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Page 2 of 4 Waheed et al. Hepatoma Res 2018;4:45 I http://dx.doi.org/10.20517/2394-5079.2018.58

many years until 2015, the global burden of disease figure came out and hepatitis is considered as the 7th
[2]
leading cause of deaths worldwide. After that hepatitis is included in the Sustainable Development Goals
by United Nations . World Health Organization (WHO) has developed a Global Health Sector Strategy
[2]
(GHSS) to eliminate viral hepatitis by 2030. The major goals of GHSS on viral hepatitis are to reduce
hepatitis incidence by 90% and to reduce hepatitis mortality by 65% by 2030 . Globally, 71 million people
[3]
were living with hepatitis C virus (HCV) in 2015 and 75% of them were living in lower and middle-income
countries. According to the Polaris Observatory, 7.1 million hepatitis C cases are present in Pakistan, which
covers about 10% of the global HCV burden .
[4,5]

WHO is working with health authorities in different countries to develop effective hepatitis control
programs, and to achieve hepatitis elimination by 2030. As of November 2017, 84 countries have developed
national plans and strategies to control hepatitis . Nine countries (Iceland, Qatar, Australia, Georgia, Japan,
[5]
Netherlands, Egypt, France, and Germany) are on track to achieve HCV elimination targets by 2030, 22
countries are working towards elimination and Pakistan is among the countries in which HCV elimination
is un-achievable with its present policy .
[6]

The government of Pakistan has launched the National Hepatitis Strategic Framework (2017-2021) in
October, 2017. Effective implementation of NHSF depends on the concerted Federal and Provincial actions
from all stake holder in the health and other sectors to respond to viral hepatitis . The major routes of
[7]
hepatitis transmission in Pakistan are unscreened blood transfusions, shaving from barbers, reuse of needles
and syringes and reuse of the same dental and surgical instruments for different patients . Pakistan is the
[8]
country with the highest number of therapeutic injections per person per year. The most dominant genotype
of hepatitis C in Pakistan is 3 . The conventional and Pegylated Interferon based therapy also showed good
[8]
results in Pakistani patients in the last decade as compared with genotype 1 patients [9-11] . The Sofosbuvir
based therapy showed excellent response in Pakistani Hepatitis C patients . There is a dire need to speed
[12]
up the registration and availability of new direct acting antivirals for Hepatitis in Pakistani market.

There is a strong need for early diagnosis and treatment of HCV in Pakistan. According to WHO’s progress
report on access to hepatitis C treatment, 161,000 HCV patients got treatment in Pakistan in the year 2016
(mostly through the private sector) . A recent modelling study suggests that Pakistan needs to scale up its
[5]
HCV treatment number (up to 880,000 treatments per year), to achieve the GHSS targets on viral hepatitis.
The treatment number can be minimized (to 525,000 per year) by targeting the treatment to people who inject
drugs and people living with cirrhosis and through scaling up prevention interventions . Recently, Punjab
[13]
provincial government has promulgated the Punjab Hepatitis Ordinance 2017. Hopefully this ordinance will
play an important role in controlling hepatitis in the province.

Pakistan also needs to improve its HCV surveillance system. According to a national survey conducted
in 2007, 4.8% of the Pakistani population was living with HCV , which according to current population
[14]
estimates (207 million) constitutes about 9.9 million HCV cases, while the Center for Disease Analysis
estimates suggests the presence of 7.1 million HCV cases in the country .
[4]

There is a strong need to speed up the HCV diagnosis and find the missing millions living with HCV.
[5]
Globally, only about one in five people affected with HCV in 2016 had been diagnosed . Non-governmental
organizations (NGOs) are playing a significant role in the fight against hepatitis across the globe. There is
no funding specifically allocated for the NGOs’ work on hepatitis elimination in Pakistan. The prevalence of
Hepatitis is very high in high-risk population groups including people who inject drugs, thalassemia patients
and refugees [15,16] . There is a dire need to start HCV micro-elimination projects in high-risk population
groups including people who inject drugs, transgender population, and homeless people.