Introduction
Hepatitis C virus (HCV) infection remains a global health challenge, with chronic Hepatitis C affecting millions of people worldwide. The virus leads to progressive liver damage, including liver cirrhosis and hepatocellular carcinoma, contributing to significant morbidity and mortality. In Africa, where access to healthcare resources is often limited, countries like Zimbabwe struggle to achieve diagnostic and treatment targets, hindering progress toward the World Health Organization’s (WHO) HCV elimination goal by 2030.
Addressing this issue requires strategic investments in screening, diagnosis, and treatment options. The introduction of direct-acting antivirals (DAAs), particularly sofosbuvir/velpatasvir (sof/vel), alongside breakthrough treatments from Gilead Sciences and Johnson & Johnson, has dramatically improved efficacy, offering cure rates exceeding 94%. Other key players include AbbVie, Bristol-Myers Squibb, Roche, Merck, and Cipla, contributing to treatment accessibility. However, affordability, infrastructure, and awareness remain significant barriers. This article evaluates the cost-effectiveness of screening and treating chronic Hepatitis C in Zimbabwe and explores strategies to enhance accessibility
The Burden of Chronic Hepatitis C in Zimbabwe
HCV affects approximately 67,000 individuals in Zimbabwe, with an estimated 582 annual deaths attributed to complications such as liver cirrhosis and cancer. Despite the growing disease burden, diagnostic and treatment coverage remain alarmingly low. As of 2024, only 16% of infected individuals were diagnosed, and less than 1% received treatment. This stark gap underscores the urgent need for intervention through targeted screening and accessible treatment options.
Chronic Hepatitis C: Limited Access to Screening
One of the primary barriers to HCV elimination in Zimbabwe is the lack of routine screening, particularly for high-risk populations, including:
- People who inject drugs (PWID)
- Men who have sex with men (MSM)
- Commercial sex workers (CSWs)
- Individuals aged 50–79 years
Due to stigma, lack of healthcare infrastructure, and cost constraints, routine HCV testing is unavailable in public-sector health facilities. Furthermore, knowledge gaps among healthcare providers result in missed diagnoses, delaying treatment initiation and increasing HCV-related mortality rates.
Chronic Hepatitis C: Challenges in Treatment Accessibility
DAAs such as sofosbuvir/velpatasvir have revolutionized HCV treatment by providing high cure rates and minimal side effects. However, cost remains a significant hurdle—a full 12-week treatment course costs approximately $1400 in Zimbabwe. Despite price reductions from branded medications, affordability remains out of reach for most patients, considering that the average monthly household income is $370, and healthcare insurance coverage is limited.
Additionally, pre-treatment assessments, including fibrosis evaluation and laboratory testing, add to patient costs, further restricting access. The introduction of lower-cost diagnostic tools and alternative shorter treatment regimens could significantly improve affordability and treatment uptake.
Chronic Hepatitis C: Evaluating Cost-Effectiveness of Screening Strategies
Screening Approaches
To determine the most cost-effective approach for Zimbabwe, three screening and treatment strategies were evaluated:
- No screening and no treatment (status quo): Reflecting current healthcare gaps, where routine HCV testing is unavailable.
- General population screening: Targets all individuals aged 18 and above for universal HCV testing.
- High-risk population screening: Focuses on key vulnerable groups with higher HCV prevalence rates, including PWID, CSWs, MSM, and those aged 50–79 years.
Decision Tree Model Findings
A decision tree model was developed to assess the impact of different screening strategies on morbidity and mortality rates. The results revealed that high-risk population screening was the most cost-effective strategy, yielding significant health benefits at a lower cost per Quality-Adjusted Life Year (QALY) gained.
Cost Analysis and Economic Implications
An Incremental Cost-Effectiveness Ratio (ICER) was calculated for each strategy:
| Screening Strategy | Incremental Cost ($) | Incremental QALYs | ICER ($ per QALY) |
|---|---|---|---|
| No screening, no treatment | Baseline | Baseline | – |
| High-risk population screening | $604 | 2.01 | Cost-effective |
| General population screening | Dominated | -1.04 | Not cost-effective |
These findings indicate that screening high-risk populations and treating them with DAAs is the most economical approach, costing $604 per QALY gained, well below the economic threshold (0.5 times GDP per capita = $796).
Strategies for Improved Treatment Accessibility
Reducing Drug Costs
One viable solution for cost reduction is adopting shortened treatment regimens, such as 8-week courses of sofosbuvir/ledipasvir (sof/led) or glecaprevir/pibrentasvir. Shorter-duration treatments have demonstrated comparable cure rates to traditional 12-week regimens, significantly lowering costs.
Another cost-saving measure involves expanding pooled procurement options, reducing the price of DAAs. If treatment costs decrease to $550 per course, the ICER drops to $173 per QALY gained, improving affordability for low-income patients.
Healthcare Infrastructure Strengthening
Investments in point-of-care diagnostic testing streamline the treatment process, minimizing delays. Additionally, integrating HCV services within existing HIV/AIDS programs enhances coverage, leveraging Zimbabwe’s successful HIV treatment infrastructure.
Addressing Stigma and Social Barriers
High-risk populations, particularly PWID and MSM, encounter stigma and discrimination, discouraging healthcare access. Community-driven initiatives, including peer-supported healthcare models, improve engagement, fostering trust and adherence to treatment protocols.
Conclusion
Zimbabwe stands at a pivotal moment in its fight against Chronic Hepatitis C. Implementing targeted screening among high-risk populations and ensuring access to cost-effective treatments such as sofosbuvir/velpatasvir presents a viable and sustainable solution. However, success hinges on policy adaptations, financial investments, and healthcare infrastructure improvements.
By prioritizing affordable medication, integrated treatment frameworks, and public awareness, Zimbabwe can progress toward WHO’s 2030 elimination targets. Collaborative efforts among government bodies, healthcare providers, and global stakeholders will be essential to achieving widespread HCV screening and treatment—ultimately saving lives and improving overall public health outcomes.
Reference
Dzingirai, B.; Katsidzira, L.; Postma, M.J.; Hulst, M.v.; Mafirakureva, N. Cost-Effectiveness of Screening and Treating Chronic Hepatitis C Virus Infection in Zimbabwe. Int. J. Environ. Res. Public Health 2025, 22, 509. https://doi.org/10.3390/ijerph22040509
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