The World Health Organization recently released their global progress report on access to diagnostics and treatment for hepatitis C. For the first time, the third biennial report entitled “Accelerating Access to Hepatitis C Diagnostics and Treatment” outlines information on hepatitis c diagnostics and highlights progress made by national strategies to scale up access to treatment, with a special lens on low and middle-income countries. 

Access to affordable Hep C treatment is on the rise. Between 2016 and 2020, the WHO has approved six generic manufacturers to produce at least one DAA through voluntary licensing from originator companies. Increased generic competition curtails cost of DAAs, with some LMICs now able to secure a full three-month course of generic sofosbuvir/daclatasvir for as low as $60USD.

Based on a 2019 WHO survey, twelve high burdened countries – Egypt, Pakistan, China, India, Brazil, Georgia, Mongolia, Russian Federation, Rwanda, Morocco, Ukraine, and Malaysia – are on the forefront of making headway to HCV elimination. Criteria for country selection hinged on both the high burden of Hepatitis C within their borders and success in the progress towards achieving universal access to HCV diagnostics and treatment. By the end of 2018, the cumulative amount of people receiving HCV treatment in these countries stood at 2.6 million – a 20-fold increase since 2015.

Progress towards HCV elimination in these twelve countries highlight similarities in the use of the following six public health strategies, which the WHO report also regards as the key enablers to accelerating access to HCV diagnostics and treatments.

1. Strong political commitment to a public health approach through universal health coverage
2. Scale up of access to affordable testing such as rapid diagnostics tests
3. Prioritization of product registration for DAAs
4. Price reduction of treatment through increased generic competition
5.  Partnership with civil society organizations to advocate and service key populations
6. Leveraging existing international procurement mechanisms to finance HCV response

Novel reporting on HCV diagnostics reveals barriers to affordable testing persist. Although in 2020 WHO-prequalified rapid diagnostics tests were offered at a price between $1USD-$8USD per test, many countries are not able to obtain such tests at these prices. Despite reagents used for HCV RNA detection falling between $14USD-$30USD, the analyzers themselves range from $10,000USD to an upwards to $100,000. Manufacturers have made their analyzers more accessible through reagent rental and leasing agreements, but with screening programs in many LMICs lacking the necessary infrastructure and testing capacity, the opportunity is often underutilized.

With disruptions to essential hepatitis services caused by the COVID-19 pandemic, it is imperative for health systems to continue strengthening their service delivery models to prevent further disparities in hepatitis testing and treatment and remain on track to achieve the 2030 WHO elimination goals.