Jeevan Rekha- A Counter For Hepatitis C Epidemic in Haryana

1. Jeevan Rekha- A Counter For Hepatitis C Epidemic in Haryana Dr. PARVEEN MALHOTRA MD,DNB (GASTRO),MNAMS,FIACM,FICP,PGDD PROFESSOR & HEAD DEPTT. OF MEDICAL GASTROENTEROLOGY PGIMS, ROHTAK

2. THE CULPRIT- NO VACCINATION

3. REAL CAUSE FOR FIGHT

4. Sources of Infection for Persons with Hepatitis C Sexual 15% Transfusion 10% (before screening) *Nosocomial; Health-care work; Perinatal Other* 5% Injecting drug use 60% Unknown 10% Source: Centers for Disease Control and Prevention Source: Sentinel Counties, CDC

5. Indian Scenario • Nearly 12.5 million Indians are suffering from Hepatitis C affecting the liver. • Over one lakh people get infected every year in India, according to the Indian National Association for the Study of Liver (INASL) study. • Every 15th carrier of the HCV is an Indian, according to a recent report and it is responsible for as many as one in four cases of liver cancer and chronic liver disease.

6. HARYANA SCENARIO • Initially in Haryana , the prevalence of Chronic hepatitis C was thought to be comparable to other parts of India. • Now the prevalence has drastically increased and is reaching the levels of areas with high incidence like Manipur and Punjab. • There are certain districts like Jind , Kaithal, Fatehabad, Panipat, Karnal and Sonepat where Prevalence is touching even 40-50%.

7. GOOD NEWS FOR HARYANA • Haryana has become the first state of India where a separate, dedicated centre has been started under Department of Medical Gastroenterology, PGIMS, Rohtak. • Free treatment of Chronic Hepatitis C has been started for patients belonging to BPL/SC and at subsidized rates for general population. •  Twenty Eight thousand patients have been screened over different parts of haryana.

9. HEALTH TALKS

10. HEALTH LECTURES

12. MEDIA INTERACTIONS

13. BILONA VILLAGE

14. AWARENESS TALK AT DERAS

15. DHABI TEK SINGH VILLAGE

16. Patients were treated inetially with standard doses of Pegylated Interferon and Ribavarin. • 1533 patients have completed treatment. • At present 20000 more patients are currently on treatment.

17. GENDER DISTRIBUTION

18. DEMOGRAPHICAL PROFILE

19. MARITAL STATUS

20. AGE DISTRIBUTION

21. DISTRICT WISE DISTRIBUTION

22. RISK FACTORS

23. SYMPTOMATOLOGY

24. GENOTYPE DISTRIBUTION

25. SIDE EFFECTS

26. VIROLOGICAL RESPONSE

27. COMPLIANCE RATE

28. HEPATITIS C HELPLINE 08950012900

29. CHEER LEADERS

30. CHEER COUPLE

31. ACTIVE ROLE OF NGO’S

34. AWARENESS BY STAFF

35. MOTIVATION FROM TOP

36. SOFOSBUVIR- BROUGHT A NEW HOPE • 500 patients have been put on treatment • Majority were put on Triple therapy • Dual therapy – Decompensated cirrhotic or on patient will • RVR has been achieved in 95% of patients • Excellent Compliance rate

37. ENTRY OF LEDIPASVIR & DACLASTAVIR • Became available on 20TH December, 2015 • The real game changer in treatment of hepatitis C. • The initial cost was Rs 14,000/month and total expenditure was Rs 42,000 with all viral load testing and genotyping free, till SVR is achieved. • Now with persistent efforts it has declined to Rs 62,00/month and total expenditure is Rs 18,600. • The Aim is to get free availability of these drugs to everyone in haryana.

38. CONCLUSIONS • Haryana has become new hub of Chronic hepatitis C in India. • Majority of patients are male and belong to young age group i.e. 20-40 years of age group. • Genotype 3 most common and Genotype 4 is more common in comparison to other parts of Northern India. • Most common side effects- Myalgia, Anxiety, Dyspepsia. • Good compliance and success rates are being achieved.

39. TAKE HOME MESSAGE • Most important and first step is appreciation of problem. • Next step is to prioritize resources in more prevalent areas. • Development of Vaccine and Interferon free regimen is future dream for hepatitis C. • Regular Screening camps and awareness in society is utmost need of hour to curb the menace of this disease. • Do not wait till all resources are compiled- Start moving.