Expertise from UK university key to Hepatitis C battle in Africa

An expert from a leading UK university who led work on effectively eliminating Hepatitis C in a Scottish region, the first in the world to do so, will spearhead a £2.2 million project in Ethiopia that has the potential to benefit future elimination efforts in Ghana.

The DESTINE project will bring together the Universities of Dundee and Bristol and Scottish health boards with several medical schools and other key institutions in Ethiopia. The team will investigate the extent of Hepatitis C (HCV) infection in the country using epidemiological and modelling techniques. They will then design care based around treatment pathways created in the UK but moulded to suit the Ethiopian context.

The collaboration will be led by John Dillon, Professor of hepatology and gastroenterology at the University of Dundee and consultant hepatologist at NHS (National Health Service) Tayside. He and his colleagues previously carried out the pioneering work that led to Tayside becoming a world leader in HCV elimination.

Professor Dillon’s projects focused on working with people that use intravenous drugs and those who have a challenging time accessing care due to stigma and limited availability. The project began by offering a needle exchange program and this soon evolved to provide much needed HCV testing and treatment.

He said that DESTINE, funded by the National Institute for Health Research (NIHR), would help address a desperate need for effective HCV strategies in countries like Ethiopia.

“The World Health Organisation has set a target for the world to eliminate HCV by 2030 and, while many of the more developed countries have put plans in place to reach this target, this has been more difficult in low- and middle-income countries. For example, in Ethiopia the number of people living with HCV infection is not known, although estimates suggest it may be around 3 million.

“Our work in Tayside largely centred around removing the barriers faced by patients. We knew that at each step of the pathway we lost people, so the aim was to make the steps smaller and simpler. That is the principle we will be applying to the Ethiopian context.

“The project will explore ways of delivering HCV testing and cure, in ways that work with the novel and evolving ways of delivering health care in Ethiopia. The outputs of this research will be useful in countries across Africa similarly affected by HCV.”

Hepatitis C (HCV) is a blood borne virus which affects the liver and can lead to cirrhosis, liver failure or liver cancer. Around 90% of HCV infections occur in people who inject drugs, or have previously done so, through sharing needles.

To date, the programme instigated by NHS Tayside has treated almost 2,000 people living with Hepatitis C, more than 90% of the estimated number of people in the region living with HCV. This reduction in prevalence met both the WHO and Scottish Government targets for HCV elimination ahead of schedule.

Professors Peter Vickerman and Matthew Hickman at the University of Bristol have led a substantial body of work, including infectious disease and economic modelling, that has transformed the evidence base for the prevention and treatment of HCV among groups at risk of transmission. Their work has underpinned WHO treatment guidelines (2018) and guided over ten countries’ HCV elimination initiatives.

The Ethiopian Government and clinicians in the country urgently seek the development of an HCV strategy. They have identified the need for implementation and scale-up of testing and treatment, and development of effective preventive strategies.

The four-year project will measure how common HCV infection is in Ethiopia, predict how its ongoing HCV epidemic will progress, and model the effect of this prediction on the Ethiopian health service.

The project will inform Ethiopian Government strategic planning for HCV and enhance associated skill sets within the four major Ethiopian Medical schools, thereby enhancing the country’s research infrastructure.

Professor Dillon was last year recognised as a 2021 Elimination Champion by the Coalition for Global Hepatitis Elimination for his contributions in Scotland and making a global impact.