One year,1198 patients

MSF's hepatitis C clinic in Uttar Pradesh, India

By MSF

March 2^nd, 2018

MSF has been running a pilot project providing free hepatitis C diagnosis and treatment in Meerut, a city in Uttar Pradesh, since January 2017. In the past year, the team has placed 1,198 patients on hepatitis C treatment, of whom 290 have been declared cured.

When MSF's medical team opened the clinic they expected to see a large number of patients. Within weeks they were overwhelmed with the number of people seeking treatment and were forced to set up a waiting list, which grew to 2,500 people in one year.

To boost the number of people who successfully complete their treatment, MSF is using simplified, decentralised models of care that bring care closer to those who need it and means patients only have to attend the clinic once a month to receive treatment.

As well as screening patients, the clinic uses the latest generation of hepatitis C drugs, called direct-acting antivirals (DAAs), which are available at a much lower cost in India compared to many other countries. These drugs are still priced out of the reach of millions of patients in India and around the world.

Patients outside the waiting area of hepatitis C clinic at PL Sharma District Hospital, Meerut, Uttar Pradesh

MSF Nurse Jijo Xavier checks the vitals of a patient at the hepatitis C clinic in PL Sharma District Hospital

MSF Counselor Prajesh Kumar Gupta counsels patient Geeta who was declared cured on the day.

Lab technician Dhanesh Kumar draws blood at the PL Sharma district hospital where MSF-NHM UP run the free hepatitis C clinic

MSF Dr Sevantee Ghosh speaks to a patient who is currently undergoing treatment at the hepatitis C clinic in Meerut.

MSF Nurses Jijo Xavier dispenses drugs to a patient at MSF’s hepatitis C clinic located in PL Sharma District Hospital, Meerut

As the only free hepatitis C clinic in the State at primary healthcare level, the clinic receives many patients in and around Meerut region

Naimpal, 43 years old, farm worker; Fatima, 45 years old, housewife

Naimpal: “I didn’t know how dangerous hepatitis C was. But now that I know, I take all measures to make sure that no one else gets infected.” Naimpal Bhatti, 43, found out he had hepatitis C in 2014, but couldn’t find treatment at the time because it was too expensive. He was declared cured in November 2017. “I have told my sons about how hepatitis C spreads and I ensure that the razor blades are always changed when we got to our local barber," he adds.

Fatima* (Name changed on request): "I was very scared when I found out, because I had never heard of hepatitis C. Some people scare you by spreading misinformation. But I am cured now, and I tell everyone there is no point getting scared. Everyone should get tested. And if they have hepatitis C, they should get it treated.” She recently completed her hepatitis C treatment with MSF. In the course of her treatment, her mother-in-law Rabia* was also diagnosed with hepatitis C and is currently receiving treatment.

Naimpal Bhatti, 43, found out he had hepatitis C in 2014, but couldn’t avail treatment at the time because it was too expensive.

Naimpal Bhatti changing the blade in his shaving razor at home in Meerut.

Fatima (left), 45, recently completed her hepatitis C treatment at the free hepatitis C clinic in Meerut and has been cured of the disease.

During the course of Fatima's treatment, her mother-in-law Rabia* was also diagnosed with hepatitis C and is currently receiving treatment.

"More than a disease"

Sevantee Ghosh, a medical doctor from Kolkata, has been working with MSF’s hepatitis C project since it opened in January 2017.

"In the past year, we have seen how hepatitis C is much more than a disease. It affects many other aspects of patients’ lives. There are young women who are not able to get married because they have hepatitis C; young men want to go out of the country and start businesses but they are unable to secure visas because they have hepatitis C.

"So for me, the best day is when we can give the patient their ‘cured’ certificate. As a doctor, I look forward to it as much as a patient does. I remember a 60-year-old man from Bijnor who was diagnosed with hepatitis C over five years ago. He had started treatment but had to drop out midway because it was so expensive. He was able to resume treatment last year with MSF, as we provide the treatment for free. When he was cured, he told me, “I was not sure I’d live to see this day.”

Sevantee Ghosh, a medical doctor from Kolkata, has been working with MSF’s hepatitis C project in Meerut, Uttar Pradesh, since January 2017.

Geeta, hailing from village Bhopada, Meerut district shows her certificate of cure.

Ankush,30 years old, construction worker & Geeta, 32 years old, housewife

Ankush: “I had never heard of hepatitis C before. I felt jolted when I learned I was hepatitis C positive. I wondered, ‘What is this new disease that only I have?’ I later found out that approximately 80 per cent of the people in my village has it. Even my sisters have it.” Ankush, 30, is a construction worker from UP’s Muzaffarnagar district who was diagnosed with hepatitis C in 2015. He lost his appetite as a result, and got tired very quickly. Since getting cured in October 2017, Ankush has been able to resume work. Seeing him getting cured and regain his energy has inspired his sisters to also finish their treatment.

Geeta: “The counselors here told me to keep taking the medicines and assured me that I would get well. I did the same and could notice the difference and felt that I was getting healthier. Despite many people telling me that the medicines may cause a lot of side effects and scaring me, I kept at it and am very happy that I no longer have the disease,” said Geeta, who hails from Bopara village.

Ankush, 30, is a construction worker from UP’s Muzaffarnagar district who was diagnosed with hepatitis C in 2015.

He lost his appetite as a result, and got tired very quickly. Since getting cured in October 2017, Ankush has been able to resume work.

Patient Geeta reacts as she’s informed by MSF counselor Prajesh Kumar Gupta that she was now cured of hepatitis C.

prevention is better than cure

Meerut is one of the largest cities of Uttar Pradesh, a state with a population of approximately 200 million people. The region is semi-urban and many people depend on daily labor and farm work to earn livelihood.

Most of the patients seeking care at the clinic are believed to have been infected through poor medical practices, such as unsafe blood transfusions and by the use of unsterilised equipment by rural, unqualified, medical practitioners or traditional healers. However, lack of information about the disease often means people are unaware of its transmission. Health promotion therefore, plays a vital role in educating the community about transmission, disease progression, its prevention and access to testing and treatment.

Wasim Ahmed, MSF’s health promotion officer conducts health promotion activities everyday at the clinic. As part of this activity, he educates people about the disease, its transmission, how it can be prevented and about the treatment for hepatitis C.

“There are a lot of myths surrounding hepatitis C. Many people think it spreads through drinking contaminated water, eating contaminated food or even through the air. That’s why it is important for me as a health promoter to inform and educate people about the disease so that they can take measures to prevent further spread of hepatitis C,” says Wasim.

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MSF believes that hepatitis C treatment should be accessible and affordable for everyone who needs it. This pilot project is bringing simplified, decentralized models of care closer to patients to increase the likelihood they will complete their treatment. MSF is calling on the Indian government to adopt decentralization into its national action plan for hepatitis C, which is currently under development and has the ultimate aim of eliminating hepatitis C by 2030.

Wasim Ahmed, MSF’s health promotion officer educates people about the disease, its transmission & how it can be prevented.

Local villagers work at a sugarcane mill. Sugarcane farming and processing is one of primary sources of income.

Wasim Ahmed, MSF’s health promotion officer speaks to the patients and their attendants about hepatitis C.

A crowded street in Meerut city where MSF in collaboration with NHM UP runs a free hepatitis C clinic at PL Sharma district hospital

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