In March 2018, the World Health Organization (WHO) released its Progress Report On Access to Hepatitis C Treatment: Focus On Overcoming Barriers in Low- And Middle-Income Countries. The information contained in this report provides a good contrast to my blog from two weeks ago. In Hepatitis C Report: State of Medicaid Access, I wrote about the abysmal state of affairs regarding access to hepatitis C treatment for people utilizing Medicaid across the United States. Access to care is interfering with our chances of eliminating hepatitis C. Using the WHO Progress Report, let’s look at how the rest of the world is doing with their elimination plans. In other words, how does the U.S. stack up?
Let’s begin with a summary of the WHO Progress Report. According to WHO, options for treating hepatitis C virus have improved and thus, increased. Further, treatment using direct-acting antivirals (DAAs) is revolutionizing the chances of ending hepatitis C epidemics.
The number of people who used DAA-based treatment for hep C rose between 2015 and 2016, from approximately 1 million to 1.5 million. However, this increase is largely due to a small number of countries. Egypt and Pakistan accounted for about half of all people who started DAA treatment in 2016. Australia, Brazil, China, France, Georgia, Mongolia, Morocco, Rwanda and Spain also have increased the number of people who are being treated for hepatitis C. The higher treatment rates in some of these poorer countries correlates with the availability of generics.
Unfortunately, hepatitis C treatment is largely unaffordable in many upper-middle- and high-income countries where generics are not available. Globally, roughly 38 percent of people living with hepatitis C are in countries that lack access to generic DAAs.
How Does the United States Stack Up Globally?
The high cost of hepatitis C treatment and lack of access to affordable health care are major obstacles to large scale and evenly distributed treatment. A recent study found that almost half of Medicaid patients were refused hepatitis C treatment. Moreover, there is a major inadequacy when it comes to screening people for viral hepatitis.
This inadequacy isn’t limited to the United States. Worldwide, the majority of the estimated 71 million people living with hepatitis C remain untreated, mostly because they are not diagnosed. Globally, this translates to approximately one in five people living with HCV have been diagnosed in 2016. In low-income countries, this drops to less than 10 percent of people living with hepatitis C.
It’s hard not to be discouraged by the apparent lack of progress. However, we can’t change things if we don’t know what change is needed.