How is Hepatitis B and C treated free of charge in Kazakhstan?

There has not yet been any vaccine against hepatitis C.

Always remember and follow the following rules:

• if you are scheduled for any surgical intervention with minimal damage to the skin or mucous membranes, be sure to undergo an ELISA diagnosis for hepatitis C markers;
• do not forget about the contraception barrier methods which significantly reduce the risk of hepatitis C infection;
• don't take narcotic
• those infected with hepatitis C virus should never share their personal items with others (for example, razors, toothbrushes, nail scissors);
• those who apply tattoos or piercings are at risk of infection, as the other people's blood may remain on the instruments;
• be careful when you provide first aid, especially in case of bleeding wounds;
• patients or those who have had hepatitis C cannot be the donors of the blood, organs and tissues;
• the cuts, scratches should be covered and not touched;
• when you provide first aid, even with minor harm or damage to the skin with the blood discharge, be sure to use disposable medical gloves, which must be utilized properly after the treatment.

In Kazakhstan, within the GSBP under Constitution of RK Article 29 for all categories of citizens (with no exception) infected with hepatitis B or C virus, in the presence of indications and the absence of contraindications, antiviral therapy funded from the republican budget is carried out free of charge.

The only condition is a patient should be registered for follow-up care (FUC) in the health facility at the place of residence. The patients with chronic illness, for example, diabetes mellitus, hypertension, stomach ulcers or hepatitis C have a mark “FUC” in their medical record. It means that the patient must be checked on a regular basis.

Also, the citizens have the opportunity to be treated in private facilities.

For a primary patient, when registering for follow-up care, the following list of studies is required to be undertaken:

1. ELISA analysis (Hbsag.aHCV)
2. PCR qualitative test (with a positive HBsag - a qualitative test for HBV DNA, with a positive aHCV - a qualitative test for HCV RNA)
3. Biochemical blood test (ALT, AST, total and direct bilirubin, GGTP, ALP)
4. Complete blood count with platelets
5. Abdominal ultrasound (if available within the last 6 months)
6. Referral from a general practitioner/infectious disease specialist for a consultation with an infectious disease specialist/gastroenterologist at the Hepatocenter.

You will receive detailed explanations of the diagnosis and treatment, including the normalization of nutrition and lifestyle changes.

If necessary, a hepatologist may prescribe additional studies.

Due to modern medicine hepatitis B can be prevented and treated, and hepatitis C can be completely cured. If the signs of viral hepatitis B or C were found for the first time based on the ELISA and positive PCR diagnostics, with an unexplained increase in the hepatic ALT, AST levels, you need to contact outpatient facility at your place of residence or health facility you are attached to receive the drugs free of charge.

Make an appointment with a gastroenterologist/hepatologist, a general practitioner or an infectious disease specialist.

If the doctor suspects hepatitis B or C in the patient, he or she will refer the patient to the screening examination. For some groups of the patients, the screening examinations are free of charge. Upon the diagnosis confirmation, all further diagnostics is carried out free of charge, including expensive examinations.

The patient is referred to antiviral therapy to the hepatology center. In the absence of contraindications, the patient receives free of charge drugs for the entire course of treatment.

The hepatological centers provide consultation services, arrange the admission to the infectious disease doctors, gastroenterologists, who are directly involved in the diagnosis and treatment of viral liver diseases of various etiology and severity.

All citizens of Kazakhstan can undergo the screening diagnostics for viral hepatitis B and C. These types of studies are primarily the ELISA diagnostics, if a positive result is obtained, a PCR (qualitative) study must be performed.

For the citizens who are faced with the diagnosis of hepatitis C for the first time, there are several opportunities to get more information about the disease and its treatment. One of them is public foundation "AGEP'C" (ANTIHEPATIT'C), a non-profit organization that assists the patients with hepatitis C and B.

The one can be attached to the outpatient facility at the place of permanent or temporary residence, with the possibility to choose one PHC facility within one administrative-territorial unit (village, town, city, district in the city of regional significance, cities of republican significance, capital city).

The one can be attached to the outpatient facility online through the e-government portal. In this case, he will receive a notification (coupon) of the attachment or a reasoned rejection in the form of an electronic document in the "Personal Account", signed by EDS of the PHC facility.

The surest way to avoid infection is to be vaccinated against hepatitis B. Safe and reliable vaccines are available. It is recommended to give three injections of the vaccine within 6 months. Vaccination is possible for people of any age. Vaccination is especially important for people at risk.

You should always remember and follow the following rules:

• if you are planning any surgical intervention with minimal damage to the skin or mucous membranes, be sure to undergo ELISA diagnostics for markers of hepatitis B (D);
• do not forget about barrier methods of contraception, which significantly reduces the risk of contracting hepatitis B;
• pregnant women should be screened for hepatitis B. In case of detection of infection in the mother, the newborn should be vaccinated in the first 12 hours after birth.
• do not use drugs;
• those infected with hepatitis C virus should never share their personal items with others (for example, razors, toothbrushes, nail scissors);
• those who apply tattoos or piercings are at risk of infection, as the other people's blood may remain on the instruments;
• be careful when you provide first aid, especially in case of bleeding wounds;
• patients or those who have had hepatitis C cannot be the donors of the blood, organs and tissues;
• when you provide first aid, even with minor harm or damage to the skin with the blood discharge, be sure to use disposable medical gloves, which must be utilized properly after the treatment.

1. Biochemical blood test (ALT, AST, total and direct bilirubin, GGTP, ALP)
2. Total blood count with platelets
3. Quantitative PCR for HBV DNA (once every 6 months) for patients with hepatitis "B", quantitative, genotyping for HCV RNA (once a year) for patients with hepatitis "C".
4. Abdominal ultrasound (if available within the last 6 months)
5. Other tests, studies that the doctor determined at the previous appointment. 
6. Referral from a general practitioner / infectious disease specialist for a consultation with an infectious disease specialist / gastroenterologist at the Hepatocenter.

Since 2011, drugs "Sofosbuvir" and "Daklatasvir" have been purchased for Kazakhstan, they are suitable for all genotypes of viral hepatitis C. These are generics, their effectiveness is comparable to the original drugs, they are recommended by the WHO. According to the various source data, the efficiency is 96-98 percent. With the emergence and spread of the state hepatitis C treatment program in Kazakhstan, residents of the country no longer need to travel abroad to receive expensive treatment.

Also in Kazakhstan, patients with hepatitis B receive free medicines. They are treated with Tenofovir.