A Path to Ending Hepatitis C in Ethiopia: A Phased Public Health Approach to Achieve Micro-Elimination

Belaynew Wasie Taye Faculty of Medicine, The University of Queensland, Brisbane, Australia;
Department of Epidemiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

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Ethiopia’s hepatitis C virus (HCV) prevalence is predicted to rise by 2030. To halt this increasing trend, a suitable approach to the elimination of HCV is needed. This review explores the current status, challenges, and opportunities and outlines a strategy for the micro-elimination approach in Ethiopia. I searched PubMed and EMBASE using combined Medical Subject Heading databases for the literature on HCV micro-elimination. A phased public health approach to HCV micro-elimination, including preparation/capacity building (phase I), implementation (phase II), and rollout and scale-up (phase III), targeting people living with HIV, prisoners, chronic hepatitis and cancer patients, blood donors, and pregnant women is a pragmatic strategy to Ethiopia. This can be implemented at general and tertiary care referral hospitals with a future scale-up to district hospitals through task-shifting by training general practitioners, nurses, laboratory technologists, and pharmacists. Availability of the highly effective direct-acting antivirals (DAAs) can be ensured by expanding the existing program that provides highly subsidized DAAs through an agreement with Gilead Sciences, Inc. and eventually aiming at domestic generic manufacturing. The significant enablers to HCV micro-elimination in Ethiopia include the control of healthcare–associated HCV infection, blood safety, access to affordable testing and pan-genotypic DAAs, task-shifting, multisectoral partnership, and regulatory support. General population-based HCV screening and treatment are not cost-effective for Ethiopia because of high cost, program complexity, and disease epidemiology.

Author Notes

Address correspondence to Belaynew Wasie Taye, Faculty of Medicine, The University of Queensland, Herston Rd., Brisbane 4006, Australia. E-mails: b.taye@uq.edu.au or bewassie@gmail.com

Author’s addresses: Belaynew Wasie Taye, Faculty of Medicine, The University of Queensland, Brisbane, Australia, and Department of Epidemiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia, E-mail: b.taye@uq.edu.au.

  • 1.

    Sonderup MW et al. 2017. Hepatitis C in sub-Saharan Africa: the current status and recommendations for achieving elimination by 2030. Lancet Gastroenterol Hepatol 2: 910919.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Deressa T, Birhan W, Enawgaw B, Abebe M, Baynes HW, Desta M, Terefe B, Melku M, 2018. Proportion and predictors of transfusion-transmissible infections among blood donors in North Shewa zone, central north Ethiopia. PLoS One 13: e0194083.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Chan HLY et al. 2017. The present and future disease burden of hepatitis C virus infections with today’s treatment paradigm: volume 4. J Viral Hepat 24 (Suppl 2): 2543.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Demsiss W, Seid A, Fiseha T, 2018. Hepatitis B and C: seroprevalence, knowledge, practice and associated factors among medicine and health science students in northeast Ethiopia. PLoS One 13: e0196539.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Amsalu A, Worku M, Tadesse E, Shimelis T, 2016. The exposure rate to hepatitis B and C viruses among medical waste handlers in three government hospitals, southern Ethiopia. Epidemiol Health 38: e2016001.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    World Health Organization, 2016. Global Health Sector Strategy on Viral Hepatitis 2016–2021. Towards Ending Viral Hepatitis. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    World Health Organization, 2017. End Hepatitis by 2030: Prevention, Care and Treatment of Viral Hepatitis in the African Region: Framework for Action, 2016–2020. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Lazarus JV, Wiktor S, Colombo M, Thursz M, 2017. Micro-elimination–a path to global elimination of hepatitis C. J Hepatol 67: 665666.

  • 9.

    Lazarus JV et al. 2018. The micro-elimination approach to eliminating hepatitis C: strategic and operational considerations. Semin Liver Dis 38: 181192.

  • 10.

