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HIV-hepatitis C co-infection in Mykolaiv, Ukraine

Photograph by Aleksandr Glyadyelov
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Mykolaiv project shows that hepatitis C can be effectively treated in people living with HIV

Globally, 2.3 million people are co-infected with HIV and hepatitis C. For people living with HIV, hepatitis C is a leading cause of death, due to the faster progression of the disease and the higher chance of cirrhosis and liver cancer. However, hepatitis C is curable.

In Mykolaiv, in the south of Ukraine, MSF is taking an integrated approach to hepatitis C care for people living with HIV, by providing free diagnostic tests, treatment with new drugs, and education and counseling services to increase patients’ chances of success. The recent test results from patients who finished treatment since the start of the activities one year ago are extremely positive, with a success rate of over 95 percent in curing hepatitis C in patients who are also infected with HIV.

Shorter treatment with new oral drugs

“A hepatitis C infection can be deadly if untreated, especially for people living with HIV, but these test results remind us that a cure is possible,” said Franking Frias, MSF medical coordinator in Ukraine. “For treatment, we use sofosbuvir and daclatasvir, new oral drugs recommended by WHO that can cure hepatitis C in as little as 12 weeks with few adverse effects. In comparison, older hepatitis C treatment models use injectable drugs and take at least four times as long.”

Hepatitis C infection can be deadly if untreated, especially for people living with HIV, but these test results remind us that a cure is possible

Franking Frias
Medical Coordinator
MSF Ukraine

The role of peer educators

But undergoing hepatitis C treatment can still be a challenge for many. Therefore, MSF is working with peer educators, who have themselves lived with the disease. They help patients manage their treatment and give advice on how to cope with challenges that may affect their ability to complete treatment, such as discrimination, financial difficulties, and mental and physical hardships.

This has proven successful. So far, zero patients in the MSF project have failed to complete treatment as a result of missed doses or visits. In total, 341 patients on antiretroviral therapy for HIV have finished MSF’s hepatitis C treatment course. A preliminary group of 143 patients has already undergone testing, and all but one patient was found to be cured of hepatitis C.

An example for the country

About two million people live with hepatitis C in Ukraine, but most lack access to affordable diagnostics and treatment for the curable disease. MSF’s hepatitis C treatment project in Mykolaiv will treat a total of 1,000 patients for hepatitis C, of whom 750 are co-infected with hepatitis C and HIV.

MSF clinic located inside the Mykolaiv Regional Center of Palliative Care and Integrated Services.
MSF staff members work between patient visits in the Patient Support, Education & Counselling (PSEC) room at MSF’s hepatitis C treatment project in Mykolaiv, Ukraine. Photograph by Alexander Glyadyelov

“The aim of our project is to provide an example of how hepatitis C can be effectively treated in Ukraine, where access to diagnostics and treatment is currently quite limited,” said Jeri Driskill, field coordinator for the MSF project in Mykolaiv.

"I am one of you: I live with HIV and used to live with hepatitis C": Testimony of peer health educator in Mykolaiv, Ukraine

Maksym* is a peer health educator working in MSF’s project in Mykolaiv in the south of Ukraine. He explains how he draws on his own experiences to connect with patients and make sure they complete their hepatitis C treatment successfully.

“Sometimes when I try to talk to patients about hepatitis C while they are waiting in the line to see the doctor I face a lack of interest, at first. But once I say the magic phrase — “I am one of you. I live with HIV and used to live with hepatitis C.” — I see the change. People start to listen, carefully, and ask questions.

Peer to peer

"I talk to them as a person who has experienced all the difficulties of treatment and cured hepatitis C. I managed to do it, and I explain how, using examples from my own life and my own story. We talk as equals, as peers, and it really works. People open up.

“I describe to patients my condition before the hepatitis C treatment. I could barely get out of bed. Just walking to the bathroom was a challenge for me. I was very scared. I also explain that I started feeling better just a month after beginning the treatment, and a significant improvement came after three months. And now, patients see me being so active, running around, working, so they start thinking about their own plans. They see that it is possible to fight hepatitis C, despite their HIV status.

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MSF peer educator outside the MSF clinic in Mykolaiv. Photograph by Aleksandr Glyadyelov.

Maksym's own story

"Myself, I found out I had hepatitis C 18 years ago. I discovered it accidentally. I had caught a cold and went to see a general practitioner. He saw a hepatitis C-related rash on my body and recommended I get tested. I took his advice, and the hepatitis C diagnosis was confirmed. I went to an infectious disease hospital right away, but they only offered interferon therapy for hepatitis C. Those medicines are very difficult to tolerate. People who had tried the treatment themselves warned me about the terrible side effects. There were no other treatment options at that time. So, I didn’t do anything. I was waiting for a miracle, I suppose. And my condition continued to deteriorate every day until I finally started hepatitis C treatment with new, much more tolerable oral drugs through the MSF program in Mykolaiv.

Living with hepatitis C and HIV

“I learned my HIV status much later, approximately five years afterward. I had not suspected anything before. My daughter and son-in-law were sick, so I suggested the whole family to go for a medical check-up. We went, and while the doctors did not find anything seriously wrong with the rest of my family, I was diagnosed with HIV.

"It took several months before I was ready to tell anyone, even my family. Once I finally did, my family supported me. That had an enormously positive effect on my well-being. Now, as an MSF peer educator, I share this experience with the patients, as many are afraid to disclose their HIV-positive status to even their dearest loved ones. Some keep silent for 20 years. I tell them that a family can provide the support that cannot be found anywhere else.

Patients start reconsidering their lives and see that a lot of things are still possible for them

Maksym*
Peer Health Educator
Mykolaiv, Ukraine

Support is key

“Support is extremely important in this situation. As a peer educator, I provide support for those in need throughout the entire treatment course. I am always there to provide any additional clarifications regarding tests or medication, to help them formulate questions for the doctors or nurses or to listen to their complaints.  I can even help remind them to take their medication on time each day, just like my family did for me.

“I also urge the patients to seek a healthy lifestyle, because it is so important to the success of the treatment. Sometimes I even talk with family members about following the program’s recommendations themselves, such as using condoms to prevent reinfection. One time I met a husband who flatly refused to do so, saying that he would rather divorce than use contraceptives. We had long, in-depth conversations in which I explained that, if he loves his wife, he needs to follow the recommendations in order to keep her safe from harm.

Hepatitis C is curable

“Unfortunately many people give up on themselves. They do not have enough motivation. They are disillusioned. It is difficult to keep fighting, especially against both HIV and hepatitis C. However, it is still possible – hepatitis C is curable, and, with HIV, you can live longer and healthier with ART medicines. I tell them that it is possible to be happy and not lonely, even with a positive status. My wife does not have the status, neither do my kids. After discussing this, the patients start reconsidering their lives and see that a lot of things are still possible for them.

“I love what I am doing. I am glad I can help all those people."

* Name has been changed