Anush PERIKHANYAN MPH Yerevan State Medical University Department of Public Health Republic of ARMENIA Country profile http://www.who.int/countries/arm/en/ 1 Armenia - a lower-middle income country 3-5% (officially)prevalence of HCV among the general population (2013). HCV in 3rd highest rate in CIS countries (Georgia 6.7% Armenia/CIS and Uzbekistan 6.5%) Hepatitis C in Armenia- 44% have HCV genotype 1 37% have genotype 3 19% have genotype 2 Maistat L., Golovin S., Deineka O. and T, Khan. Hepatitis C in Eastern Europe and Central Asiа: Civil Society Respone to the Epidemics; 2015. http://www.aidsalliance.org.ua/ru/news/pdf/28.10.2015/EECA%20HCV%20EN.pdf. Accessed November 9, 2015 injecting drug users imprisoned persons patients getting hemodialysis commercial sex workers patients with tuberculosis healthcare workers oncological patients healthy population 70% HCV among 60% different groups is: people who inject drugs; 50% people who use intranasal drugs; recipients of infected blood products or 40% invasive procedures in health-care facilities with inadequate infection control practices ; children born to mothers infected with HCV ; 30% people with sexual partners who are HCV- infected; 20% people with HIV infection; prisoners or previously incarcerated persons; 10% people who have had tattoos or piercings 0% 1 2 In 2015 effective N3691 order-A “Methodological guideline for epidemiological management of viral Management hepatitis B, C”. of Hepatitis C The epidemiological control of viral hepatitis C is done by the National Center for Disease Control of the in Armenia Republic of Armenia (NCDC), which provides methodological management of prevention and regular control activities of HCV. 1. By health care workers Case detection 2. Detection criteria are: and data Clinical – anti-HCV positive collection Epidemiological - anamnesis, contact with hepatitis C patient, blood transfusion, invasive interventions. Laboratory - quick test (presence of HCV antibodies in the blood) and nucleic acid test for HCV RNA. 3 Pregnant women (1 per pregnancy) Recipients of blood, blood components, organs and Mandatory tissues (6 months after injecting blood or its components from people screening suspected to be infected with HCV) cost Donors of blood, blood components, organs and tissues (During each donation or taking each donor substance) Medical personnel and staff of service organizations. (once each year) Patients from the departments of Hemodialysis, Kidney transplantation, Cardiovascular and Pulmonary surgery (each month) Prices of HCV tests in the laboratories of Armenia (US $) 4 Model of combination of interferon and ribavirin No DAA medication is registered in Armenia Treatment HCV treatment medications are not included in “The list of basic medications for Republic of Armenia” or “The list of life-needed low-demand medications”. In the local market, the treatment can cost up to 16 000 US$ per 48 weeks. Primary prevention of the infection with vaccination is currently unavailable. Source- Tatevik Movsesyan, MPH. “Establishing hepatitis C patients’ surveillance system in the Republic of Armenia” Master of Public Health Integrating Experience Project. 24 weeks 48 weeks Rebetol 200mg + Pegasys 6,595 13,189 180mkg/0.5mg Rebetol 200mg + Peginteron 7,485 14, 970 150mg/0.5mg Copegus 200mg +Pegasys 4,748 9,495 Budget of 180mkg/0.5mg Copegus 200mg +Peginteron 5,638 11,276 treatment 150mg/0.5mg Interferon/riba virin and DAA (US$) Source- Tatevik Movsesyan, MPH. “Establishing hepatitis C patients’ surveillance system in the Republic of Armenia” Master of Public Health Integrating Experience Project. 5 Weaknesses Decision to be made on Health-care providers often face difficult decisions and considerable uncertainty while treating patients. They rely on the Strict national guideline for HCV scientific literature, in addition to their management knowledge, skills, experience, and patient preferences, to make their decisions. DAA registration The latest Methodological guideline Public Health companies approved by MOH describes case detection, diagnosis and registration only. Budget allocated for prevention and It does not contain information about the treatment. treatment strategies. Revision of costs High cost of treatment. No reimbursement Source- Tatevik Movsesyan, MPH. “Establishing hepatitis C patients’ surveillance system in the Republic of Armenia” Master of Public Health Integrating Experience Project. INTERESTING Doctors prescribe “Armenicum “ to HCV patients It was shown that as the results of Armenicum drug (concentrate) administration in HCV patients The level of viral load was decreased The level of biochemical parameters (ALT, AST) was decreased already after a month of initiating the drug administration. The obtained results allow to predict a positive action of the drug at the treatment of other liver diseases, such as chronic viral Hepatitis B, fatty hepatosis, liver cirrhosis, autoimmune and toxic hepatitis. Studies on this direction are being continued. 6 Thank You! 7.