Incremental Cost of Hepatitis C Screening, Diagnosis and Treatment among People Who Inject Drugs in Kenya

Abstract

Hepatitis C virus infection is a global public health threat, and has potential to progress to chronic liver disease, liver cancer and preventable deaths, if left untreated. Among people who use injecting drugs, the prevalence of HCV is 52% globally and 13-40% in Kenya, which is higher than in the general population, where the prevalence is 0.7% globally and 0.9% in Kenya. Injectable drug use accounts for 1 in 3 HCV related deaths globally. While Direct Acting Antiviral treatment has been known to eradicate the virus by 95%,15 only 23% people were diagnosed with the virus and 5% initiated treatment globally, by 2020. In Africa, of 10% diagnosed with the virus, 0.4% initiated treatment. In Kenya, there is limited data of the proportion of people diagnosed with the virus and initiated on treatment. Additionally, there is a dearth of cost data for screening, diagnosis and treatment among people who inject drugs in Kenya. This was the first cost study with the largest cohort of people who inject drugs treated in Kenya. The two aims of the study were: 1. To estimate the annual incremental costs, using a micro-costing approach and payer (Ministry of Health) perspective over 5-year time horizon and 2. To determine human and other resources use by analyzing monitoring and evaluation data from time and motion surveys and health care provider interviews. The study analyzed secondary data collected from 123 clients who underwent screening, diagnosis and treatment in 8 needle syringe program and methadone treatment centers in Kenya. The total annual incremental costs were $48,996. Total annual incremental costs per client were $398 and the biggest cost drivers were personnel, $285 (73%) and lab, stationery and supplies accounting for $83 (21%). The overall time taken for screening, diagnosis and treatment was 55 min (IQR 40, 103), out of which screening took the longest time, 20 min (18, 42). With an understanding of these costs, there is need for scale up these services to increase access to this priority population. Provision of treatment by the Ministry of Health and focus on this population, provides a valuable opportunity for Hepatitis C virus micro-elimination.