FEATURED: From screening to treatment: Rwanda’s strategy towards Hepatitis C elimination

Hepatitis C, a viral infection that affects the liver, is the second leading infectious cause of death globally, with 1.3 million deaths per year, according to the World Health Organization (WHO) 2024 Global Hepatitis Report. Although Viral Hepatitis C (HCV) has claimed several lives and has no effective vaccine, it can be treated and cured. Rwanda has established interventions to eliminate the infection. The government has given precedence to viral hepatitis since 2011, by instituting a hepatitis unit under the Rwanda Biomedical Centre (RBC), setting up screening tests and viral load platforms, and introducing Direct-Acting Antivirals (DAAs). The government also further negotiated with the Global Fund to cover HCV diagnosis and treatment. DAAs were introduced to referral hospitals in 2015. In the same year, RBC trained 110 licensed physician specialists on HCV and dispersed HCV treatment to 48 facilities nationwide. Rwanda spearheaded sub-Saharan Africa to eliminate Hepatitis C through a five-year plan launched in December 2018 to screen seven million people aged 15 years and above and treat all positive cases to reduce the HCV prevalence from 4 per cent to 1 per cent. Following the launch of HCV elimination, the country negotiated prices for tests and medicines to get a rapid test at $0.75 and a price record of $60 for the full three-month first line treatment course of Hepatitis C, to allow procurement of enough tests and medicines for the population in need. The country eased diagnostic and treatment methods by introducing Rapid Diagnostic Tests (RDTs) that provide results in 20 minutes and DAAs for a three-month HCV treatment course with little to no side effects and a cure rate of around 95 per cent. Testing and treatment services have been disseminated at different levels including referral, provincial, and district hospitals, and all health centers nationwide. As Rwanda continues the HCV elimination campaigns, in the 2022/2023 fiscal year, 579,584 people were screened, and 2,236 who have been confirmed HCV viral load positive were treated. Analysis by province shows that the Eastern Province tested the highest number of people (169,415). In contrast, the Northern Province tested fewer (70,707), and the Southern Province recorded the highest proportion of HCV-detected viral load (0.67 per cent), according to the HIV and Viral Hepatitis Annual Report 2022/2023. Additionally, several staff and managers from various hospitals and health centres have been trained on viral hepatitis management. The training also improved the management of viral hepatitis using an electronic data recording system and boosted the skills and motivation of healthcare workers by providing them with effective technical support, RBC stated. Dr Janvier Serumondo, Director of the Sexually Transmitted Infections and Other Blood Borne Infections Unit at Rwanda Biomedical Centre, said that tests and medicines have been procured at lowest prices to allow the population an easy access to hepatitis services without any financial hardship; healthcare personnel have been trained, screening and treatment campaigns have been conducted and services were decentralized up to the health center level and provided at no cost to all Rwandans and refugees residing in Rwanda. “There is a good progress in hepatitis C management. Today, statistics from RBC indicate that, since the beginning of HCV management in 2015, almost 8,000,000 people have been tested for HCV in Rwanda and 60,000 of them have been treated and cured. The estimated prevalence of chronic Hepatitis C dropped from 4 per cent in 2017 to 0.48 per cent in 2023”, he stated. Dr Serumondo stated that Rwanda is on track to achieve HCV elimination by 2030. Programmatic targets, including screening and treatment numbers, as well as the targeted reduction in prevalence have already been achieved. In addition, Rwanda was selected among the seven countries (England, Brazil, Egypt, Rwanda, Thailand, Georgia and Mongolia) to be assessed for hepatitis elimination validation readiness, and was qualified to be on track for hepatitis C elimination. Finally, on 24th October 2023, Rwanda received a champion award from the World Hepatitis Alliance for its outstanding contribution towards the elimination of hepatitis in Africa. WHO’s global health sector strategy 2022-2030, endorsed by all WHO member states, aims to eliminate viral hepatitis C by 2030.

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FEATURED: From screening to treatment: Rwanda’s strategy towards Hepatitis C elimination