1. Dr Gagandeep Singh Grover State Programme Officer, IDSP/HCV Punjab
Negotiating affordable access to diagnostics and medicines in Punjab for HCV
Dr Gagandeep Singh Grover
State Programme Officer, IDSP/HCV
Punjab

2. Has population of 29 mn appx 22 districts with wide variations
Northern State in India.
Has population of 29 mn appx
22 districts with wide variations

3. Problem of HCV-Punjab Exact magnitude was not known Prevalent Genotype
Certain studies had highlighted
PSACS (NACO) data was indicative
Prevalent Genotype
Exact was not known
PGI data was the most relevant and authentic
Risk factors
Known but not able to pinpoint due to lack of evidence

4. Urban%- 3.09 Rural%- 3.38 Total%-3.29
HCV Prevalence in Surveyed Districts
0.63
0.39
0.46
Urban%- 3.09
Rural%- 3.38
Total%-3.29
3.15
0.28
2.05
0.00
3.82
1.79
0.00
0.64
0.5
0.0
4.11
0.2
2.16
1.11
0.00
8.86
12.45
3.26
5.83
2.83
5.73
4.84
13.64
2.95
5.22
High Prevalence

5. District Wise Seropositivity of Hepatitis C; As per Data of Punjab State AIDS Control Society (PSACS)
National average <1.0%
PSACS Data 2015 (Dec)

6. District Wise Seropositivity of Hepatitis C; As per Data of Punjab State AIDS Control Society (PSACS)
PSACS Data 2015 (Dec)

7. Steps by Govt of Punjab

8. Rate Contract for HCV Testing and Treatment
Drawbacks
$ 46 for one inj
$ 1150 for 24 weeks
$ 2300 for 48 weeks
Price was still high for some groups
No mechanism of track and record of the patients
No mechanism of standardized follow up
Govt. Of Punjab did tenders for injectable drugs (Interferons) in
Drugs supplied by the pharmaceutical company
Inj. available at Jan Aushadhi Stores
Available to the patients at subsidized rates per injection

9. Dr RK Dhiman, Prof. Hepatology, PGIMER

10. Mukh Mantri Punjab Hepatitis-C Relief Fund (MMPHCRF)
A State Initiative: a public health programme for Hepatitis-C
Launched in June 2016,
offers free treatment of Hepatits C to all residents of Punjab
Funds approved by the Government of Punjab for the Hepatitis-C relief fund
Decentralized Hepatitis C treatment
22 District Hospitals and
3 Government Medical Colleges

11. Principles of MMPHCRF STANDARDIZATION EQUALITY AVAILABILITY
Testing and Treatment has been standardized
Regimens (fixed) have been designed
EQUALITY
Drugs to be provided free of cost to all
Regardless of religion, ethnicity & economic condition
AVAILABILITY
In Govt Hospitals at 3 Govt medical Colleges and 22 District Hospitals in first phase
AFFORDABILITY

12. Sensitization of Medical & Paramedical Personnel
Medical and Paramedical personnel involved in examining, diagnosing and providing treatment have been sensitized
Regimens, Follow ups and Testing
Co morbid conditions
Special circumstances

13. Sensitization before Launch of MMPHCRF
80 Medical Specialists in 3 batches
50 Pharmacists in 2 batches
25 SMOs and Nodal Officers
22 Distt Epidemiologists
25 DEOs

14. Algorithm for Treatment of Hepatitis C in Punjab
HCV RNA (+)
Cirrhosis*
Absent
Present§
Genotype-Optional¶
Genotype-Mandatory
Sofo+Dacla for 12 wks**
Genotype 1 & 4
Genotype 3
Sofo+Ledipasvir+Riba for 12 wks$
Sofo+Dacla+Riba for 24 wks
HCV RNA for ETR (Optional)
HCV RNA for SVR (Mandatory)
MMPHCRF 2016
Dr RK Dhiman

