Access to Generic Medicines for Hepatitis C in South Africa: A Journey of Discovery

The true seroprevalence of hepatitis C in South Africa is not clear, with some data suggesting a high prevalence in key subpopulations. While genotype 5 infection is highly prevalent, all other genotypes (except genotype 6) are seen, making it a pan-genotypic country. With the advent of direct-acting antiviral (DAA) therapy, patient demand for access has grown. In a country with a high GINI coefficient, affordability – as with antiretroviral therapy – was always going to be a major factor. No clear route to access these therapies existed, and at listed USA and European prices, were out of reach to most, if not all, for most, if not all, patients in South Africa. A single patient, albeit in a potentially hazardous manner, and of his own accord, made his own DAA therapy by purchasing raw active pharmaceutical ingredients and filling capsules. Unsurprisingly, when the treatment failed, the patient turned to us for assistance. Consequently, he led us to generic therapies, and through the correct processes we accessed care for him. It was this act that opened up a channel for us to assist many other patients. In time, access to lower prices for some originator DAA therapies has materialized; however, to many, this still may be out of reach. Generic medicines for hepatitis C do work and are effective and affordable. If we are going to achieve the objective of the elimination of viral hepatitis, generic medicines will need to form part of the solution.