Why One in Three Goes Untreated for Hepatitis C in Bulgaria?

The number of people infected with hepatitis C in Bulgaria is increasing, despite the existence of modern therapies that eliminate the virus and despite the World Health Organization's (WHO) goal to eradicate the disease by 2030.

So why, despite the availability of treatment in Bulgaria—fully covered by the National Health Insurance Fund—are we still losing human lives?

According to the Bulgarian Society of Gastroenterology, hepatitis C claims around 412 lives annually in Bulgaria. This is a tragic failure, especially given that effective therapy is available and reimbursed by the state. Additionally, vaccination against hepatitis B, which provides 100% protection, has drastically declined, putting an entire generation of children at risk.

Silvana Lesidrenska - patient organisation HepActive: "One of the largest reservoirs of the disease are prisoners, whose access to treatment is extremely difficult."

However, not only at-risk groups face difficulties. Access to treatment is hindered by long approval timelines, as well as by frequent and unnecessary hospitalizations for diagnostic tests, which are only available in 15 hospitals across the country. These are largely administrative barriers that have persisted for years without resolution.

Leseidrenska adds:
"To me, the biggest challenge is establishing effective collaboration between all institutions, including the National Health Insurance Fund, which plays a key role in the equation."

At the first stakeholder meeting meant to find common ground, representatives from the NHIF did not attend. Physicians and patient advocates had hoped to remove these systemic obstacles before drafting a new national hepatitis treatment strategy. Support did come, however, from the Bulgarian Medical Association—crucial, especially regarding another pressing issue: unnecessary, costly, and high-risk procedures, such as liver biopsies.

Assoc. Prof. Dr. Radin Tsonev, gastroenterologist at Tokuda University Hospital, stated:
"A liver biopsy is an invasive diagnostic method that always carries risk."

Prof. Dr. Krasimir Antonov, President of the Bulgarian Society of Gastroenterology, added:
"We managed to eliminate liver biopsies for hepatitis C. We’re still fighting to do the same for hepatitis B, but we haven’t succeeded yet."

Silvana Lesidrenska - patient organisation HepActive: "Bulgaria is the only country that continues to insist on performing liver biopsies—at the very least because it's a highly profitable clinical pathway."

The country lacks even reliable statistics on the number of infected and newly diagnosed patients. Coordination among key stakeholders in the healthcare system is also lacking. Falling behind other countries, Bulgaria is now aiming for more modest goals—not elimination, but reduction of hepatitis C by 2030.