Doctors Without Borders treats people with hepatitis C in several countries, and has dedicated HCV projects in Iran, Myanmar, Ukraine, Pakistan, India and Cambodia.
In 2019, Doctors Without Borders provided HCV treatment to some 10,000 people globally.
Doctors Without Borders is working with the Cambodian Ministry of Health to increase people’s access to care and has researched and introduced innovative ways of diagnosing and treating HCV in Cambodia. First, all patients now receive the same treatment regardless of the type and stage of their liver disease, which means they no longer need most of the pre-treatment analysis required by earlier treatments. Second, direct-acting antivirals (DAAs) are very safe, so additional tests and monitoring, which used to take place before and during treatment, are no longer necessary. In total, patients now need only five medical consultations instead of 16, which means it's easier and more affordable to adhere to or to complete the treatment. More than 13,000 patients have been treated under the new regimen since 2016.
Clinical Research and Trials
In the 1990s to 2010s, hepatitis treatment lasted anywhere between six to 12 months. On top of that, it wasn’t well tolerated, with negative side effects, and the patient had to be monitored closely. Worse still, the treatment wasn’t very effective, as the virus was only eliminated in around 50% of cases.
Treatment has been simplified in the past five years. The Drugs for Neglected Diseases Initiative (DNDi), a not-for-profit research organisation developing new treatments for neglected patients which was partly founded by Doctors Without Borders, is working to deliver a treatment that is as effective as the best HCV drugs, at a fraction of the cost. A new generation of treatments called DAAs was introduced at the end of 2013. DNDi led several clinical trials of ravidasvir (RDV) and sofusbuvir (SOF) in Malaysia in 2016, co-sponsored by the Malaysian Ministry of Health, and in Thailand in 2017, in partnership with the government.
Initial results presented in 2018 showed that 12 weeks after treatment completion, 97% of those enrolled in the treatment were cured. This means HCV is not detectable in the blood three months after completing the treatment. The results indicate that the RDV/SOF combination is comparable to the very best HCV therapies available today. This also shows that such a regimen has potential to be the simple and affordable treatment that cures existing HCV strains.
In June, 2021, Malaysia approved the use of Ravida®, which is indicated in combination with other medicinal products for the treatment of HCV infection in adults. This is the outcome of years of collaboration between DNDi and the Malaysian government to reduce barriers in access and affordability of HCV drugs for patients in Malaysia.
In the past years, Doctors Without Borders —through Access Campaign and DNDi—is advocating to lower the price of the DAAs and make it more accessible to patients who need it most. In 2018, around 3 million patients—out of the 71 million people worldwide who are living with HCV—have been enrolled in DAA treatments.
DAAs represent a treatment breakthrough for people with HCV. However, access to DAAs is limited because pharmaceutical corporations charge unaffordable prices. In some places, these corporations have even blocked the entry of affordable generics with patents. This has led many countries to reserve treatment only for people with the most advanced stages of the disease.
Although the estimated manufacturing cost for a 12-week course of sofosbuvir and daclatasvir is less than US$100, the manufacturers Gilead and Bristol-Meyers Squibb priced them at a staggering US$147,000 per treatment when they launched them in the United States. The move drew widespread outrage, but exorbitant prices remain a deadly barrier to treatment in both high-income and developing countries.
Since the launch of the first DAAs, Doctors Without Borders worked to close the HCV treatment gap with strategies aimed at increasing access to affordable, quality-assured generic versions of the drugs. In a major milestone of 2017, Doctors Without Borders’ supply centres and Access Campaign team negotiated successfully with generics manufacturers to procure DAAs for just $120 per treatment in almost all Doctors Without Borders projects, allowing teams to start more people on treatment.
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