As we mark World AIDS Day on December 1, 2.3 million people are living with HIV and hepatitis C co-infection around the world. For HIV positive people, hepatitis C is a leading cause of death, due to a faster progression of the disease and a greater risk of death from cirrhosis and liver cancer without treatment. However, hepatitis C is curable.
In Mykolaiv, in southern Ukraine, Doctors Without Borders/Médecins Sans Frontières (MSF) is taking an integrated approach to hepatitis C care for people living with HIV by providing free diagnostic tests, treatment with new drugs, and education and counseling services. Recent test results from patients who finished treatment since the start of integrated services one year ago are extremely positive, with a success rate of over 95 percent in curing hepatitis C in patients who are living with HIV.
Shorter treatment with new oral drugs
“Hepatitis C infection can be deadly if untreated, especially for people living with HIV, but these test results remind us that a cure is possible,” says Franking Frias, MSF medical coordinator in Ukraine. “For treatment we use sofosbuvir and daclatasvir, new oral drugs recommended by the World Health Organization (WHO) that can cure hepatitis C in as little as 12 weeks with few adverse effects. In comparison, older hepatitis C treatment models use injectable drugs and take at least four times as long.”
The role of peer educators
Psychosocial support also plays an essential role in patient success. People living with HIV and hepatitis C experience stigma in Ukraine and undergoing treatment can be a challenge. Therefore, MSF works with peer educators, who have themselves lived with the disease.
Peer educators help patients manage their care and give advice on how to cope with challenges that may affect their ability to complete treatment, such as discrimination, financial difficulties, and mental and physical hardships.
As peer educator Maksym (name changed) explains:
“When I talk to patients about hepatitis C while they are waiting in line to see the doctor, I sometimes face a lack of interest. But once I say the magic phrase—‘I am one of you. I live with HIV and used to live with hepatitis C.’—I see the change. People start to listen carefully, and ask questions. I talk to them as a person who has experienced all the difficulties of treatment and cured hepatitis C. I managed to do it, and I explain how, using examples from my own life and my own story. We talk as equals, as peers, and it really works. People open up.”
“Support is extremely important in this situation,” Maksym says. “As a peer educator, I provide support for those in need throughout the entire treatment course. I am always there to provide any additional explanation regarding tests or medication, to help them formulate questions for the doctors or nurses, or to listen to their complaints. I can even help remind them to take their medication on time each day, just like my family did for me.”
This approach has proven successful. So far, zero patients in the MSF project have failed to complete treatment as a result of missed doses or visits. In total, 341 patients on antiretroviral therapy for HIV have finished MSF’s hepatitis C treatment course. A preliminary group of 143 patients have already undergone testing, and all but one patient was found to be cured of hepatitis C.
An example for the country
In Ukraine, about two million people live with hepatitis C. However, most lack access to affordable diagnostics and treatment for the curable disease. MSF’s hepatitis C treatment project in Mykolaiv will treat a total of 1,000 patients for hepatitis C, out of which 750 are co-infected with hepatitis C and HIV.
“The aim of our project is to provide an example of how hepatitis C can be effectively treated in Ukraine, where access to diagnostics and treatment is currently quite limited,” says Jeri Driskill, field coordinator for the MSF project in Mykolaiv.
“Unfortunately, many people give up on themselves,” says Maksym. “They do not have enough motivation. They are disillusioned. It is difficult to keep fighting, especially against both HIV and hepatitis C. However, it is still possible – hepatitis C is curable, and, with HIV, you can live longer and healthier with antiretroviral medicines. I tell them that it is possible to be happy and not lonely, even with [an HIV] positive status. After discussing this, the patients start reconsidering their lives and see that a lot of things are still possible for them.”