Skip to main content
Top
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Debate

The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy

Authors: Fabio Mesquita, Melina Erica Santos, Adele Benzaken, Renato Girade Corrêa, Elisa Cattapan, Leandro Soares Sereno, Marcelo Contardo Moscoso Naveira

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications.
In response to the global outcry of hepatitis epidemic and the need to improve the nation’s public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means.

Discussion

This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016.

Summary

The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.
Literature
4.
go back to reference Naveira M, Barbosa J, Sereno L, Domanico A, Mesquita F, de Souza LA. 12 years of universal access to hepatitis C treatment: Brazil’s comprehensive response. J Int Assoc Provid AIDS Care. 2014;13(6):560–7.CrossRefPubMed Naveira M, Barbosa J, Sereno L, Domanico A, Mesquita F, de Souza LA. 12 years of universal access to hepatitis C treatment: Brazil’s comprehensive response. J Int Assoc Provid AIDS Care. 2014;13(6):560–7.CrossRefPubMed
5.
go back to reference Dieterich D, Bacon B, Flamm S, Kowdley K, Milligan S, Tsai N, Younossi Z, Lawitz E. Evaluation of sofosbuvir and simeprevir-based regimens in the TRIO network–Academic and community treatment of a real-world, heterogeneous population [Internet]. 2014. Available from: http://www.natap.org/2014/AASLD/AASLD_09.htm. Accessed 9 June 2016. Dieterich D, Bacon B, Flamm S, Kowdley K, Milligan S, Tsai N, Younossi Z, Lawitz E. Evaluation of sofosbuvir and simeprevir-based regimens in the TRIO network–Academic and community treatment of a real-world, heterogeneous population [Internet]. 2014. Available from: http://​www.​natap.​org/​2014/​AASLD/​AASLD_​09.​htm. Accessed 9 June 2016.
6.
go back to reference Afdhal N, Everson GT, Calleja JL, McCaughan G, Symonds WT, Denning JM, et al. Sofosbuvir and ribavirin for the treatment of chronic HCV with cirrhosis and portal hypertension with and without decompensation: early virologic response and safety. J Hepatol [Internet]. Elsevier B.V. and European Association for the Study of the Liver; 2014;60(Supplement 1):S28. Available from: http://dx.doi.org/10.1016/S0168-8278(14)60070-2. Afdhal N, Everson GT, Calleja JL, McCaughan G, Symonds WT, Denning JM, et al. Sofosbuvir and ribavirin for the treatment of chronic HCV with cirrhosis and portal hypertension with and without decompensation: early virologic response and safety. J Hepatol [Internet]. Elsevier B.V. and European Association for the Study of the Liver; 2014;60(Supplement 1):S28. Available from: http://​dx.​doi.​org/​10.​1016/​S0168-8278(14)60070-2.
8.
go back to reference Hill A, Khoo S, Fortunak J, Simmons B, Ford N. Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries. Clin Infect Dis. 2014;58(7):928–36.CrossRefPubMedPubMedCentral Hill A, Khoo S, Fortunak J, Simmons B, Ford N. Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries. Clin Infect Dis. 2014;58(7):928–36.CrossRefPubMedPubMedCentral
9.
go back to reference Amaku M, Burattini MN, Coutinho FAB, Lopez LF, Mesquita F, Naveira MCM, et al. Estimating the Size of the HCV Infection Prevalence: A Modeling Approach Using the Incidence of Cases Reported to an Official Notification System. Bull Math Biol [Internet]. Springer US; 2016; Available from: http://link.springer.com/10.1007/s11538-016-0170-4. Amaku M, Burattini MN, Coutinho FAB, Lopez LF, Mesquita F, Naveira MCM, et al. Estimating the Size of the HCV Infection Prevalence: A Modeling Approach Using the Incidence of Cases Reported to an Official Notification System. Bull Math Biol [Internet]. Springer US; 2016; Available from: http://​link.​springer.​com/​10.​1007/​s11538-016-0170-4.
14.
go back to reference Brasil. Ministério da Saúde. Portaria no 4, de 6 de fevereiro de 2014. Diário Of da União; 2014. p. 55. Brasil. Ministério da Saúde. Portaria no 4, de 6 de fevereiro de 2014. Diário Of da União; 2014. p. 55.
15.
go back to reference Chung RT, Davis GL, Jensen DM, Masur H, Saag MS, Thomas DL, et al. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology. 2015;62(3):932–54.CrossRef Chung RT, Davis GL, Jensen DM, Masur H, Saag MS, Thomas DL, et al. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology. 2015;62(3):932–54.CrossRef
16.
go back to reference Pawlotsky J-M, Al E. EASL Recommendations on Treatment of Hepatitis C 2014. Hepatology. 2015;63(1):199–236.CrossRef Pawlotsky J-M, Al E. EASL Recommendations on Treatment of Hepatitis C 2014. Hepatology. 2015;63(1):199–236.CrossRef
17.
go back to reference World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis c infection. Guidelines. 2014;(April):124, ISBN 978 92 4 154875 5. World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis c infection. Guidelines. 2014;(April):124, ISBN 978 92 4 154875 5.
Metadata
Title
The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy
Authors
Fabio Mesquita
Melina Erica Santos
Adele Benzaken
Renato Girade Corrêa
Elisa Cattapan
Leandro Soares Sereno
Marcelo Contardo Moscoso Naveira
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3784-4

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue