Q&A with Sonjelle Shilton, Project Manager for the HCV Programme
I joined FIND in 2017, and took on the role of Project Manager for the Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) project earlier this year. The majority of my career has been in Africa, where I spent 10 years as the Director of Operations of a community-based health outreach organization, HardtHaven, in rural Ghana – which showed me how critical it is that public health interventions be collaboratively designed and implemented with rigorous and meaningful data capture. If you don’t measure it, you can’t see if it’s making an impact. I brought my experiences from Ghana to the monitoring and evaluation team at Gavi, the Vaccine Alliance, where I coordinated multi-country, multi-year, prospective full-country evaluations before joining FIND. I hold a Master of Global Public Health and the Global WACh Graduate Certificate in Integrated Health of Women, Adolescents and Children from the University of Washington, USA.
Can you tell us a little more about FIND? Why are diagnostics so important?
FIND is a global non-profit organization that drives innovation in the development and delivery of diagnostics to combat major diseases affecting the world’s poorest populations. It is astounding to see how often diagnostics do not exist, are inaccessible, or cost too much. This needs to change: not only do diagnostics tell patients what is wrong with them, they allow patients to be linked to the right treatment. Plus they are essential to a fully functional health system for many reasons, including surveillance to detect disease patterns and inform public health decisions. Diagnostics also play an important role in the research and development of drugs and vaccines.
What is the HEAD-Start project all about?
Hepatitis C is an emergency – 4 out of 5 people with the virus are unaware that they have it, and the mortality rate is rising. Diagnostics exist but they are generally limited to specialist laboratory use, and not getting to the people who need them. A complicating factor is that hepatitis C predominantly affects at-risk or marginalized populations, like people living with HIV, and those who inject drugs. Our HEAD-Start project, funded by Unitaid, is working to improve diagnosis of hepatitis C by simplifying the testing process and making diagnostics more affordable and more widely available. We’re aiming to generate data that will help to drive a change in global implementation guidelines and national policies in support of the World Health Organization elimination targets for 2030.
Malaysia has declared hepatitis C to be a national health priority. How is HEAD-Start contributing to Malaysia’s efforts to tackle this disease?
The Malaysian government is showing the world how to tackle hepatitis C – we believe Malaysia should be a model and source of inspiration that other countries in the region can look to as they scale up their own HCV responses. It was therefore really important for us to include Malaysia in HEAD-Start, and it is the only high-middle-income country covered by the project. Earlier this year we signed a Memorandum of Understanding with CRM to collaborate in the research and development of an innovative hepatitis C diagnostic testing strategy that we hope will lead to more cost efficient and earlier detection of hepatitis C.
Can you elaborate on the diagnostic challenges for hepatitis C?
In many countries, including Malaysia, health services are largely centralized – which broadly speaking means diagnostic services for hepatitis C are available in hospitals or laboratories, but not at the primary care level or in community healthcare settings where people first access health services. HIV testing sites offer some of the most accessible testing services, and we believe that integrating hepatitis C diagnostics into this existing infrastructure could be a game-changer for reaching people with hepatitis C/HIV coinfections, in addition to those who inject drugs.
What does that mean in practice? How will you make tests available in primary healthcare settings and what will happen to those who get a positive diagnosis?
We are working to demonstrate the feasibility of using new, rapid diagnostic tests in decentralized primary healthcare facilities, and provide technical assistance to the Malaysian Ministry of Health for their implementation. This work is being conducted in partnership between FIND and the Drugs for Neglected Diseases initiative (DNDi). Both FIND and DNDi are product development and delivery partnership organizations, so it’s in our DNA to value collaboration on projects that facilitate equitable development along the entire care cascade. People who test positive for hepatitis C will be offered treatment in one of two ways. They can either join an ongoing DNDi clinical trial, which is co-sponsored by the Malaysian Ministry of Health and designed to assess the efficacy and safety of a new, alternative treatment regimen combining sofosbuvir with the investigational drug ravidasvir. Initial results from the first stage of this trial have indicated extremely high cure rates, including hard-to-treat cases. Alternatively, they will enter the Malaysian national hepatitis C programme, which now offers free treatment (sofosbuvir/daclatasvir) in 22 government hospitals.