By / 9 months ago / News Update / 69 Comments

The “Delhi Model” is a comprehensive guide highlighting the best practices adopted to address hepatitis C elimination via the Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) project in New Delhi

The conference brought together around 30 high level stakeholders to discuss learnings and the way forward in addressing hepatitis C virus (HCV) in India.

The Foundation for Innovative New Diagnostics (FIND) and the Institute for Liver and Biliary Sciences (ILBS) organized a daylong conference “Marching together to achieve Hepatitis C elimination – targets and action” today as a run-up to World Hepatitis Day 2019.

With over 70 million people infected globally, HCV is one of the world’s most common infectious diseases. It is estimated that 4 out of 5 people infected with HCV don’t know it. In order to address this significant disease burden, diagnosis of HCV followed by treatment with direct acting antivirals (DAA) is critical. Through the HEAD-Start project funded by Unitaid, FIND is focusing on enhancing the availability and accessibility of HCV testing and this is being executed in a phased manner across five hospitals identified by the DGHS:  Pt. Madan Mohan Malviya Hospital, Maharshi Valmiki Hospital, Sanjay Gandhi Memorial Hospital, Deen Dayal Upadhyay Hospital, and Guru Teg Bahadur Hospital. In New Delhi, the HEAD-Start project is implemented by FIND in close collaboration with ILBS. The project contributes to the development of a well-functioning network providing decentralized diagnosis for HCV, with effective linkage to treatment centres in Delhi.

The conference saw the launch of the “Delhi Model” – a result of the HEAD-Start project, which highlights that decentralized screening and treatment management at the primary health care level is the way forward for tackling HCV in New Delhi. The “Delhi Model” underpins the work undertaken by FIND and ILBS under the guidance of the Directorate of Health Services (DHS), Department of Health and Family Welfare, Government of NCT of Delhi. The booklet and a poster on HCV awareness was released by Dr Vikas Sheel, Joint Secretary, Ministry of Heath and Family Welfare along with other dignitaries on the dais.

Dr S K Sarin, Director, Institute of liver and Biliary Sciences (ILBS) said, “The implementation  of the NVHCP programme in Delhi has been possible, thanks to the support of FIND and the Government of NCT Delhi.  ILBS has a great team which combines medical and operational capabilities. I would like to reiterate that we need to use elimination as a target and not just control. ILBS has taken a few steps – we are a WHO Centre for NVHCP – but we need to do more and reach out to unreached areas. So far, we have trained 4500 health workers and are running programmes for doctors on liver therapy areas through live cases and demos. ILBS would also like to offer our services through the UNAIDS to the African countries and Nepal. The Delhi Government has been a significant ally in all our initiatives  – our steps are just a small drop as of now, so it is essential to march together as the joruney really starts now.”   

Acknowledging the combined efforts of organisations like ILBS  and FIND, Dr Vikas Sheel, Joint Secretary, Ministry of Heath and Family Welfare said, “While access to basic treatment services is available,  we intend to take this initiative further down to sub-district level, starting with all district hospitals, then block and PHC levels. We are going to start our national toll free helpline for both TB and Hepatitis from 28th July 2019 to enable people to know more about the diseases and access treatment services. We are aiming to establish a patient registry service maintaining patient confidentiality through our website with the support of all key stakeholders. My emphasis is that all these joint efforts should reflect on the NVHCP portal – we need to do more on surveillance to control new infections and provide treatment to existing patients – all of us need to work together in this endeavor. Some of the key challenges before us are tackling stigma, providing varied solutions to empower people with information and treatment access. Injection safety is another key issue especially w.r.t to informal service providers – we therefore need practical solutions – convergence among various government progammes is also essential. Lastly, there needs to be a mechanism so that stakeholders come together more often share ideas, best practice models along with greater engagement to tap the capacities of the private sector.”

Dr. Sanjay Sarin, Head of FIND India said “Dr. Sanjay Sarin, Head of FIND India said “over the last few years, there has been a significant transformation in Hepatitis C treatment with the availability of all oral, potent and well tolerated DAAs which has made it possible to achieve treatment cure rates of >90%. Access to accurate, rapid and inexpensive HCV diagnostics, however still remains a challenge Through the Delhi Model under Project Head-Start, we are providing access to HCV screening, diagnosis and treatment through an innovative decentralised model to the general population.”

The different sessions of the conference focused on the interventions of the National Viral Hepatitis Control Programme (NVHCP), defining targets for public health initiatives and laboratory diagnosis of HCV. A special session was devoted to innovations in viral hepatis testing and linkages to care.

Dr Sujeet Kumar Singh, Director, National Centre for Disease Control (NCDC) said,NCDC has been spearheading the surveillance of viral hepatitis in India since two decades. In recent years, a positive change has taken place due to the sincere efforts of FIND, which has been instrumental in enabling the launch of the National Viral Hepatitis Control Programme in India. The silent epidemic of Hepatitis remains unrecognized  with most people still unaware about this disease. The key is early diagnosis, screening and bringing infected persons for treatment. NCDC has taken several steps such as laboratory strengthening and identifying critical gaps. Currently, we have the lab capacity to assist diagnosis of Hepatitis C and B and are working to link the community directly to treatment centres. We are collaborating with NACO,  international and national agencies in this area and the states Punjab Manipur and Delhi can serve as models so that other states can adopt them. These efforts through raising awareness through right interventions will lead to reduction in the disease burden”. 

The event witnessed the presence of high level stakeholders namely Shri Vikas Sheel, Joint Secretary, MoHFW, Government of India, Dr Sujeet Kumar Singh, Director, National Centre for Disease Control, Dr S. Eswara Reddy, DCG(I), Dr S.K. Sarin, Director, ILBS, Dr Ashok Kumar, Director General, DHS, Government of NCT of Delhi, Dr Aparna Shah, Health Lab Services, Dr Bilali Camara, Country Director, UNAIDS, Dr. Rajendra Prasad Pant, Director, SAARC Centre__________, Nepal, Dr Sandhya Kabra, NCDC  among others. The key speakers spoke about defining targets for public health initiatives and laboratory diagnostics, country scenario and update on the NVHCP, learnings from global viral hepatitis control programmes, quality assurance, innovations in lab testing, point of care testing, lab networks under the national programme and innovative service delivery models. Issues such as availability of drugs at state level and challenges in implementation of district level were also discussed.

The Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) project is supported by Unitaid. It builds on earlier work supported by the government of the Netherlands, and UK aid from the UK government.

Neeraj Vats

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