LAHORE: Perturbed over ‘possible explosion’ of deadly hepatitis C in Pakistan, particularly in Punjab that accounts for 60-70 per cent of country’s disease burden, the provincial government has sought the help of the World Health Organisation (WHO) to check the epidemic.

The government has requested the WHO to dispatch a team of technical experts from its headquarters in Geneva and regional office for guidance and technical support.

The government believes that the successful ‘Egypt micro-elimination model’ is the time-tested scheme to get rid of the deadly virus playing havoc in Punjab.

It shared disturbing figures of chronic viral hepatitis B and C and the massively increasing burden of the disease. In a letter addressed to the WHO Pakistan chief Dr Palitha Mahipala, the Primary & Secondary Healthcare Department said that Pakistan had the second highest burden in the world after China and the highest prevalence after Egypt.

Written by Dr Khalid Mahmood, the Programme Manager of the Hepatitis Control Programme, Punjab, the letter was dispatched to the WHO on Jan 28.

Up to 11m individuals with active HCV viremia; province needs to treat 850,000 individuals annually

“It is estimated that there are 8 million to 11 million individuals with active HCV viremia and 240,000 new infections per year in Pakistan”, the letter said. It said Punjab accounted for almost 60 to 70 percent of HCV cases.

According to the letter, there has been initial progress in hepatitis response in Punjab with the establishment of a programme management unit in 2016.

There is a network of 138 testing and treatment sites at teaching, DHQ and THQ hospitals in the province, and access to low cost generic direct-acting antivirals (DAAs) for less than $35 for a treatment course.

Similarly, the establishment of a centralised viral load testing facility, transport network and a central hepatitis reporting dashboard were providing in real-time an overview of overall programme progress across all sites.

“Despite all efforts, the burden of the deadly disease was increasing manifold. As of end Dec 2019, more than one million persons had been tested for hepatitis B and C and around 300,000 had been treated,” reads the letter, adding most of HCV-infected individuals remain undiagnosed.

In order to meet the global deadline of hepatitis elimination by 2030, the letter says there is a need to treat more than 850,000 people in the province annually which is a huge task and significant efforts are required to meet the goal.

“There is a need for substantial scale-up of the hepatitis response, including screening, testing, treatment and preventative interventions in general population based on successful Egypt micro-elimination model”, says the programme manager.

He said the hepatitis micro-elimination project was designed in collaboration with the WHO to be implemented in Nankana Sahib, the district with high prevalence.

It was pretested in one of the union councils of tehsil Shahkot for a period of three weeks. “This pretesting phase ended successfully and hepatitis control programme achieved almost 90 per cent of the target in this phase,” reads the letter.

It apprised the WHO chief in Pakistan that the pretesting phase was being consolidated at the moment by reaching out to remaining almost 1200-1500 people, linking remaining 500 diagnosed patients to assessment/treatment and implementation of scale-up plan in other union councils of Shahkot.

“At this stage we would request that it would be great if technical experts from WHO headquarters and regional office may visit Punjab in Mid-February to meet with relevant stakeholders and also visit Nankana Sahib to provide us technical input and guidance,” reads the letter.

Published in Dawn, February 1st, 2020