Thirty hepatologists, gastroenterologist and psychiatrists gathered in Dubai at the international workshop ‘HCV Screening and Linkage to Care & Substances Users Practical View’ to discuss gaps and barriers in care models for most at risk population – people who inject drugs (PWID). Workshop organized by Gilead Sciences Middle East was endorsed by the Emirates Gastroenterology and Hepatology Society and CME accredited by the Department of Health – Abu Dhabi.
In many settings worldwide, including MENA region, more than half of people who inject drugs are infected with HCV,[1] and morbidity and mortality due to HCV infection continues to rise. The Global Burden of Disease project estimated the total burden of HCV due to injecting drug use in 2013 as measured by disability adjusted life years – DALY, including recent and former PWID. This modeling estimated 39% of HCV burden was due to HCV acquired via injecting drugs. In MENA region. in addition to the estimated 300,000 HCV-infected current PWID, there could be as many as 2 million HCV-infected people who acquired the infection through past drug injection but are no longer injecting.[2]
Dr. Huda Al Quraishi, Senior Specialist of Gastroenterology and Hepatology, Rashid Hospital, Dubai, UAE stated: “There are still substantial gaps and barriers for PWID to access testing and treatment. At the same time, because they are the most at risk population, their treatment should be a priority if we want to achieve a goal of elimination of the disease. This workshop addressed multidisciplinary interventions that would have impact on the HCV epidemic. Namely, if we don’t intervene on time, long-term care following the development of cirrhosis, decompensated liver disease, and liver cancer will add to the existing disease burden.”
However, people who inject drugs bear considerable stigma and discrimination which often reduces access to care. Globally, HCV testing and diagnosis remains inadequate, especially among PWID. UAE and Kuwait have made major strides in developing interventions that lead towards the elimination of HCV by 2030. To support screening and HCV elimination efforts in the UAE, Dubai Health Authority (DHA) announced in July 2018 the inclusion of free screening and treatment for Hepatitis C under the basic benefit plan of the Dubai Mandatory Health Insurance Scheme. However, there are still many interventions that can substantially curb the epidemic. At the same time, majority of the countries in the GCC don’t have data that would allow the evaluation of role of intravenous drug use in HCV transmission in the region.
Dr. Motaz Fathy Saad, Senior Specialist Gastroenterology and Hepatology, Mubarak Al Kabeer Hospital, Kuwait stated: “Many people are often faced with barriers to testing and linkage to care. These barriers often include lack of awareness, knowledge and understanding that can lead to stigma and discrimination. Therefore, focused testing for most affected populations such as people who inject drugs would lead to the solution of the problem. Success is possible if the access to HCV testing is increased and more people get tested. At the same time, we need to work together to develop care models that would simplify the HCV testing and treatment.”
Dr. Tarek Abdelgawad, the Treatment and Rehabilitation Director at the Abu Dhabi National Rehabilitation Centre stated: “HCV treatment and care could be delivered in various settings such as hospitals, primary health clinics or drug rehabilitation centers. The results of the study, conducted by the Abu Dhabi National Rehabilitation Centre (March 2015) showed that the financial cost of substance abuse was as much as AED 5.5 bn. Although addiction rates have risen sharply over recent years, particularly the abuse of prescription drugs, an encouraging statistic was that 75% of patients seeking treatment did so voluntarily or were referred by their families, while balance was referred by the criminal justice system. Experience has shown that multidisciplinary care that offers support for drug dependency, social and psychological services in addition to medical care, have been successful at increasing access to HCV testing and treatment among PWID.”
Development of highly effective direct acting antivirals (DAAs) with efficacy greater than 95% following 8 to 12 weeks treatment have brought significant successes in the elimination of HCV. However, just because a disease is curable, that doesn’t mean that it is defeated if most-at-risk populations, such as PWID are marginalized.
By creating a continuous medical education platform that empowers local, regional and international healthcare experts to connect and exchange ideas, Gilead Sciences reaffirms its commitment to the Middle East and educational efforts for healthcare professionals in the field of Hepatology.
[1] Nelson P, Mathers B, Cowie B, et al. The epidemiology of viral hepatitis among people who inject drugs: results of global systematic reviews. Lancet 2011; 378: 571-83
[2] Mumtaz GR et al. Hepatitis C virus and HIV infections among people who inject drugs in the Middle East and North Africa: a neglected public health burden? Journal of the International AIDS Society 2015; 18: 20582