    Abera B, Adem Y, Yimer M, Mulu W, Zenebe Y, Mekonnen Z, 2017. Community seroprevalence of hepatitis B, C and human immunodeficiency virus in an adult population in Gojjam zones, northwest Ethiopia. Virol J 14: 21.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Woldegiorgis AE, Erku W, Medhin G, Berhe N, Legesse M, 2019. Community-based sero-prevalence of hepatitis B and C infections in South Omo zone, southern Ethiopia. BioRxiv. Available at: https://doi.org/10.1101/533968.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Degefa B, Gebreeyesus T, Gebremedhin Z, Melkamu G, Gebrekidan A, Hailekiros H, Tsegay E, Niguse S, Abdulkader M, 2018. Prevalence of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among blood donors of Mekelle blood bank, northern Ethiopia: a three-year retrospective study. J Med Virol 90: 17241729.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Hebo HJ, Gemeda DH, Abdusemed KA, 2019. Hepatitis B and C viral infection: prevalence, knowledge, attitude, practice, and occupational exposure among healthcare workers of Jimma University Medical Center, southwest Ethiopia. Scientific World J 2019. Available at: https://doi.org/10.1155/2019/9482607.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Atsbaha AH, Asmelash Dejen T, Belodu R, Getachew K, Saravanan M, Wasihun AG, 2016. Seroprevalence and associated risk factors for hepatitis C virus infection among voluntary counseling testing and antiretroviral treatment clinic attendants in Adwa hospital, northern Ethiopia. BMC Res Notes 9: 121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Taye S, Abdulkerim A, Hussen M, 2014. Prevalence of hepatitis B and C virus infections among patients with chronic hepatitis at Bereka Medical Center, southeast Ethiopia: a retrospective study. BMC Res Notes 7: 272.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Kebede W, Abdissa A, Seid Y, Mekonnen Z, 2017. Seroprevalence and risk factors of hepatitis B, hepatitis C and HIV infections among prisoners in Jimma town, southwest Ethiopia. Asian Pac J Trop Dis 7: 270275.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hundie GB, Raj VS, GebreMichael D, Pas SD, Haagmans BL, 2017. Genetic diversity of hepatitis C virus in Ethiopia. PLoS One 12: e0179064.

  • 18.

    FMOHE, The Federal Democratic Republic of Ethiopia Ministry of Health, 2015. National Cancer Control Plan 2016–2020. Addis Ababa, Ethiopia: Disease Prevention and Control Directorate.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    The Federal Democratic Republic of Ethiopia Ministry of Health, 2015. Ethiopia Health Sector Transformation Plan (HSTP) 2015/16 - 2019/20. Addis Ababa, Ethiopia: Federal Ministry of Health.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Bane A, Patil A, Khatib M, 2014. Healthcare cost and access to care for viral hepatitis in Ethiopia. Int J Innovation Appl Stud 9: 17181723.

  • 21.

    World Health Organization, 2018. Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Federal Democratic Republic of Ethiopia Ministry of Health, 2016/2017. Health Sector Transformation Plan-I. Annual Performance Report. Addis Ababa, Ethiopia: Federal Ministry of Health.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Food, Medicine and Healthcare Administration and Control Authority of Ethiopia, 2015. National Essential Medicine List, 5th edition. Addis Ababa, Ethiopia: FMHACA.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Gilead Sciences Inc., 2015. Chronic Viral Hepatitis Treatment Expansion: Generic Manufacturing for Developing Countries. Available at: http://www.gilead.com/∼/media/files/pdfs/other/hcv%20generic%20agreement%20fast%20facts%20101615.pdf?la=en. Accessed July 25, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Shiferaw F, Letebo M, Bane A, 2016. Chronic viral hepatitis: policy, regulation, and strategies for its control and elimination in Ethiopia. BMC Public Health 16: 769.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Hundie GB, Raj VS, GebreMichael D, Haagmans BL, 2017. Seroepidemiology of hepatitis B and C virus infections among blood donors in Ethiopia. J Med Virol 89: 13001303.

  • 27.

    Assefa Y, Hill PS, Williams OD, 2018. Access to hepatitis C virus treatment: lessons from the implementation of strategies for increasing access to antiretroviral treatment. Int J Infect Dis 70: 6568.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Belyhun Y, Maier M, Mulu A, Diro E, Liebert UG, 2016. Hepatitis viruses in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 16: 761.

  • 29.

    Ethiopian Public Health Institute E, 2012. Public Health Emergency Management. Guidelines for Ethiopia Center PHEM. Addis Ababa, Ethiopia: Ethiopian Health and Nutrition Research Institute (EPHI).

