Expanded treatment for people with hepatitis C is saving lives in Cambodia

For World Hepatitis Day, looking at what works

Cambodia Hep-C

Cambodia 2017 © Todd Brown

NEW YORK, JULY 24, 2019—A simplified model of care and access to generic medicines for people with hepatitis C in Cambodia has shown outstanding results with 97 percent of patients cured from the disease in just three months, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said ahead of World Hepatitis Day on July 28. Since 2016, MSF has treated more than 13,000 patients in Cambodia’s capital, Phnom Penh, through a simpler screening and treatment initiation process and with more affordable medicines—a model that could increase treatment access and curb the spread of hepatitis C in the country if rolled out more widely.

Hepatitis C, a blood-borne virus that attacks the liver, is endemic in Cambodia where there is an estimated 2.6 percent prevalence. However, diagnosis and treatment are virtually non-existent in much of the country. In Preah Kossamak hospital, MSF is working alongside the Cambodian Ministry of Health to remove the obstacles people with hepatitis C face accessing treatment and to introduce innovative ways of diagnosing and treating hepatitis C.

The project uses direct-acting antivirals (DAAs)—a new class of hepatitis C drugs that are taken for shorter periods of time, are less toxic than older treatments, and can cure the disease. DAAs are still out of reach for those in countries that cannot pay the prices asked by large pharmaceutical corporations and cannot access affordable generic versions of the drugs. In other countries, many people must wait for treatment until they are severely ill.

Before DAAs, people used to have to go through rounds of pre-treatment analysis and testing to determine the most appropriate treatment for their hepatitis C type and stage of illness. People with hepatitis C used to visit the clinic eight times for their diagnosis to be completed before treatment even started. Now, people at different stages of the disease can all be put on the same treatment, which means they don’t have to go through as much analysis and testing and can start sooner.

“The simplified screening process means that patients no longer have to wait four to five months before their treatment starts—instead it takes just 10 days,” said MSF’s Dr. Kim Sann. “Also, once they start their treatment, they now have a total of five consultations instead of 16. The treatment is simpler for the patients and it’s also more efficient for the clinic, as more people can be treated by the same team.”

Although curable, hepatitis C still kills nearly 400,000 people each year globally, mostly from resulting complications, typically cirrhosis or liver cancer. To eliminate hepatitis C, large numbers of people must be screened to identify people carrying the virus in order to treat them before it damages their livers. DAAs have revolutionized hepatitis C treatment and can cure people with hepatitis C in just 12 weeks and have significantly reduced side-effects, boosting people’s motivation to finish the course of treatment.

“Based on the treatment results shown by MSF, we hope that we can provide the treatment to all Cambodian people. We hope that by the end of 2030 there will be no more hepatitis C patients in Cambodia,” said Dr. Chhit Dimanche, head of the gastrointestinal and hepatology department at Preah Kossamak hospital.

The cost of traveling to the clinic is another burden for the people in need of treatment. This simplified protocol to diagnose and treat hepatitis C also means that screening and treatment can happen more locally and cover wider areas. More steps will follow as MSF moves to decentralize its screening and treatment processes, so people can access treatment in health centers closer to their homes.

“Many people in Cambodia are poor,” said MSF’s Dr. Somalene Pa, who has worked in the clinic since 2016. “So it’s a big improvement for patients if they have fewer consultations and have to spend less on transport costs.”

MSF has dedicated projects treating people with hepatitis C in Iran, Myanmar, Ukraine, Pakistan, India, and Cambodia. In 2018, MSF provided hepatitis C treatment to approximately 14,419 people globally.

MSF has been working in Cambodia since 1979, when it provided medical assistance in the refugee camps close to the Thai border. Since then, MSF has responded to medical needs in various provinces in Cambodia. MSF works with local health authorities and other health partners to prevent and tackle disease outbreaks and to mitigate the effects of natural disasters and conflicts.