“It is not impossible”: Dundee experts battle to eliminate Hepatitis C in Ethiopia

The DESTINE project, a collaboration led by the University of Dundee and involving medical and research institutes across Ethiopia, has identified several key areas to improve testing regimes, care protocols, and treatment for people throughout the country. The findings were unveiled at the project’s annual conference in Addis Ababa, marking the culmination of the four-year project.

Funded by the National Institute for Health and Care Research (NIHR), the £2.2 million project was created with the intention of informing Ethiopian Government strategic planning for HCV and enhancing skills within Ethiopia’s major medical schools. 

John Dillon, Professor of Hepatology and Gastroenterology at Dundee’s Faculty of Health, who led the Destine collaboration, said, “Hepatis C is a cruel and deadly disease. 

“Our ground-breaking work in Tayside is only the start of the path to fulfil the WHO aspiration for HCV elimination by 2030. HCV is an illness that continues to bring misery to other parts of the world, including Ethiopia. When we started DESTINE, we were unsure of the scale of the challenge we were undertaking. Four years later, that challenge is much clearer, but so are the immediate steps required to lead the fight.

“While replicating the success we had in Tayside may take time, it is not impossible that we can one day effectively eliminate Hepatitis C in Ethiopia.”

Peter Vickerman, Professor of Infectious disease modelling at University of Bristol’s Medical School, Eliminate theme lead at the NIHR Health Protection Research Unit in Evaluation and Behavioural Science, and Destine Co-Investigator, said, “Although we have discovered the prevalence of HCV is lower than first estimated, there are still large numbers of infections in Ethiopia which will cause considerable morbidity. The evidence we produced in our project is important for guiding targeted testing strategies to diagnose and treat people with HCV in Ethiopia.”

Hepatitis C is a bloodborne virus which affects the liver and can lead to cirrhosis, liver failure, or liver cancer. In high-income countries, around 90% of HCV infections occur in people who inject drugs, or have previously done so, through sharing needles. However, until now there has been much less information about the disease in low- and middle-income countries like Ethiopia, 

The DESTINE project has, for the first time, conducted a country-wide survey in Ethiopia and shown that HCV infection rates are 10-fold lower than previously expected. They are, however, higher in several sub-groups, including those who have had medical treatments such as blood transfusions and other medical interventions. 

The project has also produced recommendations to advance the fight against HCV in Ethiopia. These include the Ministry of Health mandating the use of reliable, World Health Organization-approved HCV diagnostic testing to reduce the risk of false positives being reported and initiating better knowledge exchange mechanisms to improve access to testing. Meanwhile, pilot studies are already underway or planned to investigate the effect of targeted testing towards groups of people who are more at risk of HCV.

Wondwossen Amogne, Professor in Infectious diseases at Addis Ababa University and joint Chief Investigator, said, “To our knowledge this is the only multisectoral research project in Ethiopia with six PhD candidates enrolled while exploring the virology, public health and clinical aspects of HCV. 

“It has successfully completed mainly due to efficient project management and collaborative team members.”

Professor Dillon and colleagues previously carried out the pioneering work that led to Tayside becoming a world leader in HCV elimination. Having focused on working with people that use intravenous drugs and challenges accessing care due to stigma and limited availability, that work began by working with needle exchange programs and soon evolved to provide much needed HCV testing and treatment.

After the extraordinary success in Tayside, the DESTINE project was announced with Dundee spearheading a collaboration including the Universities of Addis Ababa, Gondar and Jimma, the Armauer Hansen Research Institute and the Ethiopian Public Health Institute in Ethiopia together with the Health Protection Research Unit in Evaluation and Behavioural Science at the University of Bristol, NHS Tayside and the Hadassah Hospital in Israel.

A statement from the Ethiopian Ministry of Health has welcomed the work of the DESTINE project, stating, “Our HIV, Viral Hepatitis (VH), and STI Program Lead Executive Office would like to express its sincere appreciation for the progressive efforts exerted to generate scientific evidence on viral hepatitis. The work accomplished is truly impressive and remarkable.

“We look forward to strengthening our collaboration in other priority research areas in the future.”

For more information on DESTINE, please visit the study’s Funding and Awards page.