HEPATITIS C Virus (HCV) is one of the most pressing public health challenges in Pakistan. More than 10 million people are already infected by it, and 450,000 acquire the infection each year.

Hepatitis C is known as a silent killer that shows no symptoms until years after the infection has set in, and the liver is damaged beyond repair. Timely diagnosis and treatment can help curb the disease and prevent the spread of infection. But because of non-specific initial symptoms, the disease goes unnoticed. Every year 366,000 people die of HCV and its complications in Pakistan.

The government of Pakistan recently launched the world’s largest HCV screening programme that will significantly contribute to elimination of this disease from the population. The programme, being a large-scale one, needs to reach an enormous number of individuals (165m). In this pursuit, several challenges may appear as the population of Pakistan is hugely diverse in terms of economic status, belief systems, trust in government-run programmes, access to healthcare, and level of literacy and awareness. In this scenario, a simplified testing option is needed that can address most of these challenges.

The WHO recently prequalified the first at-home, blood-based, self-screening test for HCV, which has the potential to address the challenge of under-diagnosis.

Self-test for hepatitis C can revolutionise screening.

Self-test requires a finger prick blood sample; the results can be obtained within minutes, in the privacy and comfort of one’s own home. The kits are cost-effective and affordable for most. They reduce the need for multiple clinic visits and lab-based screening tests, bringing down the overall cost of diagnosis. Positive results can be quickly followed up with a confirmatory viral load (PCR) test and immediate treatment, reducing delays, improving outcomes, and preventing complications such as liver cirrhosis, liver failure, and liver cancer.

The widespread use of self-test can reduce the burden on the healthcare system by allowing individuals to test themselves, freeing up resources for the government to spend equitably on those who need it most. The HCV self-test can also bring into the loop individuals who may otherwise be missed by the programme — for example, those who may not want to go to government-run clinics due to concerns of confidentiality, those who fear stigma, or those who find the process too cumbersome.

Self-testing can be a tool to expand participation in Pakistan’s national screening by contributing to the statistics and enhancing the scope of data and surveillance. This can provide a more accurate picture of prevalence of HCV in the population, consequently making the programme more inclusive and effective.

A win against any disease is simplifying the algorithms of testing and treatment and making it more accessible, ie, bringing services to where the patient is. We have witnessed this in the history of the diagnosis and management of diabetes. Invention of at-home glucometers (blood sugar-testing devices) empowered patients to take control of their health. The simple-to-operate glucometers enabled patients to test blood sugar at home, without the need of experts, and providing instant results in a matter of seconds. This transformed the day-to-day management of diabetes. Patients can now actively manage and monitor their diabetes themselves. This is a shift in the mindset of disease management that prioritises self-care and personal responsibility.

The HCV self-test is equally simple, it requires a similar amount of blood (a drop) and gives results in a matter of minutes. This self-test has the potential to revolutionise screening and bring more people into the net of testing and treatment, which is why it must be incorporated in the national strategic framework of the HCV elimination programme. To bring it within the reach of the common man in Pakistan, it must be ensured that the cost of the self-testing kit is kept low so that the most vulnerable people can afford it. Locally manufactured self-testing kits in Pakistan are comparable to imported ones in terms of sensitivity and specificity, and are available at a fraction of the cost at local pharmacies.

The future of HCV self-testing centres on making screening accessible, affordable, efficient, and integrated into public health strategies. A user-friendly testing method empowers individuals to test themselves, diagnose the infection early, and get treatment well in time.

In the highest-burden country, this can be a tool to reach underserved populations. Add to it the advancements in technology and policy, and self-testing could play a transformational role in HCV elimination in Pakistan.

The writer is Hepatitis Evaluation, Research and Outreach Fellow with the Coalition for Global Hepatitis Elimination, a programme of the Task Force for Global Health.

Published in Dawn, February 25th, 2025