Hepatitis elimination by 2030 in doubt as countries fail to scale up diagnosis and treatment

Keith Alcorn
24 April 2019

Most countries will struggle to eliminate hepatitis C by 2030 due to lack of investment and political will, missing an internationally agreed target set by the World Health Organization, The International Liver Congress in Vienna heard earlier this month.

“Despite the progress we’ve seen, we’re clearly not going to make it,” said Gottfried Hirnschall, Director of HIV and Hepatitis at the World Health Organization (WHO), speaking at a symposium on elimination of viral hepatitis organised by WHO.

The World Health Assembly agreed ambitious targets for elimination of viral hepatitis in 2016. Countries pledged to scale up prevention, diagnosis and treatment so that deaths caused by viral hepatitis would be cut by 65% and new infections cut by 90%

Although 124 countries now have national plans for viral hepatitis elimination, 42% of plans have no domestic funding, Mark Bulterys, head of WHO’s hepatitis team told the symposium.

Furthermore, although 5 million people had been treated with direct-acting antivirals (DAAs) by the end of 2017, most of these treatments occurred in ten ‘champion countries’ which have scaled up treatment quickly, including Egypt, Brazil and Australia.

Even in higher-income countries, hepatitis C elimination may only be achieved by a handful of countries by 2030, the Center for Disease Analysis estimates. Nine countries – Australia, France, Iceland, Italy, Japan, South Korea, Spain, Switzerland and the United Kingdom – will achieve elimination by 2030 at current rates of diagnosis and treatment.

Elimination may not occur before 2050 in Canada, the United States and smaller European countries, the modelling exercise found. Two-thirds of higher-income countries are seriously off-track, the Center for Disease Analysis reported.

Despite dramatic reductions in the prices of generic versions of DAAs to less than $100 per cure, some lower-income countries are still paying substantially higher prices although they are eligible for low-price drugs under voluntary licensing agreements. Sixty-two per cent of people with hepatitis C live in countries covered by these agreements, which allow generic versions of DAAs manufactured under voluntary licence from the originator company to be imported from countries such as India or Egypt.

WHO has calculated how much it will cost to eliminate hepatitis C by 2030. Its model, developed by Dr Melikha Toy of Stanford University, estimates that it will cost $58.8 billion to achieve elimination of viral hepatitis by 2030, slightly higher than the estimate presented by Professor Margaret Hellard of the Burnet Institute, Melbourne, on the opening day of the conference.

But Dr Toy said that the cost of elimination could be considerably lower if drug prices fall rapidly, if countries use voluntary licensing arrangements to obtain low-cost drugs, and if the cost of diagnostics falls, especially hepatitis B DNA testing. A large part of the cost of elimination will be the cost of HBV DNA monitoring, and much of the cost of elimination will be concentrated in the Western Pacific region and Africa due to the high burden of hepatitis B in those regions, she said.

The cost of elimination would add 1.5% to the total budget for universal health coverage proposed by WHO in 2017. The budget set out how much it would cost to achieve the Sustainable Development Goals for health by 2030 through universal health coverage in 67 lower- and middle-income countries. Hepatitis diagnosis and treatment was not included in that costing.

“If you look at data, and ask, ‘what is hepatitis achieving in the context of universal health coverage’, it’s just about getting off the ground,” Dr Gottfried Hirnschall told infohep in an interview.

“We hear about Egypt, Mongolia, Georgia, China, Brazil, but there are many other countries that are not moving yet. There are whole continents that are falling behind, Africa when it comes to hepatitis B, and for hepatitis C some of the larger high burden countries are not moving sufficiently – Russia for example, and China still has a long way to go despite some positive momentum that has been building up.”

“A movement has been created, the momentum has been sparked, the feasibility has been demonstrated in some countries but too many others are still looking across the fence and finding easy excuses for not doing it.”

To maintain a positive trajectory and accelerate it, advocacy will still be needed. We must not give the impression that HIV is almost done, and we must encourage countries to factor those services into a broader health financing approach, and we see that in some countries, such as Thailand.

“In hepatitis, we have to demystify that management is highly complex and can only be done by hepatologists – we are here at a hepatology conference and we need to convince them, ‘it’s not just your job, it can be done by any general practitioner’ and in some low-income settings it could be simplified further, which is what we’ve seen in HIV.”

Read more at : http://www.infohep.org/page/3478324/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English&fbclid=IwAR3cidqV0T8sSNjm2w_TeW9IA904gmGI5DJopHfsobf1xqogHcrQOxJEFsQ

Reaching people who inject drugs and people in prisons – a must for hepatitis C elimination

1 May 2019, PORTO – The World Health Organization (WHO) is calling for greater commitments to scale up hepatitis C virus (HCV) testing and treatment services to people who inject drugs (PWID) and people in prisons (PIP).

