Negotiating

affordable access
to diagnostics and
medicines in
Punjab for HCV

Dr Gagandeep Singh Grover

State Programme Officer, IDSP/HCV
Punjab
 Northern State in India.
Has population of 29 mn appx
22 districts with wide variations
 Problem of HCV-Punjab
Exact magnitude was not known
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
Urban%-HCV Prevalence
3.1 in Surveyed
0.0
3.09 Districts
5 0.63 0
0.0
0.2 0.39 3.8
Rural%- 8 2 0
0.46
3.38 2.0 1.7 0.6
Total%- 5 9 4
0.0 0.5
3.29 4.11
4.11
0.0 0.2
0 2.16
8.8 1.11
6
8.8
12.4 6
5
3.26
5.83
2.8
3
5.7
3
4.8
13.6 4
4
2.95 High
5.22 Prevalenc
e
District Wise Seropositivity of Hepatitis
C; As per Data of Punjab State AIDS
Control Society (PSACS)

National average <1.0% PSACS Data 2015

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

PSACS Data 2015

(Dec)
Steps by Govt of Punjab
Rate Contract for HCV Testing
and Treatment
Govt. Of Punjab did Drawbacks
tenders for injectable $ 46 for one inj
drugs (Interferons) in $ 1150 for 24 weeks
2014-15 $ 2300 for 48 weeks
Drugs supplied by the Price was still high for
pharmaceutical
some groups
company
No mechanism of
Inj. available at Jan
Aushadhi Stores track and record of
Available to the patients
the patients
at subsidized rates per No mechanism of
injection standardized follow up
Dr RK Dhiman, Prof. Hepatology, PGIMER
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
 Principles of MMPHCRF

STANDARDIZATION
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
 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
 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
 HCV RNA (+) Algorithm for
Treatment of
Cirrhosis* Hepatitis C in
Punjab
Absent Present

Genotype-Optional Genotype-Mandatory

Sofo+Dacla for 12 wks** Genotype 1 & 4 Genotype 3

Sofo+Ledipa Sofo+Dacla
svir+Riba +Riba for
for 12 wks$ 24 wks

HCV RNA for ETR

(Optional)

HCV RNA for SVR (Mandatory) MMPHCRF 2016

Dr RK Dhiman
 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
 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

 Recommended Regimens with
Treatment Durations for Patients
without Cirrhosis
Genotype Regimen Regimen Regimen Regimen
1 2 3 4
[Sofosbuv [Sofosbuv [Sofosbuv [Sofosbuv
ir/ ir/ ir/ ir/
Ledipasvir Ledipasvir Daclatasvi Daclatasvi
] / r] r/
Ribavirin] Ribavirin]
Genotyp 12 weeks No 12 weeks No
e1
Genotyp No No 12 weeks No
e2
Genotyp No No 12 weeks No
e3 MMPHCRF 2016
Dr RK Dhiman
 Recommended Regimens with
Treatment Durations for Patients with
Cirrhosis
Genotype Regimen Regimen Regimen Regimen
1 2 3 4
[Sofosbuv [Sofosbuv [Sofosbuv [Sofosbuv
ir/ ir/ ir/ ir/
Ledipasvir Ledipasvir Daclatasvi Daclatasvi
] / r] r/
Ribavirin] Ribavirin]
Genotyp 24 weeks 12 weeks 24 weeks 12 weeks
e1
Genotyp No No 12 weeks No
e2
Genotyp No No No 24 weeks
e3 MMPHCRF 2016
Dr RK Dhiman
 Rate Contract for Drugs
(DAAs)
Standardized procurement
PHSC procurement agency
RC done twice
For 12 For 12
weeks weeks
Regimen Drugs
(1st (2nd
tender) tender)
Regimen
Sof + Ledi $ 306 $ 191
1
Regimen Sof + Ledi +
$ 331 $ 215
2 Riba
Regimen
StorageSofat+3Dacla
Drug Ware Houses
$ 267 $ 105
3
Regimen
DistrictSof
HQ+ Dacla
$ 280 $ 128
 Comparison of Rates of DAAs

Drug MRP ($) Market Punjab

Price ($) Govt Rates
($)

Sof+ Ledi 357 143 64

Dacla 100 64 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
 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
Monitoring & Evaluation
MMPHCRF Patient Cascade
(18.6.16 to 06.04.2017)
Case Load Centre wise
Prevalent Genotypes
Rural/ Urban
Age wise Distribution (%)
Cirrhotic/Non Cirrhotic
SVR outcome
SVR Certificate
Awareness Campaigns
Collaborations
 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
 M&E - CHAI

Analysis
Enrollment
Outcome
LFU - tracking
GIS mapping for hotspot
identification
ECHO
 ECHO for HCV in Punjab

Node: PGIMER Chandigarh

Deptt of Hepatology
State Deptt of Health
Spokes
3 GMCs
22 DHs
ECHO Sessions
Taking small Steps
towards
Strengthening of
surveillance
with aim of
Provision of quality
diagnostics & drugs
with vision of
HCV Elimination
in Punjab