15. Rate Contract for Testing
Tenders for baseline and follow up testing (Viral Load and Genotype)
Baseline testing standardized
Anti HCV-ELISA: Free in 25 centres
CBC Free in 25 centres
LFT Free in 25 centres
RFT Free in 25 centres
USG

16. Rate Contract for Testing
RC with Dr Lal Path Lab
Rates fixed for Viral Load and Genotype tests
$ 31 for viral load (quantitative)
$ 43 for genotype (for cirrhotics)
SVR test is free under MMPHCRF
160 collection centres in State

17. Recommended Regimens with Treatment Durations for Patients without Cirrhosis
Genotype
Regimen 1
[Sofosbuvir/ Ledipasvir]
Regimen 2
[Sofosbuvir/ Ledipasvir/ Ribavirin]
Regimen 3
[Sofosbuvir/ Daclatasvir]
Regimen 4
[Sofosbuvir/ Daclatasvir/ Ribavirin]
Genotype 1
12 weeks No
Genotype 2
Genotype 3
Genotype 4
Genotype 5
Genotype 6
MMPHCRF 2016
Dr RK Dhiman

18. Recommended Regimens with Treatment Durations for Patients with Cirrhosis
Genotype
Regimen 1
[Sofosbuvir/ Ledipasvir]
Regimen 2
[Sofosbuvir/ Ledipasvir/ Ribavirin]
Regimen 3
[Sofosbuvir/ Daclatasvir]
Regimen 4
[Sofosbuvir/ Daclatasvir/ Ribavirin]
Genotype 1
24 weeks
12 weeks
Genotype 2 No
Genotype 3
Genotype 4
Genotype 5
Genotype 6
MMPHCRF 2016
Dr RK Dhiman

19. Rate Contract for Drugs (DAAs)
Standardized procurement
PHSC procurement agency
RC done twice
Storage at 3 Drug Ware Houses
District HQ
Regimen
Drugs
For 12 weeks
(1st tender)
(2nd tender)
Regimen 1
Sof + Ledi
$ 306
$ 191
Regimen 2
Sof + Ledi + Riba
$ 331
$ 215
Regimen 3
Sof + Dacla
$ 267
$ 105
Regimen 4
Sof + Dacla + Riba
$ 280
$ 128

20. Comparison of Rates of DAAs
Drug
MRP ($)
Market Price ($)
Punjab Govt Rates ($)
Sof+ Ledi
357
143 64
Dacla
100 13
Sofo
260
157 22
Riba
129 71 8
Prices for one bottle of 28 caps
Except Riba where one bottle is of 140 cap

21. Follow up and Tracking of patients
Treatment Cards for patients availing MMPHCRF
Personal details
Medical details
Regimens and Follow ups
Master Data with UID for each case
Follow up of case
Centralized case record
ETR (End of Treatment): Not recommended
SVR (Sustained Viral Response) records: 12 weeks after ETR

22. Monitoring & Evaluation

23. MMPHCRF Patient Cascade (18.6.16 to 06.04.2017)

24. Case Load – Centre wise

25. Prevalent Genotypes

26. Rural/ Urban

27. Age wise Distribution (%)

28. Cirrhotic/Non Cirrhotic

29. SVR outcome

30. SVR Certificate

32. Awareness Campaigns

33. Collaborations

34. CHAI MoU with CHAI M&E tool for HCV cases under MMPHCRF
M&E tool enabling:
Demographic profile of the patients
Prevalence of various genotypes in different areas
Hot Spots (as per the cases recruited under MMPHCRF)
List of patients due for follow up
Any patient LFU (Lost to Follow Up)
Expected ETR and SVR dates

35. M&E - CHAI Analysis GIS mapping for hotspot identification Enrollment
Outcome
LFU - tracking
GIS mapping for hotspot identification

36. ECHO

37. ECHO for HCV in Punjab Node: PGIMER Chandigarh Spokes
Deptt of Hepatology
State Deptt of Health
Spokes
3 GMCs
22 DHs

38. ECHO Sessions

39. Taking small Steps towards Strengthening of surveillance with aim of Provision of quality diagnostics & drugs with vision of HCV Elimination in Punjab