HCV elimination in Sindh: insights from Prof Muhammad Sadik Memon and Dr Zaigham Abbas
This article is part of a series on hepatitis C virus (HCV) elimination in Pakistan and other high-risk countries around the world. Other articles in this series cover the Pakistani provinces of Punjab and KPK. Scroll to the bottom of the article for the full list.
HBV and HCV are major public health threats in Pakistan, affecting almost 15 million people across the country. The province of Sindh has one of the world’s highest rates of HCV infection and bares the second highest disease burden of both HBV and HCV of all the provinces in Pakistan .
Situated in the south-eastern corner of the country, Sindh province faces many challenges in diagnosing and treating HCV-related conditions for its 48 million residents. Like in most other parts of the country, low health literacy among the general population leads to unhealthy behaviours, such as the re-use of needles for therapeutic injections and poor sterilisation of medical equipment. The province, which is the second largest by population after Punjab, also faces many of the same infrastructure, workforce and funding constraints as neighbouring territories. This is particularly true in Sindh’s rural areas, where nearly half of the province’s population resides.
To learn more about these challenges and opportunities to address them, Lab Insights spoke with two prominent figures in the fight against HCV in Sindh province: Prof Muhammad Sadik Memon, Consultant Physician and Gastroenterologist at the Asian Institute of Medical Sciences in Hyderabad; and Dr Zaigham Abbas, Head of Gastroenterology at Ziauddin University Hospital in Karachi.
Expanding access through policy
Alongside the national Prime Minister’s programme that is working towards the WHO goal of HCV elimination in Pakistan by 2030, Sindh province launched the Hepatitis Prevention and Control Programme, which aims for a hepatitis-free Sindh.
As part of these efforts, 48 sentinel sites have already been set up across the province. Each site has a team that includes a medical officer, nurse, data processor, laboratory technician and attendant. The sites offer a range of free resources, including HCV screening tests, HBV vaccinations, and treatments for both HCV and HBV. Sindh has centralised labs for PCR testing, and adequate logistical options for transporting samples from collection centres in rural areas; however, more technicians are required to carry out PCR testing.
Despite strong national and regional programmes for HCV elimination, experts agree that more outreach is needed in rural areas. “We need to test all of the community at the same time and then vaccinate them,” states Prof Memon. However, gaps still remain, especially in HCV screening efforts. “We are not really able to find the missing millions—people who are the source of infection,” says Dr Abbas.
Part of the problem is that health authorities have other priorities, such as fighting other infectious diseases like COVID-19, polio and malaria. “We need to keep pressuring the government so politicians become aware of the severity of the situation,” urges Dr Abbas. “We must not get disheartened if there is not a proper response initially.”
HCV screening and treatment protocols in Sindh
Prof Memon explains that once a patient tests positive for HCV, they are first encouraged to be vaccinated for HBV. Further PCR testing is then carried out to confirm the presence of HCV, and lateral flow dipstick (LFD) testing and ultrasound are applied to rule out liver cirrhosis. If a patient is found to have cirrhosis, they will be followed up by phone every six months and encouraged to go for ultrasound assessments and endoscopy as needed. Prof Memon also notes that nurses can be trained to help manage patients with HCV who are not suffering from cirrhosis, and this may ease some of the burden on physicians.
PCR testing in Pakistan can be costly, and many patients that undergo such testing need to do so privately. Treatment with direct-acting antivirals (DAAs), however, is provided free-of-charge by the government. In addition, Prof Memon’s hospital is also able to provide three months of free treatment with DAAs. After treating patients, he explains that they will be followed up with further PCR and LFD tests after six months, or referred to their local physician to continue treatment and follow-up.
To bolster HCV screening and treatment services in Sindh, Prof Memon notes that raising awareness among both healthcare workers and the general population is critical. In parallel, it is also important to put pressure on the government and highlight the severity of the situation. Government backing will be key to bolstering healthcare capabilities, conducting mass screening, and providing treatment and HBV vaccination services.