Introduction
Hepatitis C is a major global health problem caused by the hepatitis C virus, which can result in mild to severe symptoms, including liver cirrhosis and cancer. Unsafe medical practices, lack of awareness, poverty, intravenous drug abuse and limited access to healthcare facilities contribute to the high prevalence of this disease. An estimated 58 million people are effected with hepatitis c worldwide and every year 1.5 million are adding to burden (1).Pakistan is one of the countries with the highest burden of hepatitis C, affecting around 12 million people having 4.2 % prevalence (2). While the Pakistani government and international organizations have taken steps to eliminate hepatitis C, challenges remain, such as the stigma attached to the disease, limited access to screening and treatment in remote areas, and inadequate funding for hepatitis control program (3).
Aims & Methods
To address the issue of hepatitis C elimination in rural Pakistan, a cross-sectional observational study was conducted from January 2021 to December 2022 at the MTI Gajju khan Medical College Swabi. All patients above 18 years of age who visited the gastroenterology OPD were screened for Hepatitis C. Patients who were positive for Anti HCV antibody and had detectable HCV RNA were enrolled in the study. Patients were divided into four groups: Chronic hepatitis C non cirrhotic treatment naïve and treatment experienced, Compensated Cirrhosis naïve and experienced. Sofosbuvir and Daclatasvir for 12 or 24 weeks were given, and Ribavirin was given to treatment-experienced and cirrhotic patients. Prevalence , efficacy of available free DAAs , recommendation to achieve elimination goal were discussed at end of study.
Results
Out of 10,240 patients screened for hepatitis C during their first visit to the gastroenterology OPD, 420 patients with a mean age of 36+16 having positive HCVRNA were enrolled. Almost 90% of the patients were non-affordable. After initial evaluations, the patients were separated into four groups. Chronic hepatitis C without cirrhosis was present in 287 patients, while cirrhotic were 137. Treatment-naïve patients were 307, and 113 patients were treatment-experienced. ETR was achieved in 403 (96%) patients, and SVR was achieved in 413 (91.5%) patients.
Conclusion
To achieve the hepatitis elimination goal 2030 in countries with low human development indexes, chronic hepatitis C screening, diagnosis, and management must be sponsored by national and international organizations. One-time screening should be offered for every patient above 18 years on first contact with healthcare workers. Unsafe medical practices should be strongly discouraged. The freely available drugs Sofosbuvir and Daclatasvir, with or without RBV, are highly effective treatment options for chronic HCV and the most adaptable strategy to eliminate hepatitis C. This regimen has produced excellent results in our country, influenced mainly by the presence or absence of cirrhosis and the easy and free availability of drugs.
References
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Disclosure
Authors have no conflict of interest in study.
