Gia Lộc

HCM CITY— A former intravenous drug user in HCM City had the hepatitis C virus (HCV) for many years but did not know about it.  

Through a pilot project for raising HCV awareness among high-risk populations in the city and screening for the disease, she recently came to know about her status.

But she said in tears, “I cannot get treatment because I cannot afford the medicines.”

The medicines alone cost VNĐ7.5-15 million (US$322- $644) a month, whether at private or public hospitals.

Dr Vũ Ngọc Bảo, deputy programme director of HIV/TB at PATH, a global NGO, said high-risk populations cannot afford HCV screening, diagnosis and treatment costs.

According to Nguyễn Đăng Tấn Lộc, an HCV and HIV counsellor at Galant Clinic, the demand for HCV testing among the clinic’s patients is high, and when they find out they are infected, they face high treatment costs.

“Even if health insurance covers 50 per cent of the treatment costs, many of them cannot afford the rest because their incomes are too low.”

At his clinic, HCV patients could pay in instalments for their treatment, he added.

Dr Tiêu Thị Thu Vân, director of the HCM City HIV/ADIS Prevention Centre, called on pharmaceutical companies to reduce drug prices.

Many people at high risk of contracting HCV in the country are also those who are at increased risk of HIV, including people who inject drugs and men who have sex with men (MSM), according to a press release from PATH.

PATH works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world’s most pressing health challenges.

HCV is an infectious disease that can result in serious liver damage and death. Many people with HCV have no symptoms until long-term infection gives way to these serious consequences.

The virus spreads through the blood of an infected person.

Up to 4 per cent of the Vietnamese population has evidence of exposure to HCV, with many developing long-term infection.

Since January 2018 PATH, the HCM City HIV/AIDS Prevention Centre, Gilead Sciences, and private clinics and community-based organisations (CBOs) in the city have collaborated for a new approach to increase awareness and expand access to HCV testing among those most at risk of infection.

It built on the platform developed by USAID/PATH Healthy Markets and the Việt Nam Administration for HIV/AIDS Control (VAAC) to increase access to HIV services for key populations by integrating HCV information and services into established community-based services and communication channels.

“The introduction of community-based testing for HIV in Việt Nam provides a strong platform and timely opportunity for also increasing awareness and uptake of HCV testing among [high-risk] groups,” Vân said.

An assessment done by the project found that most people at risk of HCV did not know about the risks and consequences of HCV, where to go for screening, diagnosis and treatment or how to prevent HCV.

In response, PATH, HCMC PAC, Gilead, private clinics, and CBOs worked together to develop educational and behavioural changes and a demand creation campaign called ‘Healthy Liver, Happy Life’.

This campaign mobilised social media networks, community-led offline events, and in-clinic counselling (integrated into counseling for HIV testing and other HIV-related services) to raise awareness of HCV and encourage people to engage in HCV testing. 

Concerns about discrimination at testing facilities were also barriers to testing and so this project leveraged USAID/PATH Healthy Markets and the VAAC’s experience in introducing community-based HIV testing to reach those most at risk of HCV.

Studies conducted by USAID/PATH Healthy Markets found that PWID (people who inject drugs) and MSM lay health workers (CBO staff and peers) in the city were just as skilled as trained healthcare workers in delivering HIV tests and significantly more likely to reach new HIV testers.

Those testing at PWID and MSM-led CBOs and clinics are also more likely to be HIV positive than those testing at public facilities since many of them prefer to receive services from people they know and trust.

Following these lessons, this pilot project enabled HIV positive and negative and PWID and MSM groups to access quick and easy HCV testing through community-led private clinics and CBOs, often at the same time as testing for HIV.

Trained staff offered rapid diagnostic tests that require a small amount of blood from the prick of a finger.

The process is simple, safe, and painless. If the test was positive, people were assisted with confirmatory diagnosis and treatment.

Since April this year 3,116 people have undergone HCV testing. As many as 217 received a reactive result with the rapid test, and 111 were subsequently diagnosed with HCV and linked to further medical care.

“The path to eliminating hepatitis C starts with awareness, screening and diagnosis,” Boon-Leong Neo, senior director, public health & medical affairs, at Gilead Sciences, said.

The clinics involved in this pilot will continue to provide integrated HIV and HCV counselling, screening and linkages to care.

Community-based organisations will also continue to provide information, counselling and referrals to HCV services at the same time as providing HIV services.

PATH and Gilead will each continue to seek opportunities to advocate for the further development of community-based HCV services in HCM City and across Việt Nam, including raising awareness and increasing access to care. —VNS