Group of young men sitting and discussing

Médecins du Monde

Around 71 million people are infected with chronic HCV worldwide with PWID being disproportionately affected. They account for the highest proportion of new infections – 23% of the 1.75 million infections that occur every year. As for PIP, up to 1 in 4 can be HCV positive. The elimination targets set by WHO aim to diagnose 90% and treat 80% of all eligible persons by 2030.

Today at the Harm Reduction International Conference (HR19), WHO is releasing a new policy brief “Access to hepatitis C testing and treatment for PWID and people in prisons – a global perspective”. The policy brief looks at the global landscape of national hepatitis plans and country experiences, showcasing some of the gains and gaps in reaching PWID and PIP with HCV services.

New findings

The policy brief outlines the following analysis.

  • More countries have developed national hepatitis plans as at February 2019, but many of these plans overlooked the needs of PWID and PIP.
  • Of the 81 national plans and treatment guidelines reviewed by April 2019, 51 (63%) included services for PWID, and 37 (46%) did so in full alignment with the WHO “Global health sector strategy on viral hepatitis, 2016–2021”.
  • 28 (35%) plans and guidelines included services for PIP, and 23 (28%) did so in full alignment with the WHO “Global health sector strategy on viral hepatitis, 2016–2021”.
  • 11 (14%) plans and guidelines specified restrictive requirements such as drug use abstinence (commonly for a period of 6 months or longer) for PWID to be eligible for HCV testing and treatment.
  • Many national plans and guidelines also specify requirements for health insurance coverage, which presents a barrier for PWID and PIP in some countries.

Country snapshots

The policy brief also provides select country experiences:

  • Australia recently published its fifth national strategy (2018–2022) on the path to hepatitis elimination by 2030. The country used a simplified approach to service delivery, integrating hepatitis testing, treatment and harm reduction for PWID at decentralized sites, and engaging peer workers and general doctors. Concerted implementation of HCV testing and treatment in several prisons shows elimination in these settings is possible.
  • China is undertaking development of a national hepatitis plan, which references PWID as a priority population for HCV testing and treatment. The government and health insurance providers are in the process of negotiating lower prices for DAAs – the results of these negotiations will be key to the strategy’s success.
  • India launched a national action plan to combat viral hepatitis in February 2019, targeting PWID as a priority population, aiming to provide 1 000 000 DAA treatment courses annually over the next 3 years.
  • The Islamic Republic of Iran has a 3-year national hepatitis plan that proposes interventions for PWID and PIP. DAAs can be obtained for as little as US $81, but only for people with health insurance. Many PWID and PIP without insurance face a higher cost of US$ 2200.
  • Ukraine is developing a national strategy to contain tuberculosis, HIV and viral hepatitis. Generic DAAs are now available for less than US$ 100. Effective collaboration with the Ministry of Justice enabled HCV testing for 1 000 PIP living with HIV in 2018. Of these people, 50 were treated with DAAs, achieving a 98% completion rate.
  • The United States of America also has a viral hepatitis action plan and policies that target PWID and PIP. But high costs for DAAs (between US$ 15 000 and US$ 94 000) are a major implementation barrier.

Steps for HCV elimination among PWID and PIP

The WHO policy brief calls for greater political will to improve testing and treatment access for these marginalized populations. HCV treatment prices also need to drop further. Reaching PIP with public health services is feasible– and can help achieving HCV elimination within this specific population group.

Reaching PWID and PIP with HCV testing and treatment services as part of a comprehensive harm reduction approach is an essential element of hepatitis elimination efforts and embodies the principles of the Universal Health Coverage (UHC) agenda to ensure that no one is left behind.

Reflecting voices of PWID and PIP and other key and at-risk populations in shaping hepatitis elimination and UHC efforts is a critical step as well. This week, WHO is supporting the participation of 7 key population scholars in multi-stakeholder consultations, in preparation for the UN High-Level Meeting on UHC to take place in September 2019.

Read more at : https://www.who.int/hepatitis/news-events/pwid-prison-hcv-access-story/en/?fbclid=IwAR3Sx303t71KP2WdlNubSzaGAsa6wD5E7DIVLbhleW1BSfieML7Zy7c8JPU

Aku Janji Ubati Hep C

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Malaysian AIDS Council

Salam #Ramadan dan Selamat Berpuasa. Nama saya Basri, saya bertugas sebagai rakan sokong bantu bagi program TAPS (Treatment and Adherence Peer Support) bersama NGO Persatuan Perantaraan Pesakit Kelantan. Saya juga seorang PLHCV (people living with #hepatitis C), saya telah ketahui status saya sejak tahun 2007. Saya mengetahui mengenai rawatan baru DAA #HCV apabila mengikuti workshop bersama MTAAG+. Saya mengalakkan komuniti PWID/PWUD (people who inject drugs/people who use drugs) di Kelantan untuk menjalani saringan dan mendapatkan rawatan HCV yang percuma di fasiliti kesihatan kerajaan. #akujanjiubatiHepC