The roadmap for eliminating Hepatitis C in Turkey has been announced

All barriers to accessing treatments must be removed to save many lives Results from the "Turkey Hepatitis C Elimination Roadmap Report," prepared under the leadership of Barcelona University's Global Health Institute, Turkish Liver Research Association (TKAD) and Society for Combating Viral Hepatitis (VHSD), with support from Gilead Sciences and contributions from specialist physicians representing all regions of Turkey, have been shared with the public. The report noted that while curative treatments for the disease are available worldwide and in Turkey, "Having treatments that eradicate the disease is not sufficient on its own; removing all bureaucratic and physical barriers to accessing these treatments will produce very important positive results from a Public Health perspective."

In this context, it was emphasized that by 2030, approximately 6,320 liver-related deaths, 4,400 liver cancer cases and 4,060 cases of decompensated cirrhosis could be prevented, thereby saving approximately 15,000 lives.

The "Turkey Hepatitis C Elimination Roadmap Report," prepared under the leadership of Barcelona University's Global Health Institute, Turkish Liver Research Association (TKAD) and Society for Combating Viral Hepatitis (VHSD), with support from Gilead Sciences and contributions from specialist physicians representing all regions of Turkey, was unveiled to the public on 27 July at a press conference held in Istanbul. The report noted that the World Health Organization (WHO) has formulated plans and set targets for the complete elimination of Hepatitis C by 2030, stating: "These can be briefly summarized as a 90 per cent reduction in new Hepatitis infections, diagnosis of 90 per cent of Hepatitis C patients and treatment of at least 80 per cent of these patients. Each country is expected to chart its own course and contribute to WHO targets." The report, which notes that there are very significant treatments for this disease worldwide and in Turkey, emphasized that "merely having treatment is not sufficient on its own; removing all bureaucratic and physical barriers to accessing these treatments will produce very important positive results from a Public Health perspective." At the meeting held as part of World Hepatitis Day, Prof. Dr. Jeffrey Lazarus from Barcelona University's Global Health Institute gave a special keynote address, followed by a panel discussion. The panel featured TKAD Board Chairman Prof. Dr. Ramazan İdilman, VHSD Board Chairman Prof. Dr. Fehmi Tabak, VHSD Board Vice-Chairman Prof. Dr. Rahmet Güner and Asia-Pacific Liver Research Association Board Member Prof. Dr. Necati Örmeci as speakers. Prof. Dr. Jeffrey V. Lazarus noted that this report is Turkey's roadmap and stated that "through necessary legal regulations, Turkey can quickly reach WHO targets and become an exemplary country." Prof. Dr. Lazarus explained, with examples, how the idea of HCV elimination emerged globally during the workshops conducted during the report's preparation, the targets proposed by WHO for HCV elimination, the micro-elimination approach and its benefits, and best practices carried out to date in other countries regarding HCV elimination. He summarized the fundamental steps that need to be taken in Turkey as follows: "Implementation of a national plan by the state, particularly screening in high-risk groups and removal of all barriers to access to all treatments"

UNCONTROLLED COMMUNICABLE DISEASES IN THE COMMUNITY CONTINUE TO SPREAD

Speaking at the meeting where the report was unveiled, Society for Combating Viral Hepatitis Chairman Prof. Dr. Fehmi Tabak said: "We have very important treatments, but merely having treatment is not sufficient. Removing all bureaucratic and physical barriers to accessing these treatments will produce very important positive results from a Public Health perspective. Moreover, what I consider important—widening diagnosis and screening, equal access to medicines—will enable Turkey to reach WHO targets. Noting that communicable diseases will continue to spread as long as they are not controlled within the community, Prof. Dr. Fehmi Tabak continued: "We focused precisely on this issue and tried to assess what needs to be done in the report launched today. Based on analyses conducted with Dr. Homie Razavi from the USA and our colleague Prof. Dr. Lazarus, who is with us today, as a result of regulations to be made in Turkey in line with WHO targets, by 2030 approximately 4,400 liver cancer cases, 6,320 liver-related deaths and 4,060 cases of decompensated cirrhosis could be prevented. Preventing these cases is very valuable both for community health and for efficient use of resources, which is why we greatly emphasize reaching WHO targets."

