International research collaboration to investigate eliminating hepatitis C in Ethiopia

An international research team will lead elimination efforts of Hepatitis C in Ethiopia – one of the worst affected African countries of the disease – thanks to funding of £2.2 million by the National Institute for Health Research (NIHR).

The DESTINE project will bring together the Universities of Bristol and Dundee and NHS Tayside 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 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 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, while working with stakeholders and community members in the country to ensure that any outputs take account of local attitudes to service providers, stigma and regional and ethnic issues.”

Hepatitis C (HCV) is a blood borne virus which affects the liver and can lead to cirrhosis, liver failure or liver cancer. Around 90 per cent 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 per cent 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 a 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.

Much of the work will be done by PhD students who will matriculate at either Dundee or Bristol and split their studentships between the UK and Ethiopia. These students will receive training in techniques specific to their project and in clinical research generally.

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.

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