Sindh winds up its failing hepatitis control programme

The Sindh government has announced a wind-down of its hepatitis control programme and said it would now provide funds to Aga Khan University Hospital (AKUH) for the screening, diagnosis and treatment of hepatitis C patients, initially in two districts and later in the entire province.

“Today, we have signed an agreement with Aga Khan University Hospital, under which we would provide Rs219 million to the network for the screening, diagnosis and treatment of thousands of hepatitis C patients, initially in the Larkana and Nawabshah districts of Sindh,” Health Secretary Dr Fazlullah Pechuho told The News on Saturday after signing the agreement with AKUH Chief Executive Officer Johannes (Hans) Theodorus Kedzierski at the AKUH.

Dr Pechuho announced that they have decided to wind up the Sindh Hepatitis Control Programme, saying the funds which used to be allocated for the programme in the Annual Development Programme would now be given to the AKUH for the eradication of the disease from the province.

According to AKUH officials, Pakistan is the second highest bearer of hepatitis C patients after China in the world and, as per some conservative estimates, 20-22 million people in Pakistan are infected with hepatitis B and C.

Dubbed as “silent killer”, hepatitis C is a viral infection of the liver and it spreads through infected blood and exchange of some other body secretions, but most of the people infected with the virus remain oblivious of their disease until it irreversibly damages their liver and ultimately causes death.

Dr Pechuho said that initially the AKUH would screen, diagnose and treat patients in the Larkana and Nawabshah districts and in the later stages more funds would be provided to the health network to extend this service to other districts of the province, including Mithi, Shikarpur, Khairpur and ultimately Karachi.

Giving reasons for selecting the AKUH for taking over the tasks of the programme, he said the programme had failed to yield positive results and there were issues with its management, due to which it was decided that the government should enter into a partnership with Aga Khan Hospital for the treatment of hepatitis C patients.

“Sindh Hepatitis Control Programme was not yielding positive results despite huge funding as people were getting medicines for a month and then they would stop getting the treatment. This was also resulting in resistance and other complications for the patients and causing a bad name to the government also.”

Liver transplant funds

The health secretary said that if required and suggested by AKUH experts, any patient in Sindh requiring liver transplant would be provided funds or treatment facility anywhere in Pakistan so that his or her life could be saved.

“If AKUH experts suggest that liver transplant is the only option left for the patient to save his or her life, we would definitely provide funds or arrange treatment of that patient,” he said, adding that the government was already financing bone marrow transplants of those patients at the National Institute of Blood Diseases (NIBD) who could not afford the costly treatment.

Speaking of the liver transplant options in Sindh, he said that at the moment three institutes — Gambat Institute of Medical Sciences (GIMS), Dow University of Health Sciences (DUHS) and Sindh Institute of Urology and Transplantation (SIUT) — were trying to perform liver transplants, but these facilities were still performing the complicated surgery on an experimental basis.

“Gambat Institute of Medical Sciences is an excellent facility, but it is facing some financial issues at the moment. We are working on resolving these issues so that it could be able to perform liver transplants on a regular basis.”

AKUH Chief Executive Officer Johannes (Hans) Theodorus Kedzierski said they were working with the government as well as with NGOs in Sindh and other provinces to help in their capacity building.

He added that this partnership with the Sindh government for the elimination of hepatitis C would benefit not only the people of this province but also those living in other provinces of the country as data collected through this programme would be used for research also.

He maintained that the AKUH had the best team of liver disease physicians and surgeons at the moment and, with their help, they would try to manage hepatitis C and work on its prevention, which was the best available strategy to eliminate the viral disease from the country.

Dr Faisal Wasim, assistant professor, Section of Gastroenterology, Department of Medicine at the Aga Khan University, emphasised that while those treated and cured from hepatitis C could go back to living a regular life, patient cooperation was essential for successful treatment.

“Hepatitis C is curable if diagnosed in the early stage and if treated properly. While the duration of the treatment we offer is three months, patients are required to be proactive in taking their medication, adopting safe behaviour and getting tested regularly and consulting routinely with the doctor as required.”

Eliminating hepatitis C is a global health and development priority under the United Nations Sustainable Development Goals. The hepatitis C virus affects 70-150 million people, globally. People living with the disease are at risk of developing liver complications, including cirrhosis and liver cancer, resulting in an estimated 700,000 deaths annually.

Studies show that hepatitis C can present itself in other ways, including cardiovascular, renal, and metabolic and central nervous system diseases.