August 22, 2022

Bringing the hepatitis C cure closer to patients in Nigeria

Hepatitis C (HCV) is an infectious, bloodborne virus that causes liver inflammation and can lead to liver failure and cancer. It is a silent killer, as patients do not exhibit any symptoms.

Every 30 seconds, a person dies from a hepatitis-related illness; elimination of HCV cannot wait!

HCV is endemic in many parts of the world, with an estimated 58 million people infected globally. Every year, about 290,000 people die from HCV-related complications, making it one of the world’s most prevalent infectious diseases. Despite the high number of people suffering and dying from the disease, only 21 percent know their HCV status. As of 2019, the WHO estimates that merely 62 percent of people with the disease had received treatment.

Right now, the world has an opportunity to eliminate HCV as a public health threat and prevent millions of deaths. The availability of simple and effective screening and an affordable cure has made elimination possible. Through a 12-week once-daily oral treatment with minimal side effects, governments can now bring care closer to vulnerable communities and populations where they are needed. By increasing access to this medication, we can reduce the number of new HCV cases by 80 percent and deaths by 65 percent by 2030 in line with the global hepatitis elimination target.

CHAI is working to support governments launch and scale national HCV programs to expand access to viral hepatitis care across communities starting with seven program countries: Cambodia, India, Indonesia, Myanmar, Rwanda, Vietnam, and Nigeria.

Governor of Nasarawa state engaging CHAI’s senior leadership

Plan wisely, test smart, cure-all, and prevent new cases

Nigeria has approximately 2.2 million people living with HCV, which is about one percent of the total population. However, states in the North Central region such as Nasarawa have double-digit HCV prevalence rates — much higher than the national average.

States such as Nasarawa face multiple yet connected challenges in addressing the viral hepatitis burden. There is a lack of awareness of the disease, unavailability of HCV diagnostic infrastructure and treatment services, and high costs required for patients to access these services.

In response to these challenges, the Nasarawa State Government officially committed to the elimination of HCV in 2020 and announced a five-year strategic plan to screen 2.5 million and treat 141,000 people by 2025. A Technical Working Group (TWG) was inaugurated to drive the implementation of this plan.

Dr. Ruth Bello, Gastroenterologist/Executive Director Nasarawa State HIV/AIDS Control Agency

“Hepatitis C remains curable. Everyone is encouraged to get tested, treated and stop the spread. We have worked hard in Nasarawa State to ensure that HCV diagnostics and curative treatments are readily available.” – Dr. Ruth Bello

Nasarawa’s elimination strategy is guided by four principles — plan wisely, test smart, cure-all, and prevent new cases. It focuses on the optimal deployment of resources for case finding, ensuring treatment for identified patients, and rollout of prevention strategies in areas with higher transmission rates.

The state’s commitment to HCV elimination is evident in the words of Dr. Emmanuel Akabe, the Deputy Governor: “The health of our people in Nasarawa State is my prime concern, and I will leave no one behind in the battle to end viral hepatitis C by 2025, five years ahead of the global target of 2030.”

Negotiating price reductions and using domestic financing to kickstart the HCV response

To kickstart the plan, Nasarawa state leveraged domestic funding and with CHAI support optimized this funding for screening and treating people. The government procured 7,000 screening kits, 700 viral load tests, and 320 treatment courses. Additionally, the TWG requested and received additional donations of 7,000 screening kits from Healthline pharmaceuticals, a local distributor company supporting HCV elimination.

With the support of partners such as the World Hepatitis Alliance and CHAI, Nasarawa state negotiated with Viatris to reduce the price of a 12-week treatment course from US$135 to US$60, setting a new global benchmark. These negotiated prices have reduced the estimated cost to reach elimination in the next four years by 24 percent.

‘’Nasarawa State is currently prioritizing the HIV/HCV co-infected population which it considers low-hanging fruit to catalyze its elimination efforts” said Dr. Ibrahim Adamu, Director Public Health, Nasarawa State Ministry of Health.

Dr. Ibrahim Adamu, Director Public Health, Nasarawa State Ministry of Health

Integration is essential in providing patient-centered healthcare

Program integration is the bedrock of Nasarawa’s journey to HCV elimination. The Nasarawa State Elimination program is employing a model that ensures easy access by communities in need. These include:

  • Timely testing to ensure patients know their status and are initiated on treatment as soon as possible.
  • Integrating HCV testing on seven out of 19 GeneXpert devices used for tuberculosis testing in the state.
  • Leveraging existing tuberculosis sample transportation networks to ensure that patients do not have to travel or wait for long turnaround times to know their status.
  • Implementing multi-month dispensing to minimize loss-to-follow-up – meaning that all patients are successfully linked to care and complete their treatment doses while minimizing multiple facility visits.

A patient recently commented that “when I tested positive for hepatitis, I was worried because I could not afford the treatment. Thanks to the Nasarawa state government for providing free hepatitis services.”

Task shifting: Capacity building for ART care providers

A micro-elimination approach to HCV elimination prioritizing vulnerable and key populations

Despite starting an elimination program amid the COVID-19 pandemic, Nasarawa state has achieved multiple successes.

To date, the state has successfully integrated HCV care into HIV services across 13 antiretroviral therapy (ART) sites with minimal to no changes to normal clinic flow. To bring care nearer to the communities, Nasarawa is effectively using a task-sharing approach, building capacity from one specialist to 115 ART care providers and expanding access to care from one to 18 facilities. Since the announcement of the HCV elimination agenda, the state has screened over 11,000 people living with HIV and successfully initiated 45 percent with chronic hepatitis on treatment.

Pharmacist Ahmed Yahaya, Honourable Commissioner for Health, Nasarawa State

Although free HCV services are only offered to those co-infected with HIV, the state recognizes that the mono-infected across the population cannot wait. The state is now implementing the Provider Initiated Testing and Counselling (PITC) approach to ensure that all eligible patients who test positive for HCV are linked to treatment. Since the launch of the elimination goal, 103,000 people have been screened with 24 percent of those with chronic infection initiated on treatment.

Pharmacist Ahmed Yahaya, Honourable Commissioner for Health, Nasarawa State reiterated that “Eliminating viral hepatitis is a task that must be accomplished and we are well poised to make that happen in Nasarawa State.”

Contributing authors:

Folu Lufadeju, Jibrin Kama, Muhammad-Mujtaba Akanmu, Olayinka Adisa, Onyeka Nwobi, and Dr. Ibrahim Adamu

Learn about our work on hepatitis

Written by Amy Azania, Associate, Hepatitis Country Support; Chukwuemeka Agwuocha, Senior Associate, Hepatitis Program, and Yahaya Ahmed, Commissioner for Health, Nasarawa State