Catalyst for Change. Viral Hepatitis Control Program Country Model Ukraine. Zahedul Islam

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1 Catalyst for Change Viral Hepatitis Control Program Country Model Ukraine Zahedul Islam Director: Treatment, Procurement & Supply Alliance for Public Health Ukraine

2 Alliance for Public Health Alliance for Public Health is an international non-governmental professional organization working in the area of HIV/AIDS, tuberculosis, viral hepatitis and other harmful diseases in Ukraine and the EECA region. APH operates in partnership with the government and civil society organizations to deliver its programs APH is also partners with 30 Linking Organizations of International HIV/AIDS Alliance, UK worldwide

3 Epidemiological Background (HPV) Population: as of August 1st, 2018 Estimated 3% HCV prevalence in Ukraine ( ) More than registered cases of HCV-infection in % were detected with Viral Hepatitis C Markers among new HIV cases persons were co-infected with HIV/HVC as of January 1st, % HIV prevalence among estimated number of PWID HCV prevalence among PWID in Ukraine exceeds overall average, reaching 63.9% ( , Alliance bio-behavioral research) persons living with HIV

4 Alliance Key Interventions in Viral Hepatitis Awareness and Advocacy Prevention Diagnostics, treatment and care Capacity building

5 Testing, Diagnostics and HCV Treatment in the Penitentiary Sector of Ukraine December July 2018 In 2017 in close cooperation with the Ministry of Justice Alliance was the first to launch HCV testing, diagnostics and treatment with DAAs in the Penitentiary sector of Ukraine HIV+ patients tested for HCV 139 HIV+ prisoners were laboratory diagnosed for HCV 50 HIV+ persons received HCV treatment 74% HCV+ results 84% HCV confirmed % treatment success attained

6 Scaling up Accessible and Effective HCV Treatment through Community-Based Treatment Model for Key Populations in Resource Constrained Ukraine Key populations: PWID, OST patients, SW, MSM, PWID partners, war veterans Enrollment criteria: Fibrosis F2 (priority F3, F4), METAVIR Project key objectives: Implementation of community-supported DAAs-based HCV treatment model for key populations Access to laboratory diagnostics (treatment monitoring and follow-up) Operational research Effectiveness of HCV Treatment Program for MARPs

7 Model: community-supported HCV treatment END of TREATMEN T Step 1. Sharing information on the Project via NGOs, communities and medical staff; referrals to HCV diagnostic Step 8. Treatment success evaluation (SVR12) Step 2. Case-manager informs potential patients about enrollment criteria and refers patients to a doctor Step 3. A doctor advices a list of examinations required to take enrollment decision MDT Diagnostics Step 7. Laboratory monitoring of treatment Step 6. Social support provided by a case manager; 3 sessions on reinfection prevention Step 5. Doctor selects the treatment regimen for enrolled patients Step 4.Multi-disciplinary team consisting of a doctor, a nurse and a social worker takes joint decision on patients enrollment (MDT)

8 Multidisciplinary Approach to Patient Oriented Integrated Services Multidisciplinary team (MDT) takes joint decision on patients enrollment Doctor & Nurse Consultations Diagnostics Administering treatment Dispensing medicines Clinical monitoring Laboratory monitoring Re-directing to TB and HIV services Hello, I am your case manager Case manager Counseling Scheduling visits to doctors Three sessions on reinfection prevention Linking ART and OST

9 Patient-Oriented Activities: Re-infection Prevention Education (3 sessions)

10 Treatment Outcomes DAAs-based courses of HCV-infection treatment were provided, 1421 out of them interferon-free sof/riba and led/sof courses 1873 patients successfully finished full course of treatment 98,2% retention on treatment 34 patients (1,8%) terminated treatment on different reasons, 6 out of them re-started treatment within the Project 1837 patients were diagnosed (PCR RNA HCV) after 12 weeks of treatment (SVR 12) 95% treatment success

11 Treatment Outcomes as per Key Group (n=1837) SVR12 8% 4% 4% 1% 98% 97% 96% 96% 98% 96% 81% 95% 95% 94% 94% 93% PWID 92% PWID partners SW MSM PWID&PWHL Advocates

12 PWID Treatment Success (n=1479) SVR 12 94,6% 96,8% 97,4% 92,3% 93,2% 91,7% 781/ /208 90/93 227/233 55/59 55/60 HCV/HIV HCV PWID in remission Active PWID PWID on OST

13 Treatment Success (SVR 12) as per HIV Status (n=1837) % ,8% 95,3% 80% % % HIV + HIV % 0% Tested for SVR 12 Reached SWR 12 Treatment success %

14 Challenges Lack of awareness and knowledge about HCV treatment High diagnostic cost was a barrier for enrollment (Alliance provided 50% discount) Limited knowledge of medical staff on DAA administration and treatment No access to medicines to treat adverse reactions during treatment

15 Conclusion Significant reduction of HepC treatment cost Alliance agreed price (900 USD/12w treatment course) for Sof and Sof/led became a benchmark for the state procurement DAAs-based regimens were integrated in National HCV treatment guidelines and in the essential medicine list PWID identified as KP in National HCV treatment guidelines Model is recognized as the best practice in the national HCV elimination strategy

16 Thank you!

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