Friday, September 13, 2013

Indonesia's Hepatitis C time bomb is ticking

In 2007, Indonesia's Health Ministry estimated that more than 7 million Indonesians -- more than 2 percent of the country's population -- had hepatitis C. Approximately half of hepatitis C-infected people could progress to chronic liver disease, and one-third could develop liver fibrosis or cancer. HIV-infected people who injected drugs were particularly vulnerable, since HIV tripled the risk for liver disease and death.

Injection drug users often could not access harm reduction strategies to prevent hepatitis C and recommended hepatitis C treatment. A research with drug-using communities in eight Indonesian cities revealed that nearly two-thirds of drug users received harm reduction services, but half of those accessing harm reduction services never received hepatitis C testing and treatment information.

To determine proper hepatitis C treatment, patients needed diagnostic tests that cost up to $580, three times the average Indonesian's monthly salary. Each of the six hepatitis C genotypes responded differently to treatment. Many local and international advocates recently demanded that multinational pharma companies cut prices to increase access to hepatitis C treatment.

The Indonesian government provided some public support for hepatitis C treatment through insurance programs for government employees, employees of some businesses, and low-income individuals. However, most Indonesians either did not know about available programs or did not qualify for these programs.

Indonesian government recently announced that National Health Insurance would cover hepatitis C treatment beginning in 2014. The Health Ministry established a national program focused on hepatitis C in 2011 and would begin to implement a national plan sometime between 2015 and 2019.

HCV is spread (transmitted) most efficiently through exposure to infected blood. The most common route of transmission is needles shared among users of illicit drugs. Accidental needle-sticks in health care workers also have transmitted the virus. Some people acquire the HCV infection from transfusions of blood or blood products. HCV infection also can be passed from mother to unborn child. A small number of cases are transmitted through sexual intercourse. The risk of transmission of HCV from an infected individual to a non-infected spouse or sexual partner without the use of condoms over a lifetime has been estimated to be between 1% and 4%. Finally, there have been some outbreaks of HCV when instruments exposed to infected blood have been re-used without appropriate cleaning between patients.

Transmission of HCV can be prevented in several ways.

Prevention programs can be aimed at avoiding needle sharing among drug addicts. Needle exchange programs and educational interventions have reduced transmission of HCV infection. However, the population of drug addicts is a difficult population to reach, and rates of HCV remain high among addicts.
Among healthcare workers, safe needle-usage techniques have been developed to reduce accidental needle-sticks. Newer syringes have self-capping needle systems that avoid the need to manually replace a cap after drawing blood and reduce the risk of needle-sticks. There is no clear way to prevent transmission of the HCV from mother to child. Persons with multiple sexual partners should use barrier precautions such as condoms to limit the risk of HCV as well as other sexually-transmitted diseases. Screening tests for blood products can almost eliminated the risk of transmission of HCV infection through transfusion. People with HCV infection should not share razors or toothbrushes with others. It is critical that physicians and clinics follow manufacturer's directions for sterilizing/cleaning instruments and that disposable instruments be discarded properly.

Through both prevention and other education campaign Indonesia can help reduce the impact of hepatitis C on its population.


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