Resource-limited settings - Mongolia
Mongolia is one of the most sparsely populated countries in the world: it has a population of approximately 3.03 million at a density of 1.9 people/km2. The low population density and harsh climate make communication, transport and economic development challenging, thereby complicating health service provision.1 Arkanghai Province is a remote agricultural area in the middle of the country with no scheduled flights to its main airport.
The burden of hepatitis C in Mongolia
Hepatitis B and C viruses (HBV and HCV) are the second highest causes of death in Mongolia, after cardiovascular disease. According to a 2003–2005 survey, the prevalence of HCV in Mongolia was 10–15%.2 As a result, Mongolia has the world’s highest rate of liver cancer mortality – at nearly eight times the global average.3
Figure 1: Top seven countries in the world with the highest annual liver cancer mortality rates3
Studies indicate that the peak of viral hepatitis transmission was in the 1970s and 1980s before disposable syringes were available in Mongolia. Poor infection control, reuse of syringes in health settings and administering injections at home led to the rapid spread of viral hepatitis. HCV is spread among people from 19–65 years of age. People undergoing surgical procedures or receiving blood products in a hospital are twice as likely to contract HCV.2
Gilead is proud to support elimination in countries with limited access to resources. By providing life-saving direct-acting antiviral (DAA) therapy, Gilead is actively supporting the efforts of the Government to end HCV in Arkhangai Province, Mongolia, through proactive screening and treatment.Together we’re supporting elimination in Mongolia to help make HCV history.3-6
The Liver Disease Free Arkhangai project7
Aims of the project:
- In 2016 Gilead partnered with the Mongolian Government and Arkanghai Province Health Department to eliminate HBV and HCV in the region7
- The National Hepatitis Programme was modified in May 2017 to include the goal of eliminating HCV by 20208
Historically, no public health programme existed in Mongolia to address the viral hepatitis epidemic7
By the end of 2016, the province had screened 17,600 people. 1,774 people were positive for HCV RNA7
Treatment uptake increased from 100 in 2015 to 6,500 in 20168
By the end of 2017, all Arkhangai’s residents aged between 40-65 years old had been screened7
To date, almost all people who tested positive and had a confirmed diagnosis of HCV RNA have been cured7
Screening the at-risk population younger than 40 years will now begin and steps to improve awareness and treatment coverage of HBV are being made7
Gilead supplies the medication and the Mongolian Government pays for screening, viral load confirmation and drug distribution7
Details on innovative elimination projects in Australia
An overview of the TraP C elimination project in Iceland
The journey to elimination
Read more on the context of HCV global elimination efforts and how to support elimination in your community.
- Chaabna K and Abu-Raddad LJ. Hepatitis C infection epidemiology in Mongolia: protocol of a systematic review and meta-analysis. Systematic Reviews 2017;6:1–5.
- World Health Organisation. Hepatitis: a crisis in Mongolia. July 2017. Available at: http://www.who.int/westernpacific/news/feature-stories/detail/hepatitis-a-crisis-in-mongolia (accessed March 2019).
- Stanford University. Hepatitis Prevention, Control, and Elimination Program in Mongolia. Executive Summary. Available at: https://medicinex.stanford.edu/wp-content/uploads/conference/HPCE%20Program%20-%20Executive%20Summary.pdf (accessed March 2019).
- Sajed N, et al. Support of Global Efforts Toward Elimination of Hepatitis C Virus. Poster #28 presented at the International Viral Hepatitis Elimination Meeting (IVHEM 2017), Amsterdam, The Netherlands. Available at: www.gilead.com/-/media/files/pdfs/other/hcv%20infographic.pdf?la=en (accessed February 2019).
- World Health Organization. Viral hepatitis in Mongolia: situation and response 2015. Available at: http://iris.wpro.who.int/bitstream/handle/10665.1/ 13069/9789290617396_eng.pdf (accessed March 2019).
- Dashtseren B, et al. First results from the general population hepatitis screening in Mongolia. Poster THU-104 presented at the International Liver Congress 2018, Paris, France.
- Asia-Pacific Biotech News. Viral hepatitis in Arkhangai: How Asia’s first micro-treatment program’s successes can be leveraged to treat a “silent killer“. Available from: www.asiabiotech.com/22/2207/22070026x.html. (accessed March 2019).
- World Health Organisation. Progress report on access to hepatitis c treatment focus on overcoming barriers in low- and middle-income countries, 2018. Available at: http://apps.who.int/iris/bitstream/handle/10665/260445/WHO-CDS-HIV-18.4-eng.pdf?sequence=1 (accessed March 2019).
LID/IHQ/18-12//1048h(1) Date of preparation August 2019