A viral infection can manifest in different ways–fever, fatigue, shortness of breath, or even a skin rash, prompting one to seek medical attention. Some viral infections, however, can remain asymptomatic during the initial stage, of which Hepatitis C, also known as the silent epidemic, is an example.

According to the World Health Organization (WHO), approximately 6 to 12 million people in India are chronically infected with Hepatitis C [1] whereas the global tally stands at 50 million [2]. Hepatitis C is a bloodborne virus characterized by inflammation of the liver, which can result in long-term health implications, including diabetes, liver cirrhosis [3], and hepatocellular carcinoma [4] or liver cancer.

Exposure to the virus is primarily linked to unsafe medical practices, blood transfusions, intravenous drug use, and unprotected sexual contact (with an infected individual) that leads to blood exposure. Hepatitis C is not spread through breast milk, food, water, or casual contact such as hugging, kissing, and sharing food or drinks with an infected person [5].

While a recent Hepatitis C infection may not present any visible signs, symptoms occur over time and can include:

  • Persistent fatigue
  • Loss of appetite
  • Fever
  • Discomfort or pain in the upper right side of the abdomen
  • Abdominal swelling
  • Jaundice or yellowing of the skin and eyes
  • Nausea and vomiting
  • Pale stools or dark urine

When it comes to diagnosis, timeliness and accuracy are instrumental. A blood test is typically the first step, but other diagnostic procedures are used to evaluate the extent of the infection and to provide targeted treatment. For instance, a healthcare provider may perform an antibody test, an ultrasound, magnetic resonance imaging (MRI) [6], CT scans, liver biopsy, or other liver function tests.

If we talk about management, there have been significant medical advancements in the past decade. While there is no vaccine to prevent Hepatitis C, direct-acting antivirals (DAAs) are now being actively used for patients and have seen an efficacy rate of over 95% [7], revolutionizing care and treatment. However, accessibility and affordability for these drugs remain a key concern, especially in remote and underserved regions. Additionally, lifestyle modifications, including quitting drinking and smoking and following a healthy diet, are also essential for effective management.

Supporting the National Viral Hepatitis Control Programme (NVHCP)

To combat Hepatitis and achieve countrywide elimination of Hepatitis C by 2030, the Government of India is driving the National Viral Hepatitis Control Programme (NVHCP). It encompasses various initiatives oriented towards enhancing community awareness, developing standard protocols for diagnosis and treatment, strengthening existing infrastructure facilities, and collaborating with healthcare institutions and non-governmental organizations to expand reach [8].

Another crucial component of this programme is the capacity-building of all cadres of healthcare professionals, especially given the high prevalence and complex nature of Hepatitis C. This is vital to support continuing medical education, keeping health providers updated with the latest advancements and best practices. Additionally, capacity-building can help ensure standard and uniform care across various healthcare settings and timely intervention while improving overall patient outcomes.

In 2019, the Directorate General of Health Services (DHS) Punjab collaborated with ECHO India to mentor doctors on Hepatitis C treatment and management. With the Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh as the hub, the initiative leveraged the ECHO Model of case-based learning for weekly sessions over a period of 18 months. [9]

The initiative was designed under the stewardship of Dr. Gagandeep Singh Grover, State Program Officer, DHS Punjab. In a brief interview, Dr. Grover discussed how the association with ECHO India improved the outcomes of common health diseases such as Hepatitis C in Punjab. “Until 2018, the PGIMER Chandigarh hospital treated around 1500 cases of hepatitis-C in Punjab each year. ECHO, a telementoring initiative, aspires to reach out to remote patients, and has resulted in an increase in HCV diagnosis from 1500 to 150,000 patients through this program. The treatment burden on PGIMER decreased substantially when district provider efficacy increased.”

Even today, DHS Punjab continues to use the ECHO Model to train and help primary care providers (PCPs) in Punjab in learning about new treatment options, side effects, and treatment adherence for Hepatitis and other disease areas. ECHO’s virtual learning platform also helped enhance cost-effectiveness, especially as travel expenses for trainers and trainees were reduced significantly. Similarly, didactic and case presentations and recommendations from peers and a multidisciplinary team of specialists fostered a community of practice for healthcare providers across Punjab.

“The case presentations have been beneficial to my team; when they find themselves in challenging situations, they can look forward to the ECHO sessions to discuss their cases with peers and experts from the field”, said Dr. Gagandeep Singh Grover.

ECHO India has also been supporting various initiatives for the Directorate General of Health Services (DHS) Haryana, National Health Mission (NHM) Meghalaya, and Pt. BD Sharma PGIMS Rohtak, empowering health workers to effectively manage and treat Hepatitis C cases.

While significant progress has been made under NVHCP and medical advancements shine a beacon of hope, Hepatitis C continues to be a public health challenge in India. The need for capacity-building of healthcare professionals cannot be overstated, and collaborative efforts and continuous education are essential in paving the way for a future sans Hepatitis C. By adopting a multifaceted approach, ECHO India remains committed to supporting the elimination of Hepatitis C by 2030 and strengthening health systems across the country.

To know more about our initiatives across various Sustainable Development Goals (SDGs), visit www.echoindia.in.

To collaborate with us, reach out at partnerships@echoindia.in.

Sources:

[1] https://www.who.int/india/health-topics/hepatitis

[2] https://www.who.int/data/gho/data/themes/chronic-viral-hepatitis#:~:text=An%20estimated%201.3%20million%20people,with%20viral%20hepatitis%20each%20day

[3] https://www.sciencedirect.com/topics/medicine-and-dentistry/liver-cirrhosis

[4] https://radiopaedia.org/articles/hepatocellular-carcinoma

[5] https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

[6] https://www.sciencedirect.com/topics/neuroscience/magnetic-resonance-imaging#:~:text=Magnetic%20resonance%20imaging%20(MRI)%20is%20a%20noninvasive%20imaging%20technique%20that,and%20excited%20by%20a%20radiofrequency

[7] https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00335-7/abstract

[8] https://nvhcp.mohfw.gov.in/about_us

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052426/