Antibiotic Treatment

Hepatitis C (viral hepatitis C) is a major cause of acute and chronic morbidity and mortality worldwide. The disease is caused by the RNA Hepatitis C Virus (HCV), and is transmitted by exposure to blood [injections or other transdermal procedures using equipment contaminated with the virus, sharing needles for injecting drugs, unsafe sex, vertical transmission from mother to fetus]. Acute infection can manifest as fatigue, jaundice, and joint pain, but is usually asymptomatic, after which most patients (55%-85%) will remain carriers of the virus and develop chronic hepatitis. Although the carrier state may be asymptomatic for years, a significant proportion of carriers will develop various complications, primarily the severe complications of cirrhosis (a condition in which normal liver tissue is replaced by scar tissue due to chronic inflammation) and primary liver cancer (hepatocellular carcinoma), as well as a number of extrahepatic complications (1).

The World Health Organization (WHO) estimates that approximately 71 million people worldwide are chronically infected with hepatitis C, with around 400,000 deaths each year due to complications of the disease (1). Hepatitis C is the leading cause for liver transplantation in both the United States and Europe. In Israel, the prevalence of HCV-positive serology is estimated at about 2% of the general population, with significantly higher rates among high-risk groups. The number of carriers in Israel is estimated at approximately 100,000, and it is believed that around 75% of those infected remain undiagnosed and unaware of their condition (2,3). Currently, there is no effective vaccine for hepatitis C. For many years, the treatment of hepatitis C relied on the prolonged administration of a combination of interferon and ribavirin. Interferon was delivered via injection and had a significant side effect profile, coupled with limited efficacy. In 2011, a new class of antiviral drugs—direct-acting antivirals (DAAs)—was introduced, specifically targeting the HCV virus. These drugs are administered orally in combination, offering a treatment that is not only safer and shorter in duration but also highly effective (95%-100%). DAAs were added to the Israeli health basket in 2015, and since 2018, all HCV carriers have been eligible to receive them, regardless of the virus genotype or disease stage. The availability of these effective treatments has fostered hope for the potential eradication and elimination of hepatitis C. In 2016, the World Health Organization launched an initiative with the goal of reducing new HCV infections by 90% and hepatitis C-related mortality by 65% by 2030, as part of a broader effort to eliminate the disease (5). The Ministry of Health in Israel joined this international initiative and recently introduced the National Hepatitis C Elimination Program. This program involves proactive serological screening of high-risk populations for hepatitis C, followed by the referral of identified carriers for evaluation, treatment with antiviral drugs, and ongoing monitoring of treatment response (3,4).

‬The diagnosis of hepatitis C begins with a serology test to detect antibodies against the virus. A positive result indicates a past infection but does not differentiate between individuals who have recovered from the disease and those who have become carriers of the virus. Carriers are at risk of developing complications and can potentially spread the infection. To identify carriers, a molecular test is required to detect viral RNA in peripheral blood. This test helps identify individuals with chronic hepatitis C infection, allowing for early evaluation and treatment before severe complications arise. Moreover, effective treatment can reduce the risk of transmitting the virus to the healthy population.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬
The first quality measure integrated into the Hepatitis C Indicators Program is the rate of molecular testing for the HCV virus among insured patients with a positive serology test. With the implementation of the National Hepatitis C Eradication Program in Israel, the set of quality indicators in this field will be expanded accordingly.

Note: This is the first quality measure introduced within the framework of the Hepatitis C program, following the implementation of the National Hepatitis C Eradication Program in the country, which is being carried out accordingly.