Equal Access for all: Addressing Hepatitis C Disparities in Uganda

A look into the findings of the Market Intelligence Study for Uganda

Opinion Research

Equal Access for all: Addressing Hepatitis C Disparities in Uganda

Blog post by Anne Lumbasi[1]

Uganda like many other African countries is facing turbulent times and wadding murky waters following the withdrawal of USAID & PEPFAR funding. Indeed, all eyes are on the imminent impact that this will have on access to HIV/AIDs services/health care since the greatest support of this external funding was directed towards addressing the HIV & TB disease burden.

In full recognition of the gloom that hovers around the withdrawal of funds, allow me shed a little light to another critical disease area that is calling for our attention. In June 2024 CEHURD in collaboration with the Kenya Legal and Ethical Issues Network on HIV/AIDs (KELIN) conducted a Market Intelligence Study with support from the International Treatment Preparedness Coalition (ITPC) Global.  This study report focused on identifying priority health products for intervention, specifically targeting HIV and TB, with inclusion of Hepatitis C (HCV) and cervical cancer.

This study report highlights the WHO Hepatitis global report of 2024 which estimated a total of hepatitis C infections (all ages) in Uganda at 356,043 with Hepatitis C incidence at 5,678 and number of deaths caused by hepatitis C infection at 723. Unfortunately, the study found that the diagnosis coverage (total) was as low as 9% by end of 2022 with treatment coverage, (of all infected) at 0% at the end 2022. According to the market intelligence study report, the prevalence of chronic HCV (RNA+/cAg) in Uganda is 0.75% as at (2022), and the prevalence of chronic HCV (RNA+/cAg) among persons who inject drugs is 20.6% (2017).

While the above statistics provide a small inkling of why we should care, there is more reason to spotlight Hepatitis C from this market intelligence report because of the following issues;

  • Lack of data on Hepatitis C Virus (HCV); There is limited data on the burden of HCV in the country, according to the WHO the actual prevalence of Viral Hepatitis C in Uganda is unknown, the data from the National Blood Bank indicates that the prevalence of Hepatitis C among blood donors in Uganda is approximately 1.5%. It is therefore difficult to prioritize the necessary treatment without data and this means many affected Ugandans will suffer in silence.
  • Hepatitis C Treatment Not Included on the Essential Medicines List; None of the HCV Direct Acting Antivirals (DAA) in the Uganda Guidelines for Prevention, Testing, Care and Treatment of Hepatitis B and C Virus Infection, November 2019 is in the National Essential medicines and health supplies list (EMHSLU) of 2023. This therefore means that Ministry of health cannot procure this treatment and an import permit for medicines not on the list will only be processes under extra ordinary circumstances.
  • National Treatment Guideline (NTG) for Hepatitis C not updated; The Uganda Guidelines for Prevention, Testing, Care and Treatment of Hepatitis B and C Virus Infection was last updated in 2019. The current NTG for HCV defers treatment for <12 years until 12 years of age in those without cirrhosis or with only compensated cirrhosis. The 2022 updated WHO guidelines lower treatment age to those between 3 to 12 years of age i.e., older children (6–11years) and younger children (3–5 years).
  • Minimal registration for HCV drugs with National Drug Authority (NDA); According to the June 2024 NDA Register, there were 74 Marketing Authorizations (MAs) for drugs in the National Treatment Guideline (NTG) for the treatment and prevention of HIV infections, 133 MAs for TB drugs, and only 4 MAs for drugs used in the management of HCV in Uganda.
  • Not supported by government donors; There are significant challenges in the supply chain for HCV treatment products. HCV Direct Acting Antivirals (DAAs) are not currently supported by the government or donors and patients are referred to private sector pharma distributors. The only local distributor with stock for HCV DAA had branded Sofosbuvir (400 mg)/Velpatasvir (100 mg), a pack of the Fixed Dose Combination was priced at UGX 1,400,000 (USD 376.32). In comparison, a generic from Global Fund Pooled Procurement Mechanism costs USD 58.0021 before freight and insurance, a 549% difference. Which means that equitable access HCV DAAs remains a critical challenge

With the above challenges on Hepatitis C the following recommendation/proposals should be embraced and implemented;

  • Enhance Funding Mechanisms; The government should increase its contribution to the health commodity budget, particularly for HCV treatments to cover gaps as donor priority pivots to other global health challenges in light of increasing non communicable disease burden.
  • Review and Update National Treatment Guidelines; Regular review and update of the NTG for HCV and the national essential medicines list to include up to date WHO recommendations for HCV management. There is need to update the national guidelines to bring them in full compliance with WHO updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics in 2022
  • Engage stakeholders on pricing; There is a need for increased stakeholder engagement to understand and address prices for branded HCV commodities to ensure equitable access to HCV DAAs
  • Encourage Registration of NDA HCV DAAs as a critical step towards making the medicines available for use in clinical settings. There is need to engage and support manufacturers to apply for registration of their products by the national regulatory authority.
  • Concerted effort among all stakeholders to influence donor and national procurement decisions towards sourcing of DAAs, especially pan-genotypic DAAs that eliminate the need for genotyping for adults in treatment to make the medication available to the most impacted vulnerable poor that access healthcare through public health facilities.
  • Dialogue with Ministry of Health to ensure inclusion of HCV treatment is added on National Essential Medicines and Health Supplies List (EMHSLU) and in the National Treatment Guideline (NTG)
  • Fast track adoption of WHO recommendations and prequalification of new treatment options for HCV

Although Hepatitis C is not as prevalent as HIV/AIDs in Uganda, we must ensure equitable access to treatment for all patients as a critical tenet of the right to health enshrined under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). Even as we grapple with funding for HIV treatment, we should not forget that people living with HIV/AIDs are most at risk of co-infection with Hepatitis C and yet early detection and treatment can go along away. The fact that there is not much attention or resources allocated to address incidences of Hepatitis C cannot be excused and we call upon key stakeholders to ensure that 723 Ugandans do not die every year due a preventable cause like this one. Every life counts.

Here is a link to the full report of the Market Intelligence Study Conducted in Uganda 

[1] Anne is the Programme Manager – Campaigns, Partnerships and Networks at the Center for Health, Human Rights and Development (CEHURD) in Uganda.