IF RECOMMENDATIONS IN THE REPORT ARE FOLLOWED, HEPATITIS C ELIMINATION IS POSSIBLE

Turkish Liver Research Association Chairman Prof. Dr. Ramazan İdilman spoke about the preparation and development process of the report as follows: "Since viral hepatitis is an important health problem for our country, there was a need for a national program to combat it. Under the leadership of the Ministry of Health's Public Health Directorate, a National Viral Hepatitis Prevention and Control Program was prepared in collaboration with TKAD and VHSD. Its publication and implementation in the field are awaited. Both associations and Ministry of Health officials will monitor the healthy implementation of this program in the field. In addition, working together with Gilead Sciences, we have conducted "Hepatitis C Elimination" Workshops since the beginning of 2017. To date, four broadly attended meetings have been held, and a report was created by gathering proposals and contributions from thought leaders experienced in this field in Turkey. We believe that with the recommendations in the report, significant progress can be made in Turkey regarding Hepatitis C elimination."

MANY PHYSICIANS DO NOT KNOW THAT HEPATITIS C CAN NOW BE CLEARED FROM THE BLOOD

Asia-Pacific Liver Research Association Board Member Prof. Dr. Necati Örmeci drew attention to the fact that awareness about Hepatitis C treatment is very low not only at the public level but also among physicians and in public institutions. Prof. Dr. Necati Örmeci stated: "For example, many physicians do not know that Hepatitis C can now be completely cleared from the blood. It is particularly important that physicians who follow this subject, such as General Practitioners, Internal Medicine Specialists, Nurses, Surgeons, Anesthesiologists, Psychiatrists, Prison Physicians and Nephrologists, educate these physician groups and increase their awareness. Since blood-borne transmission is very common, increasing awareness among these physician groups in particular should be a primary target."

LIVER BIOPSY SHOULD NOT BE REQUIRED FOR TREATMENT

Society for Combating Viral Hepatitis Vice-Chairman Prof. Dr. Rahmet Güner stated: "Screening programs can be initiated particularly among those estimated to have high Hepatitis C rates—those born in 1970 and earlier, those with liver disease, intravenous drug users, prisoners, patients with a history of transplantation, those undergoing dialysis treatment, and individuals infected with HIV or Hepatitis B. HCV evaluation during pregnancy can be included in routine pregnancy follow-up programs. Access to Hepatitis C treatments in our country is available at 58 hospitals in 39 provinces. For this reason, it is important that treatment access be available in every province of our country." Noting that liver biopsy, currently a requirement for providing treatment, should be eliminated, Prof. Dr. Rahmet Güner continued: "In this way, faster and easier access to medication can be provided. Physicians should be able to select the direct-acting antiviral agent that best matches the most appropriate Hepatitis C treatment for their patients." "We made efforts to ensure that the report, prepared to suit the conditions of our country, is as simple and implementable as possible. Our hope is that this report will be used as a roadmap for eliminating Hepatitis C from our country."

MANY LIVES CAN BE SAVED IN OUR COUNTRY

Gilead Sciences General Manager Şebnem Girgin said at the meeting: "Gilead Sciences has succeeded in becoming a key strategic partner of countries through its work within the framework of elimination plans worldwide. We are proud to have contributed to the emergence of today's report both by supporting the scientific platform established and by sharing our experiences from other countries. If the recommendations in the report are implemented, approximately 15,000 lives can be saved by 2030, and Hepatitis C disease can be eliminated and completely removed from our country's health agenda." Şebnem Girgin continued: "In this context, I would like to declare here that as Gilead Sciences, we have completed all our investment preparations regarding the domestic production of our Hepatitis products in a way that will serve our state's strategies to increase investments in the production of innovative medicines in our country, and we are ready for action."

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