HCV elimination in Northern Pakistan: Prof Aamir Khan on treating patients in KPK province and the Afghan borderlands
This article is part of a series by Lab Insights on hepatitis C (HCV) elimination in Pakistan and other high-risk countries around the world.
Khyber Pakhtunkhwa province, or KPK, is situated in the north-western region of Pakistan, on the border with Afghanistan. As elsewhere in Pakistan—a country with one of the world’s highest rates of HCV infection—its healthcare systems face mounting pressure from HCV-related conditions.
KPK is Pakistan’s third largest province in terms of both population and economy, despite being geographically the smallest. Its economy has grown rapidly in recent years, and in 2020, it launched a free healthcare system. Yet many patients in the region still struggle to access basic healthcare services, particularly in the rural areas of this mountainous region.
Prof Aamir Khan, Head of the Gastroenterology and Hepatology division at Lady Reading Hospital Peshawar, is one of the region’s top experts in HCV elimination. In an interview with Lab Insights, he spoke about his efforts to improve HCV care in KPK, including for patients from neighbouring provinces in Afghanistan who cross the border to seek treatment at his hospital.
HCV elimination programmes in KPK
While KPK has its unique sociocultural nuances, many of the risk factors for HCV infection in the region are similar to other parts of the country. These include traditional medicine practices that rely on intravenous injections, as well as the widespread re-use of syringes. “Health-related policies and government-sponsored treatment programmes may also be poorly implemented so the problem continues to worsen,” observed Prof Khan, inspiring him to start the KPK Hepatitis Control Program, which provides free HCV treatment for to patients.
Prof Khan is also involved in the Prime Minister’s Programme to eliminate hepatitis B and C. The programme aims for eradication of the disease by 2030 with the objective of screening all of the adult population—around 140 million people—and ensuring all patients are accurately diagnosed and appropriately treated. Prof Khan also believes there is a critical need for a central decision body to set guidelines and recommendations that will simplify the treatment pathway and facilitate the mass screening and treatment efforts.
In addition to his regular duties in clinical care and medical education, Prof Khan’s future plans involve the creation of a national hepatitis C registry to support accurate identification of the HCV-infected population locally and nationally, improve administrative capacity, streamline treatment provision and drive research efforts.
Providing care in the Afghanistan-Pakistan border zones
Prof Khan believes that HCV prevention and education in the community will help to pave the way to elimination and reduce the stigma surrounding the disease. Individuals who are diagnosed with HCV in Pakistan are often shunned by the community and even within their own households, where they may be forced to live in separate rooms away from their family members. This lack of awareness and stigmatisation often discourages people from getting tested.
In a BBC radio interview intended to raise awareness of HCV, Prof Khan discussed the disease in detail and explained how it’s transmitted and how people can protect themselves. The broadcast resulted in patients in neighbouring Afghanistan travelling many miles to his hospital for treatment. “We want to provide healthcare free of charge to whoever needs it,” he says. “I cannot deny patients in need from Afghanistan.”
Prior to the outbreak of COVID-19, Prof Khan recalls one patient with liver cirrhosis who travelled for four days from a mountain village in Afghanistan to see him. The patient was carried in a child’s bed and then transferred to a car to complete the journey to Pakistan. While treating the patient, Prof Khan learned that the village had only one glass syringe for all its inhabitants, suggesting that many others were likely to be infected there.
With the tightening of border controls due to COVID-19, Prof Khan has seen a major reduction in patients from across the border in Afghanistan. “I suspect that we are losing a lot of patients who are not able to access us,” he worries. He is concerned that with no medical assistance, patients will likely be exposed to poor and unsanitary medical practices.
“The healthcare provision situation in Afghanistan is already critical,” he explains. “If we are not reaching patients, they may go on to develop cirrhosis and hepatocellular carcinoma.”
Prof Khan believes that continued support is needed from the government, NGOs and private healthcare firms to improve disease awareness and treatment in the community. Initiatives should include training doctors and hospital staff, counselling patients on HCV, launching auto-disable syringes that can be used only once, providing disposable dental and surgical instruments, and the implementing strict penalties for illegal practices by unregistered dentists and doctors.