Hepatitis prevalence: Despite falling cost, many still cannot afford treatment

Islamabad among high risk districts as major public hospitals lack testing facilities

ISLAMABAD: Sakina Khatoon was diagnosed with hepatitis C some five years ago but she is still without treatment.

“The treatment is very expensive. I can’t afford it and don’t know about the procedures to get financial aid from the government,” she said.

Sakina, works as a janitor at various houses to help her daily-wager husband make ends meet. She says she does not have the time or the energy left to go to different offices to get financial aid because of the amount of work she has to do to make ends meet.

The 26-year-old mother of four cannot confirm how she contracted the virus, but she fears that she was infected at a public hospital during the birth of her third child.

“Doctors asked me to undergo a polymerase chain reaction (PCR) test — used to make multiple copies of a DNA sequence — to start treatment, but I can’t even afford that,” she says.

“I am taking medicine prescribed by a hakeem (traditional homeopath) and praying for a miracle.”

The PCR test assesses the prevalence of the virus in the body and helps determine the kind of treatment needed by the patient. It costs between Rs14,000 and Rs20,000 at private facilities.

Hepatitis prevalence is high in the federal capital — which is among the country’s high-risk districts — in part due to the absence of PCR test facilities at public sector hospitals.

Moreover, there is no hepatitis centre left at federal level to give free treatment to hepatitis patients after the national hepatitis programme was devolved to the provinces.



Although poor patients can get financial aid from Zakat funds and Pakistan Baitul Maal, it is a tiresome process.

“PCR test machines should be installed in public sector hospitals and patients should be facilitated through one window operations,” said Pakistan Institute of Medical Sciences gastroenterologist Dr Waseem Khawaja.

“The treatment system is not coherent and patients need to make several visits to get any financial aid, and many still don’t get anything,” he said, suggesting that patients should be facilitated for financial assistance and treatment at the same counter.

The treatment cost of hepatitis C runs from Rs300,000 to Rs600,000, depending on the stage and severity of a case.

Although with the registration of Sofosbuvir — a highly effective new hepatitis C drug — in Pakistan this year, treatment cost has fallen to Rs35,000 for a six months course. Even this amount is beyond the means of many, as hepatitis disproportionately affects the poorest classes.

“Pakistan and Egypt are the two countries in the region with the highest hepatitis burden and where advanced treatment is available at cheap price,” said World Health Organisation (WHO) representative Dr Michel Thieren said while referring to Sofosbuvir.

“This valuable and lifesaving treatment will benefit everyone in need when the drug becomes financially available to all,” he said.

Viral hepatitis – letter coded A, B, C, D, and E - affects millions of people worldwide, causing acute and chronic liver disease. Hepatitis A and E spread through contaminated food and water, while hepatitis B, C and D spread through blood and body fluids.

In Pakistan, hepatitis B and C are the major challenges. Pakistan has the second-highest hepatitis C disease burden in the world. According to a national hepatitis survey, in 2008 there were eight million cases of hepatitis C and four million of hepatitis B in Pakistan. Each year, around 250,000 new cases are reported and it is estimated that around 11 million Pakistanis currently have hepatitis C.

The WHO, however, puts the number at more than 13 million, as many people are unaware that they are infected.

Themed “Put hepatitis C medicines within everyone’s reach”, World Hepatitis Day was marked around the world on Thursday to create awareness about the disease and preventive measures.  But the day passed silently in the federal capital.

Published in The Express Tribune, July 29^th, 2016.