key resources and equipment to get discussions and programs started in order to tackle hepatitis C. There is potential in getting these programs started in countries such as Indonesia, Vietnam, Thailand, and the Philippines. Everyone should have access to treatment, no matter who they are, where they live, or what they do.
In 2015, the United Nations included viral hepatitis into the Sustainable Development Goals (SDGs), and the world’s first global hepatitis strategy was ratified a year after. Treatments and the access to vaccines have improved since then to meet the goal of eliminating hepatitis by 2030, but we are not there yet. The only way to detect hepatitis is through diagnosis. Through early education and encouraging people to get checked for the “silent killer,” and integrated treatment, we can work towards the 2030 goal – ending viral hepatitis in its every form.
- World Hepatitis Day 2018 Campaign Toolkit. World Hepatitis Alliance. http://www.worldhepatitisalliance.org/sites/default/files/whd-resources/find_the_missing_millions_campaign_toolkit.pdf
- Global Hepatitis Report, 2017. World Health Organization. http://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng.pdf;jsessionid=64D16F7938F1E37D1C84147BC40E6F7C?sequence=1
Betty Chiang is senior director, public health & medical affairs, access operations and emerging markets at Gilead Sciences.