Workshop On Viral Hepatitis C: An Emerging Public Health & Social Problem
- Part 2 -

Aheibam Koireng *

Workshop On Viral Hepatitis C at Department of Anthropology, Manipur University on 28th December 2015

ONE DAY WORKSHOP ON VIRAL HEPATITIS C: AN EMERGING PUBLIC HEALTH & SOCIAL PROBLEM
Orgd. by Centre for Manipur Studies (CMS), Manipur University (MU) & Community Network for Empowerment (CoNE)
Date: 28th December 2015, Venue: Conference Hall, Department of Anthropology, Manipur University

Keynote Speaker:

1. Dr. N. Vijaylakshmi Brara, Reader, Centre for Manipur Studies, Manipur University:

Viral Hepatitis C (HCV), also known to be the "silent killer" has become one of the biggest public health threat with an estimated 185 million people infected globally, and an estimated 350,000 deaths each year due to hepatitis C–related liver disease(Source: WHO – Guidelines for the screening, care and treatment of persons with Hepatitis C infection/2014). HCV infection has also become a major public health concern in the state of Manipur, particularly among people who inject drugs. However, the extent of the disease burden is difficult to gauge due to lack of systematic surveillance system in place, both in the state and nationwide to provide the necessary scientific data.

A recent HCV serological survey was conducted by CoNE in partnership with Directorate of Health Services, Government of Manipur across the nine districts. A total of 1011 sample size were able to reach out, out of which 465 were tested HCV antibody positive. Of this 465 who tested HCV antibody positive, 83% were found to be from the community of People Who Inject Drugs (PWID).

Few other independent studies carried out by researchers and medical professionalsalso have indicated an extensively alarming prevalence of HCV in the state, particularly amongst PWID with the estimated prevalence rates of 92% in Imphal and 98% in Churachandpur. Despite such an alarming situation in the state, none including the decision and policy makers seems to be concern and continues to remain silent.

The problem is not restricted only among the community of PWID but it is estimated that a large portion of the general population must also be carrying the virus due to other factors such as: surgical and dental procedures, blood transfusion, tattooing, etc. However, due to the stigma and discrimination associated with PWID, lack of awareness on HCV transmission and the importance of early detection among the high risk groups and the general population, large portion of the people remain either ignorant or are not coming out to get tested.

Consequently people continue to die on a daily basis due to HCV related liver complications - A disease which is curable in comparison to the drastic decrease in the mortality rate due to HIV infection which is incurable but well managed with access to Anti Retro Viral Therapy (ART). Now with the availability of generic Direct Acting Antivirals (DAAs) the treatment of HCV has become much more clinically easier with lesser side-effects, shorter treatment duration, and extremely high cure rate up to the extent of 95% to 100% compared to the old mode of treatment with Pegylated Interferon with Rivabirin.

However, majority are unable to afford the diagnostics and the treatment cost. In the initial days of the HIV epidemic in our state, it was highly concentrated among the community of PWID. This resulted into high stigma, discrimination and negative attitude toward this community leading to much delay in initiating the appropriate measures to control the epidemic.

We now need to learn from our past mistakes and ensure that our response to HCV is looked from the public health perspective and ensure that people are made comfortable to get tested free of stigma and discrimination. Tackling any epidemic for that matter should not depend on the background of the individual. We cannot tackle the epidemic unless we break the silence and remove the stigma that surrounds it.

This could only happen when all relevant governmental departments, academic institutions, civil societies & people living with HCV joins hand for a collective effort on a war footing. Therefore, as a continuation of our advocacy efforts, today we are organizing this one day workshop in partnership with Centre for Manipur Studies, Manipur University with the objective to ensure that we could collectively come up with some key suggestions and recommendations for the State to initiate relevant interventions to address this burning issue of HCV from a public health perspective.

2. RK Nalinikanta, CONE: There is inevitable necessity of responding effectively with collective collaborative effort towards addressing Hepatitis C as an emerging Public Health and social problem.

Recommendations

1. The State should take immediate measures to initiate surveillance mechanism in order understand the disease burden of Viral Hepatitis C. This will ensure in planning the necessary interventions, including prevention, diagnosis and treatment, with adequate budgetary allocation.

2. The State should formulate its own Guideline/Standard Operating Procedures which is holistic in nature by way of including prevention, diagnosis and treatment protocols of Viral Hepatitis C.

3. The State should, on an urgent basis, form an ethical committee which will review, approve and oversee all research and clinical related studies with the State. This committee is not meant for addressing Viral Hepatitis C related issues only, but will also oversee all other health related research and studies.

4. The State Health Department, academicians from Manipur University, and Non-Governmental Organizations working in the field of HIV and Harm Reduction in the state should initiate extensive operational or otherwise research and studies on Viral Hepatitis C in order to scientifically understand the trend, co-relation with HIV, behavioral patterns, socio-economic implications, and overall well-being of the citizens of the state, leading toward the Sustainable Development Goal of the United Nation.

5. The state should, on an urgent basis, initiate preventive interventions in order to halt further spread of Viral Hepatitis C among Key Affected Population and in all public/private health care settings. Capacity of health care service providers should be built on Viral Hepatitis C to ensure dissemination of correct information and necessary ethical guidelines are being followed.

6. The State should take immediate measures to spread awareness on all form of Viral Hepatitis by way of integrating mass awareness, information education and treatment literacy campaign in all ongoing public health responses in the state. Media should also be active engaged in the campaign.

The State should ensure access to free diagnosis and treatment of Viral Hepatitis C with the new Direct Acting Antivirals (DAAs) by either expanding or specific budgetary allocation for diagnosis and treatment of Viral Hepatitis C in order to ensure that the "State Illness Assistance Fund" is inclusive and does not leave behind those who does not falls under the criteria but are either unemployed or have no source to support themselves.

Rapporteur
1. Ms. Surekha Longjam, Research Scholar, CMS, MU
2. Ms. Mamta Lukram, Research Scholar, CMS, MU.

Concluded...