HCV projections and strategies in the Eastern Mediterranean Region

The Polaris team has recently updated its regional model of HCV in the Eastern Mediterranean Region with disease projections for 1) maintaining the status quo from 2016 going forward and 2) achieving the WHO 2030 Targets (90% reduction in new infections, 90% of cases diagnosed and 65% reduction in liver-related mortality by 2030). In 2016 it is estimated that 840,000 HCV patients were treated and 310,000 were newly diagnosed. If the current disease management paradigms were maintained across the region, there would be a 30% decrease in total infections, 25% reduction in decompensated cirrhosis, 35% reduction in hepatocellular carcinoma and 20% reduction in liver-related deaths by 2030. This scenario factors in a 50% decrease in annual treatment rates between 2016 and 2020 due to a diminishing pool of diagnosed patients. In order to reach the WHO Targets, the number of patients treated in a year could gradually decline to 710,000 by 2025, however the number of patients diagnosed annually would need to increase to a peak of 1,100,000 in 2025. The EMR region has made significant strides in eliminating HCV in the last year, particularly by increasing treatment from an estimated 310,000 in 2015 to 840,000 in 2016. The largest driver of this increase is Egypt which has treated over 1 million patients since the arrival of direct-acting antivirals (DAA). CDA’s regional model shows that treating at or slightly under the current level is sufficient for achieving the WHO Targets by 2030, assuming DAAs will soon be exclusively used across the region. However, efforts will need to be made, likely through national screening programs, to diagnose more patients on an annual basis in order to maintain a large enough patient pool to continue current treatment rates and achieve the 90% diagnosis coverage among total infections by 2030.

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