Uzbekistan tests innovative financing model for hepatitis

A laboratory assistant examines a blood sample. Photo by: REUTERS / Rupak De Chowdhuri

BARCELONA — The Center for Disease Analysis Foundation — a nonprofit organization that studies complex diseases and helps countries deliver effective elimination strategies — is spearheading an innovative pilot project to help fill the $6 billion annual funding gap for tackling hepatitis in low- and middle-income countries.

Fronting the initial $1.16 million needed to jump-start the program, CDAF is working in partnership with the Uzbekistan Research Institute of Virology and with the support of the Uzbekistan Ministry of Health to screen 250,000 people for hepatitis B and C within a year, as well as treat an estimated 21,000 infected patients in Uzbekistan.

“We have the tools to eliminate hepatitis and save lives, what we need is a huge push from the public health sector, funders, and government to prioritize it.”

— Chari Cohen, senior vice president, Hepatitis B Foundation

The remaining program cost of $2.2 million will come from patient payments for the medicines, purchased through CDAF’s Global Procurement Fund for Hepatitis, which keeps costs low through negotiated volume pricing and waived import taxes. Numerous innovations in care delivery and supply-chain management have also been integrated to make the program efficient, affordable, scalable, and sustainable, said Rick Dunn, senior director at CDAF.

The small mark-up patients pay provides funding to purchase the next round of diagnostics and medicines, he explained. On the last round, since there will be no subsequent round of diagnostics and medicines to purchase, the small markup will repay the initial investment.

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The objective of the project is to validate a funding model that can be used by lower-income countries without having to rely on large-scale donations, which have proved hard to come by. It follows the World Health Organization’s call for policymakers to make more political and financial commitments for hepatitis response.

Despite being one of the most common causes of death globally, hepatitis is highly under prioritized by donors, said Chari Cohen, senior vice president at the Hepatitis B Foundation. Sunday marked World Hepatitis Day to raise awareness of the disease.

An estimated 257 million people are currently living with the hepatitis B virus, or HBV, while 71 million people have chronic hepatitis C virus infection, or HCV. Together they cause 1.4 million deaths a year. In Uzbekistan, prevalence is around 8% for HBV and 7% for HCV, according to CDAF.

While there is a cure for hepatitis C, there isn’t one for hepatitis B, but the effects can be suppressed with a good diet and oral antiviral medicines such as tenofovir.

Dunn speculated that hepatitis is not attractive to donors because of its association with drug use and the potential for re-infection, as well as the cost of medicines.

“I really couldn’t point to any single organization that is putting substantial financial resources into hepatitis,” he said.

While CDAF previously tried to address the funding issue with the creation of the Global Procurement Fund, it found low prices alone were not enough to facilitate elimination efforts and that the upfront capital was a primary barrier.

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“You have to spend a substantial amount of money to go out and find people that you then treat. Countries need to have upfront capital to purchase those screening tests and diagnostics before you even get to the point or procuring medicines to treat people,” Dunn said. With little money coming from global donors and national budgets, and low-income countries unable to borrow the money from development banks, catalytic funding models are needed.

While it may not be ideal that the majority of patients who test positive will have to pay for the treatment — the poorest 20% will receive free treatment, as determined by village councils — Dunn said that if it has the potential to save millions of lives, it’s worth exploring.

“You have to come up with a model that pulls money from some sustainable source and our hypothesis for this model, which is unique, is that the patients themselves would be willing and able to contribute to their testing and treatment,” he said.

But the key will be in raising enough awareness of the disease to convince somebody who doesn’t feel sick to spend money on antivirals.

CDAF plans to tackle this by innovating around its patient interactions and conducting motivational interviews, which —  although more commonly used on those with addictions — help to develop internal motivation for individuals to seek treatment.

Cohen added that there is no reason infrastructure already used to treat other diseases, such as HIV, couldn’t work or be adapted for hepatitis. “We have the tools to eliminate hepatitis and save lives, what we need is a huge push from the public health sector, funders, and government to prioritize it,” she said.

The other challenge the project faces is limited staff capacity. “We’re going to more or less take advantage of the existing downtime they have during the course of the day and each clinic is going to process on average 350 people per day,” said Dunn. While it’s a huge workload, he said staff are incredibly competent and that there are contingency plans if the burden is too much.

“We don’t expect the program we’re rolling out in Uzbekistan to be the program that other countries can implement. What we expect is that there’s going to be enough success coming out of this that we can build upon it, make it more efficient and at a lower cost and reaching more patients, but the only way to make progress is to take the chance,” he said.

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    Rebecca Root

    Rebecca Root is a Reporter and Editorial Associate at Devex producing news stories, video, and podcasts as well as partnership content. She has a background in finance, travel, and global development journalism and has written for a variety of publications while living and working in New York, London, and Barcelona.