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Tafesse TB, Gebru AA, Gobalee S, Belay GD, Belew MT, Ataro D, Ebrahim BA, Shebeshi GM, Yimam Y, 2017. Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors. Hum Antibodies 25: 3955.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Manyazewal T, Sisay Z, Biadgilign S, Abegaz WE, 2014. Hepatitis B and hepatitis C virus infections among antiretroviral-naive and experienced HIV co-infected adults. J Med Microbiol 63: 742747.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Birhaneselassie M, 2016. Prevalence of transfusion-transmissible infections in donors to an Ethiopian blood bank between 2009 and 2013 and donation factors that would improve the safety of the blood supply in underdeveloped countries. Lab Med 47: 134139.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Teklemariam Z, Mitiku H, Weldegebreal F, 2018. Seroprevalence and trends of transfusion-transmitted infections at Harar blood bank in Harari regional state, eastern Ethiopia: eight years retrospective study. BMC Hematol 18: 24.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Graham CS, Swan T, 2015. A path to eradication of hepatitis C in low- and middle-income countries. Antiviral Res 119: 8996.

  • 35.

    Buller-Taylor T, McGuinness L, Yan M, Janjua NZ, 2018. Reducing patient and provider knowledge gaps: an evaluation of a community informed hepatitis C online course. Patient Educ Couns 101: 10951102.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    World Health Organization, 2015. Manual for the Development and Assessment of National Viral Hepatitis Plans: A Provisional Document. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Apata IW, Averhoff F, Pitman J, Bjork A, Yu J, Amin NA, Dhingra N, Kolwaite A, Marfin AJ, 2014. Progress toward prevention of transfusion-transmitted hepatitis B and hepatitis C infection—sub-Saharan Africa, 2000–2011. MMWR Morb Mortal Wkly Rep 63: 613.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Chevaliez S, Pawlotsky JM, 2018. New virological tools for screening, diagnosis and monitoring of hepatitis B and C in resource-limited settings. J Hepatol 69: 916926.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    World Health Organization, 2016. Monitoring and Evaluation for Viral Hepatitis B and C: Recommended Indicators and Framework. Available at: https://apps.who.int/iris/handle/10665/204790. Accessed July 25, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Hepatitis C Virus Infection Consensus Statement Working Group, 2018. Australian Recommendations for the Management of Hepatitis C Virus Infection: A Consensus Statement (September 2018). Melbourne, Australia: Australia GSo.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Kattakuzhy S et al. 2017. Expansion of treatment for hepatitis C virus infection by task shifting to community-based nonspecialist providers: a nonrandomized clinical trial. Ann Intern Med 167: 311318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Belperio PS, Chartier M, Gonzalez RI, Park AM, Ross DB, Morgan TR, Backus LI, 2018. Hepatitis C care in the department of veterans affairs: building a foundation for success. Infect Dis Clin 32: 281292.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Kushner R. Micro-elimination of hepatitis C: a pathway to achieve national elimination goals. CATIE, Canada. Available at: https://www.catie.ca/en/pif/spring-2019/Hepatitis-C. Accessed July 25, 2019.

    • PubMed
    • Export Citation
  • 44.

    Maticic M, Lekše A, Kozinc M, Dolničar M, Andoljšek D, Zupan IP, Faganel B, Poljak M, Lazarus J, 2018. Micro-elemination of hepatitis C among patients with congenital bleeding disorders in Slovenia. J Hepatol 68: S193S194.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Boerekamps A, Newsum AM, Smit C, Arends JE, Richter C, Reiss P, Rijnders BJ, Brinkman K, van der Valk M, 2017. High treatment uptake in human immunodeficiency virus/hepatitis C virus–coinfected patients after unrestricted access to direct-acting antivirals in The Netherlands. Clin Infect Dis 66: 13521359.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    UNAIDS, AIDSinfo, 2017. Available at: http://aidsinfo.unaids.org/. Accessed December 4, 2018.

    • PubMed
    • Export Citation
  • 47.

    Shimelis T, Tassachew Y, Tadewos A, Hordofa MW, Amsalu A, Tadesse BT, Tadesse E, 2017. Coinfections with hepatitis B and C virus and syphilis among HIV-infected clients in southern Ethiopia: a cross-sectional study. HIV AIDS (Auckl) 9: 203210.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Abate M, Wolde T, 2016. Seroprevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis among blood donors at Jigjiga blood bank, eastern Ethiopia. Ethiop J Health Sci 26: 153160.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Ayele W, Nokes DJ, Abebe A, Messele T, Dejene A, Enquselassie F, Rinke de Wit TF, Fontanet AL, 2002. Higher prevalence of anti-HCV antibodies among HIV-positive compared to HIV-negative inhabitants of Addis Ababa, Ethiopia. J Med Virol 68: 1217.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Dolan K et al. 2016. Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet 388: 10891102.

