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rising reported prevalence of HCV. After the population shifts and migrant crisis due to current geopolitical
scenario in the northern African countries and Arab world, reported prevalence in the bordering areas is
[10]
again increasing . On the other hand China and Pakistan are placed in the 2017 WHO report as the areas
of world with highest prevalence of CHC, which claims 350,000 lives every year in the world. The global
[11]
burden of chronic hepatitis B is around 350 millions, killing around 600,000 people yearly .
With the advent of highly successful therapy (> 90% success rates) for CHC as directly acting antiviral
agents (DAAs), the treatment duration has shrunk to 8-12 weeks for most of the time, despite this major
[12]
advancement, as of 2015 out of 71 million people infected with CHC, only 7% had access to this therapy .

For United States of America, CDC described that 3 to 4 million people are infected currently with HCV.
While in Egypt, the situation was very grave till early 2015 when Egypt was ranked as the country with
highest prevalence, with a prevalence rate well above 10%. The prevalence of infection is greater than 10%
in certain parts of Asia with high rates found in certain geographic regions of Taiwan, Japan and Italy.
However, there are a number of countries/regions where data are not available [13,14] .

Hepatitis C epidemic in Pakistan
Situation in Pakistan is grave, as it’s been placed among highly prevalent countries. Recently Pakistani
researchers have increased their focus on studying endemic patterns of HCV infection and genotype
[15]
distribution leading to publication of eighty six relevant studies . This data on increasing prevalence
have been comprehensively reviewed previously [15-17] . Pakistan has the second largest burden of hepatitis
[11]
C , prevalence data published locally in last seven years has shown alarming figures with an almost 40%
increase in HCV antibody detection rates in general population as per the recent review published in 2016 by
[15]
Umer et al. . This all translated into high nosocomial transmission rates, highest burden in economically
disadvantaged areas and in marginalized communities. A shift in relative distribution of genotypes in Sindh
and Khyber Pakhtunkhaw provinces is seen, which the predominant areas are dealing with migrant crises
and internally displaced peoples (IDPs). A nationwide survey on prevalence of hepatitis B and C was done
[18]
in 2007-2008 which estimated that approximately 8 million people are exposed to HCV , and 2010 saw a
landmark step as the establishment of hepatitis sentinel sites nationally and surveillance system located in
[19]
provincial and federal capitals . Despite these landmark developments, still they are far behind than what
was expected from these centres in terms of their clear task of bringing about an integrated service model
for identifying what is beneath the tip of the iceberg of HCV epidemic in Pakistan, as more recent estimates
[20]
suggests that Pakistan is home to one-tenth of the global HCV burden .

Between 2016 and 2030, it is estimated that Pakistani population will be around 250 million, and prevalence
of HCV will rise from 3.9% to 5.1%, with a disturbing figure of 1.4 million deaths among those over 20 years
of age. Burden of this endemic infection will continue to rise with 12.6 million prevalence of CHC and a
[21]
projected 1.1 million new infections with each passing year .

HCV-elimination strategies
Global hepatitis strategy by WHO defined a goal to eliminate viral hepatitis by 2030 has been adopted, which
can be achieved by reducing incidence by 90% and mortality by 65%, calling for integrated and collaborative
work and dedication by the policy makers and health care providers.

The World Health Assembly endorsed a Global Health Sector Strategy (GHSS) on viral hepatitis 2016-2021,
in May of 2016. This will translate into the elimination of viral hepatitis by 2030.

Five key pillars of global health sector strategy include strategic information, interventions equity, financing
and innovation. These key elements are devised for facilitation of progress monitoring globally, regionally