Trustees of Columbia University in the City of New York

Ending Hepatitis C in Rwanda Highly Ranked

Lead Organization

Trustees of Columbia University in the City of New York

New York, New York, United States

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Project Summary

Hepatitis C virus (HCV) is a silent and deadly virus. It causes relentless liver damage, leading to debilitating illness and death. With 71 million cases globally and half a million deaths annually, HCV is a serious public health threat. However, there is new hope. A new class of medicines can cure HCV. This offers an unprecedented opportunity for its elimination in a whole population. Rwanda is disproportionally affected by HCV, jeopardizing its population health aspirations. A significant political commitment by Rwanda underpins the partnership between ICAP at Columbia University and the Ministry of Health (MOH) to eliminate HCV. This novel project will include nationwide community mobilization; training of health and community workers; establishing laboratory infrastructure; providing treatment to all persons with HCV; and tracking progress towards elimination. The goal is for Rwanda to be the first to eliminate HCV, proving that it can be done and inspiring others to follow.

Problem Statement

The World Health Organization seeks to eliminate HCV as a major public health threat worldwide by 2030. Despite the transformative potential of new medications that can cure HCV, efforts to address this deadly disease have lagged. This is due to limited global political commitment, scant knowledge on the health impacts of HCV among populations, lack of coherent elimination plans and the high cost of treatment. Rwanda, a low-resource country of 12 million people, has a national HCV prevalence ranging from 2.5% to 5.7%, well above the global average of 1%. This is due to past traditional medical practices, unsafe injection practices, and exposure to contaminated blood during the genocide and through blood transfusions. Remarkably, the stage is set for Rwanda to make HCV elimination a reality. Most importantly, the Government of Rwanda has made a strong commitment to rid the country of HCV and it has worked diligently to get buy-in from its citizens for this effort. It has also endeavored to negotiate more reasonable treatment costs. This is the foundation on which a comprehensive elimination plan will be implemented, building on the established health communication initiatives and strengthened health system structures that exist in the country. The project partners will leverage their unique assets to this effort, with MOH leading the national mobilization and commitment, with ICAP bringing its vast experience and expertise in what it takes to scale up programs and evaluate them, and CHAI securing the necessary drugs and laboratory tests and ensuring efficient use of resources.

Solution Overview

A new class of drugs has turned HCV into a curable condition. Taking just one pill a day for 12 weeks achieves a cured status in more than 90% of individuals. But, while political commitment and a simple cure are essential, these elements are insufficient to achieve HCV elimination in Rwanda. This project seeks to put together all the components of a comprehensive effort to reach this goal across every region in the country. ICAP, the Rwanda MOH, and CHAI will work jointly and strategically on an intensive nationwide effort to mobilize communities, establish HCV community committees, train and mentor the health workforce, prepare health facilities, procure the treatment and the necessary laboratory tests, and put in place the required support and follow-up to ensure successful treatment, while at the same time launching an HCV prevention campaign in the country. ICAP with MOH will establish a robust evaluation plan to measure progress and outcomes based on pre-determined quantitative and qualitative milestones. This will allow for prompt harvesting of success stories, and the ability to build on progress and rapidly pivot away from interventions that do not work. It is expected that the project will avert 10,638 new infections and 35,000 premature deaths. It will also strengthen the health system in the country, enhancing its capacity to effectively address other current and emerging health priorities. If successful, Rwanda would be the first country in the world to eliminate HCV, a historic achievement that undoubtedly will inspire other countries to follow suit.

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