  • 51.

    Orlien SMS, Sandven I, Berhe NB, Ismael NY, Ahmed TA, Stene-Johansen K, Gundersen SG, Morgan MY, Johannessen A, 2018. Khat chewing increases the risk for developing chronic liver disease: a hospital-based case-control study. Hepatology 68: 248257.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Lee A, Rajanayagam J, Abdel-Hady M, 2015. Chronic hepatitis C infection in children: current treatment and new therapies. J Clin Transl Hepatol 3: 3641.

  • 53.

    Dhiman RK, Grover GS, Premkumar M, Taneja S, Duseja A, Rathi S, Satsangi S, 2019. Direct-acting antiviral therapy is safe and effective in pediatric chronic hepatitis C: the public health perspective. J Pediatr Gastroenterol Nutr 68: 7480.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Molla S, Munshea A, Nibret E, 2015. Seroprevalence of hepatitis B surface antigen and anti HCV antibody and its associated risk factors among pregnant women attending maternity ward of Felege Hiwot Referral Hospital, northwest Ethiopia: a cross-sectional study. Virol J 12: 204.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Kebede W, Mekonnen Z, Gerbi A, Abebe G, 2017. Transfusion-transmissible infection surveillance among blood donors in southwest Ethiopia: a six years retrospective study. Asian Pac J Trop Dis 7: 156161.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Biadgo B, Shiferaw E, Woldu B, Alene KA, Melku M, 2017. Transfusion-transmissible viral infections among blood donors at the North Gondar district blood bank, northwest Ethiopia: a three-year retrospective study. PLoS One 12: e0180416.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Mohammed Y, Bekele A, 2016. Seroprevalence of transfusion-transmitted infection among blood donors at Jijiga blood bank, eastern Ethiopia: retrospective 4 years study. BMC Res Notes 9: 129.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Ishizaki A, Bouscaillou J, Luhmann N, Liu S, Chua R, Walsh N, Hess S, Ivanova E, Roberts T, Easterbrook P, 2017. Survey of programmatic experiences and challenges in the delivery of hepatitis B and C testing in low- and middle-income countries. BMC Infect Dis 17: 696.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Hill A, Khoo S, Fortunak J, Simmons B, Ford N, 2014. Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries. Clin Infect Dis 58: 928936.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Suthar AB, Harries AD, 2015. A public health approach to hepatitis C control in low- and middle-income countries. PLoS Med 12: e1001795.

  • 61.

    Human Resource Development and Administration Directorate, 2019. Human Resource Development and Administration Directorate. Human Resource Development. Ethiopia: Federal Ministry of Health. Available at: http://www.moh.gov.et/web/guest/human-resources. Accessed January 9, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62.

    Mathur P, Comstock E, McSweegan E, Mercer N, Kumar NS, Kottilil S, 2017. A pilot study to expand treatment of chronic hepatitis C in resource-limited settings. Antiviral Res 146: 184190.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Marinucci F, Manyazewal T, Paterniti AD, Medina-Moreno S, Wattleworth M, Hagembe J, Redfield RR, 2013. Impact of horizontal approach in the vertical program: continuous quality improvement of malaria and tuberculosis diagnostic services at primary-level medical laboratories in the context of HIV care and treatment program in Ethiopia. Am J Trop Med Hyg 88: 547551.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64.

    Shiferaw M, Amare H, Fola AA, Derebe M, Tadese Kebede A, Admas Kebede A, Emiru M, Gelaw Z, 2015. Tuberculosis laboratory diagnosis quality assurance among public health facilities in west Amhara region, Ethiopia. PLoS One 10: e0138488.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65.

    Abreha T et al. 2014. Malaria diagnostic capacity in health facilities in Ethiopia. Malar J 13: 292.

  • 66.

    FitzSimons D, Hendrickx G, Hallauer J, Larson H, Lavanchy D, Lodewyckx I, Shouval D, Ward J, Van Damme P, 2016. Innovative sources for funding of viral hepatitis prevention and treatment in low- and middle-income countries: a roundtable meeting report. Hepatol Med Pol 1: 16.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67.

    Wallace J, Richmond J, Ellard J, Power J, Lucke J, 2018. Eradicating hepatitis C: the need for a public health response. Glob Public Health 13: 12541264.

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