The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy

Abstract

BackgroundHepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications.In response to the global outcry of hepatitis epidemic and the need to improve the nation’s public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means.DiscussionThis paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016.SummaryThe remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.

Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil

“…A strategic plan has been outlined recently to address HCV infection in Brazil. It comprises incorporating new, effective, affordable drugs guiding physicians in treating HCV patients, and promoting diagnostic campaigns in populations aged > 40 years, as recent studies have shown a higher prevalence of infection [8,12,13]. Studies assessing HCV prevalence in Brazil are scarce, and the HCV seroprevalence is estimated between 0.69 to 1.89% [6,13,14].…”

Innovative strategies for the elimination of viral hepatitis at a national level: A country case series

“…Globally, nine of the 10 people living with viral hepatitis are unaware of their infection, and lack of public knowledge is often compounded by viral hepatitis‐related stigma and discrimination. Implementation of a viral hepatitis strategy should therefore include awareness‐raising activities to generate demand for viral hepatitis care (eg through social media campaigns, such as in Brazil) in conjunction with supportive laws, policy and guidelines that aim to reduce stigma and enable the establishment of community‐focused responses …”

Doppler ultrasonography: A non‐invasive method used to diagnose and follow up patients with chronic hepatitis C

“…The initial hepatocellular lesion caused by hepatitis C virus, when not diagnosed and treated properly, progresses to liver fibrosis, cirrhosis, and even liver cancer. 3 Between 1992 and 2002, more than 1500 patients were treated at the outpatient clinic of the Fundação Santa Casa de Misericórdia do Pará (FSCMPA), 85% of whom were considered to have chronic liver disease. 1 Its chronic form presents a worldwide prevalence of around 3%, with more than 200 million infected, being 20-30% of these evolving to cirrhosis and 1-4% to hepatocellular carcinoma.…”

“…2 In Brazil, there are approximately 1.7 million hepatitis C carriers. 3 Between 1992 and 2002, more than 1500 patients were treated at the outpatient clinic of the Fundação Santa Casa de Misericórdia do Pará (FSCMPA), 85% of whom were considered to have chronic liver disease. 4 Liver biopsy is considered the gold standard in evaluating the degree of fibrosis when chronic liver disease is suspected.…”