Geneva, Paris, New York – The Drugs for Neglected Diseases initiative (DNDi), Médecins Sans Frontières (MSF), FIND, the global alliance for diagnostics, and the Treatment Action Group are joining forces to tackle a ‘silent’ public health injustice: the continuing disparities in access to diagnostics and treatment for the hepatitis C virus (HCV) in low- and middle-income countries (LMICs), home to 75 per cent of those living with this viral illness.

The Hepatitis C Partnership for Control and Treatment, or Hepatitis C PACT, will foster an enabling environment for testing and treatment for HCV in LMICs by rolling out all-oral cures, scaling up community-based testing to find the missing millions of undiagnosed people, and addressing domestic financial challenges that prevent the launch of national programmes. It will also tackle patent and access barriers that stand in the way of reaching World Health Organization (WHO) goals of controlling hepatitis C by 2030. 

Through its cumulative expertise and independence, the new partnership will build collaborations with countries and community and civil society groups, and develop evidence to support ambitious test-and-treat programmes while addressing HCV financing obstacles.

“Investing in public health partnership approaches, as in the case of the hepatitis C, saves people’s lives, saves costs in national budgets, proves cost-effective, and shows significant returns on investment,” says Dr Noor Hisham Abdullah, Director General of Health, Ministry of Health, Malaysia.

Our organisations already have a successful track record in supporting test-and-treat programmes in ‘champion countries’, such as Cambodia, India, and Malaysia. The Hepatitis C PACT will make best use of countries’ strategic capacity to increase access to HCV care globally.

“In Malaysia, we have a collaborative partnership between government, non-governmental organisations, and civil society to reach the 400,000 people living with hepatitis C in our country,” says Abdullah. “We have shown that we can make a difference with sustained financing, rolling out simpler diagnostic tests, and ensuring access to the best prices for treatments.” 

HCV can lead to chronic liver disease, cirrhosis, cancer, and death. Of the 58 million people with chronic HCV, an estimated 9.4 million people have been effectively cured. Twelve LMICs account for half the treatment uptake, with one country, Egypt, treating 4.4 million people.

“MSF has been working with Cambodia's Ministry of Health since 2016 to enable access to treatment, simplify hepatitis C care, and integrate this model in routine health services,” says Mickaël Le Paih, MSF head of mission in Cambodia. “The cure rate for thousands of patients remained over 97 per cent for patients treated in tertiary level clinics or primary health care centres.

“We have shown through our collaboration with the Cambodian Communicable Disease Control Department and through peer-reviewed reports that such a model of HCV care allows rapid scale-up while maintaining a high quality of care, mostly delivered by trained nurses,” says Le Paih. “Communicable diseases such as HCV can be controlled through supporting state-run response programmes.”

The Hepatitis C PACT will address four key areas responsible for such a low rate of access to testing and treatment – concentrating on boosting access to both polymerase chain reaction (PCR) testing and newer-generation hepatitis C drugs called direct-acting antivirals (DAAs). DAA treatments can cure patients in two to six months but non-generic versions have come with an infamously high price tag.

The partnership will focus on:

1. Increasing awareness among decision-makers: there is insufficient knowledge about HCV control among policymakers and other leaders. The partnership will generate key evidence on hepatitis C diagnosis and linkage to care, including in sexual health and harm reduction settings, advocate for policy change, raise awareness that the disease can be controlled, and provide community education.
    
2. Developing financing mechanisms for viral hepatitis strategies: currently there is insufficient domestic and global financing for HCV control. A new financing working group comprising representatives from over a dozen agencies will identify and design sustainable financing mechanisms for DAAs and diagnostics to support and catalyse global and domestic resources in priority countries.
    
3. Supporting simplified viral hepatitis diagnostics: there is a need for simplification of the diagnosis of the chronic hepatitis C infection. The development of simple and affordable of such diagnostic tools will be prioritised, enabling decentralisation of mass testing strategies.
    
4. Supporting access to simple and affordable DAA treatments for HCV in high-burden LMICs: despite decreases, DAA prices are generally too high to support large scale-up of treatment. The partnership will improve access to DAAs approved by WHO using a successful public-private partnership approach recently deployed in Malaysia for the approval of ravidasvir, a new DAA.

The Hepatitis C PACT is being launched with financing from MSF’s Transformational Investment Capacity initiative, with the objective of increasing access to treatment for HCV patients in LMICs.