Advancing Hepatitis C Treatment Financing Model in Cameroon
Exploring a successful financing model to eradicate Hepatitis C in Cameroon through innovative treatments and funding strategies. The initiative aims to identify and treat Hepatitis C carriers in partnership with the Ministry of Health, focusing on expanding treatment access and incorporating a pay-for-performance model. The project has shown promising results, with high cure rates among patients and a sustainable approach to funding through fixed outcome payments. The ultimate objective is to scale up the program and integrate Hepatitis C treatment into healthcare systems more broadly.
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A Financing Model to eradicate Hepatitis C, our experience in Cameroon Roel Coutinho (r.coutinho@pharmaccess.org) GFAN World Caf 9 Dec 21
Background Hepatitis C Virus (HCV) Transmitted through blood and unsterilized medical equipment After infection about 75% remain (asymptomatic) chronic carrier for life (HCV RNA positive) After 20-30 yrs about 1/3 of chronic carriers develop serious sequellae (liver cirrhosis, primary liver cancer) 71 million chronic carriers worldwide High HCV prevalence in Cameroon (27 million inhabitants) due to mass treatment programs and vaccinations with unsterilized needles and syringes: about 200 000 HCV carriers, very few know that they are infected With new 3 months antiviral treatment >95 % of carriers cured
What we achieved up till now 1. Phase One (2017-2019): 96% cure rate among 161 HCV carriers treated with Harvoni (Gilead) 2. Phase two (September 2020 ): HCV carriers identified among potential blood donors and referral from clinics, treated with Sofosbuvir/Velpatasvir (Mylan) using a simplified diagnostic algorithm (WHO). 258 patients enrolled, cure rate 95%. Financing through a performance-based financing (PBF) structure (pay for success): Direct costs financed through an impact financing facility* Facility is repaid through fixed outcome payments for each cured patient Outcome validation and confirmation by an independent outcome validator Independent facility Agent manages all fund flows 3. Phase three (April 2021 ): Individuals enrolled in HIV treatment programs in greater Yaounde are tested for HCV; if HCV RNA positive treatment by general practitioners. 5000 HIV patients tested, 3.25% HCV RNA positive. Half of them started treatment. Financing: Gilead * Patients pay a small amount themselves
Our objective Roll-out HCV treatment in Cameroon with support of the MoH based on the successful experience up till now Identify and treat HCV carriers through blood banks and clinics in additional regions Identify and treat HCV-HIV co-infected patients in the same areas Simplified diagnostic algorithm, treatment with pangenotypic Sofosbuvir/Velpatasvir Financing with Pay-for Performance model with a fixed amount per cured patient Embed HCV treatment in screening program
How does our PBF work PBF Player Role Potential entity types Investor (JLI) Investors Joep Lange Institute Provide capital to service providers upfront or over the duration of the contract Investment firm (impact), Development finance institutions (DFIs), CSR branches, Public sector entity, Individual, Trust, Foundation. Administrator Implementing Organization (PAI) Outcome Payer Achmea Found. Implementing Organization PharmAccess, LRHCS/FMBS UYI Coordinate implementation and administration of social service in transaction Non-profit or for-profit social enterprise, Non-profit or Non- governmental Org, Cooperative Service Provider Yaound University Teaching Hospital CPC, etc. Implementation of social service in transaction Clinics, Laboratories, Doctors, Nurses, etc. Service provider Service provider Service provider Evaluator ANRS Evaluators ANRS Assess outcome of programs Independent evaluation firm, Research institution, University Outcome funders Achmea Foundation and Patients Pay for outcomes Government agency, Foundation, CSR branches Target population Service Data Funds Conditional payment
