Dáil Éireann Debate, Tuesday - 15 September 2020
672. Deputy Joe O'Brien asked the Minister for Health if all new diagnoses of hepatitis C here are immediately being referred to the highly successful treatment; and if he will make a statement on the matter. [23402/20]
View answer673. Deputy Joe O'Brien asked the Minister for Health his views on whether Ireland is on track to eliminate hepatitis C by 2030 as per the WHO commitment given by Ireland. [23403/20]
View answerI propose to take Questions Nos. 672 and 673 together.
Ireland is committed to the WHO target of eliminating hepatitis C, including making it a rare disease by 2030.
The HSE established a National Hepatitis C Treatment Programme (NHCTP) in 2015 and began the process of providing treatment for Hepatitis C using Directly Acting Antivirals (DAA’s) to patients prioritised according to clinical need. Since 2016, the HSE in its National Service Plans has committed to the continued implementation of a multi annual public health plan for the therapeutic treatment of hepatitis C. The NHCTP goal is to make hepatitis C a rare disease in Ireland by 2026. In order to achieve this, the Programme is allocated funding of €25m each year.
The programme continues to progress the extension of hepatitis C treatment away from the traditional based healthcare within a number of HSE Addiction Treatment Centres with the latest centres opened in the Thompson Centre, Grangegorman and the Tolco Clinic, Cabra in North Dublin. Outcomes from these programmes are extremely positive with each patient engaging fully with their treatment and for those who have completed their treatment they have each received a sustained virological response i.e. a cure.
In tandem the programme is progressing the pilot of extending treatment availability within the community with treatment being provided by General Practitioners and corresponding oral substitution dispensing community pharmacists. Once proof of principle has been determined this project will be stepped up nationally.
In 2014 studies indicated that Ireland had a prevalence of 20,000-30,000. It should be noted that this is an estimate of the prevalence and the true prevalence rate in Ireland is unknown. There is no general screening of the population to determine prevalence rates. To date a national sero-prevalence study has not been undertaken. However, the NHCTP has observed a marked decline in numbers of newly diagnosed infections in recent years and a significant increase in the numbers of patients successfully completing treatment.
It is estimated that at least 50-60% of the potential number of people in Ireland with Hepatitis C are not aware of their diagnosis and so therefore in order for the programme to achieve its aim of making hepatitis C a rare disease by 2026, focus needs to turn to identifying the population and case finding. Globally the availability of Direct Acting Antivirals (DAA) has shifted the focus towards elimination of HCV. The WHO has stated that national testing policies in addition to increased screening are essential so that the goal of elimination can be reached. In this regard, the National Hepatitis C Treatment Programme is commencing a communications campaign ‘Find the missing Millions’ to promote the work of the NHCTP and to find the people who do not realise they are infected with Hepatitis C and offer them the treatment. The NHCTP is committed to treating as many people that are infected with Hepatitis C that are found, and as soon as they are identified.
The NCHTP is committed to evolving the changing needs in hepatitis C care for patients. A programme of work to refresh the National Hepatitis C Treatment Programme Strategy and Planning Document 2020-2026 is nearing completion. This will set a clear direction for the further expansion of the programme.
The NHCTP is also supported by a Programme Advisory Group who provide advice, support and strategic direction to the HSE of the successful development and implementation of the programme and a Clinical Advisory Group whose role is to provide clinical advice.
Since 2015 The NHCTP has provided treatment to over 5,500 people in Ireland using DAA Medication with cure rates in excess of 95%. The goal of making Hepatitis C a rare disease in Ireland is a reality since the availability of transformative therapeutic drug regimens to successfully treat and cure people with Hepatitis C.
To ensure we reach our goal of Hepatitis C becoming a rare disease in Ireland by 2026 the programme will:
- Continue treatment using DAA’s which have a significantly higher rate of patients achieving Sustained Virological Response or cure.
- Increase numbers of patients being treated to achieve > 60% reduction in liver related deaths & 90% reductions in total and new infections – actively ‘Seek and Treat’ harder to reach client groups in collaboration with Addiction services
- Expand screening programmes to identify all infected patients
- Expand treatment criteria to treat all infected patients – i.e. treatment as prevention and treatment to elimination.
- Promote the awareness of Hepatitis C and the need to get tested and treated
- Progression of the Community G.P/Pharmacy Dispensing Pilot
- Conduct an epidemiology study to determine the prevalence of Hepatitis C in Ireland to inform the efforts of the programme
With the outbreak of COVID-19 Hepatitis C clinics were significantly impacted. However, clinics are returning to normal and the NHCTP is confident that the programme is on target to eliminate Hepatitis C in Ireland by 2026.
