Progress and difficulties in the elimination of HCV infection: A population-based cohort study in Spain

Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain 

Regina Juanbeltz, Alejandra Pérez-García, Aitziber Aguinaga, Iván Martínez-Baz, Itziar Casado, Cristina Burgui, Silvia Goñi-Esarte, Jesús Repáraz, José Manuel Zozaya, Ramón San Miguel, Carmen Ezpeleta, Jesús Castilla

Published: December 4, 2018
https://doi.org/10.1371/journal.pone.0208554 

Full-text article available online: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208554

Abstract 

Background
The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain.

Methods
Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period.

Results
At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950–1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels.

Conclusions
The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary.

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Efforts to Eliminate Hepatitis C

Hepatitis C: is eradication possible?

Reviews
Hepatitis C: is eradication possible? 
Andrea Lombardi Mario U. Mondelli ESCMID Study Group for Viral Hepatitis (ESGVH)

First published: 25 November 2018
https://doi.org/10.1111/liv.14011 

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. 

Please cite this article as doi: 10.1111/liv.14011

Abstract

Hepatitis C has a relevant global impact in terms of morbidity, mortality and economic costs, with more than 70 million people infected worldwide. In the resolution “Transforming our world: the 2030 Agenda for Sustainable Development” was included as a focus area in the health‐related goal with world leaders pledging to ‘combat’ it by 2030. In response, WHO drafted the Global Viral Hepatitis Strategy carrying the ambitious targets to reduce the number of deaths by two thirds and to increase treatment rates up to 80%. Despite the availability of highly effective therapeutic regimens based on direct acting antivirals many barriers to HCV eradication still remain. They are related to awareness of the infection, linkage to care, availability of the therapeutic drug regimens and reinfection. Overall, if an effective prophylactic vaccine will not be available, HCV eradication appears difficult to achieve in the future....

Key points:
DAA availability increased hope of HCV elimination and WHO defined that as a goal to be achieved by 2030. 

DAAs proved to efficiently eliminate HCV in specific settings/populations, but economical and logistic reasons make extremely difficult to apply this approach globally. 

A therapeutic vaccine is considered essential to reliably target HCV eradication.

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We Cured Hepatitis C - Now The Work Begins: Finding Neglected Patients

Conference Coverage:
MedPage Today
Twitter @medpagetoday

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IDSA Video Conference Reporter: AASLD 2018
Watch exclusive comments from study authors and discussants at AASLD 2018

One Health System's Efforts to Eliminate Hepatitis C
Douglas Dieterich, MD



Topics Of Interest 
Treatment for Non-alcoholic Fatty Liver Disease
Emerging Therapies in Ongoing NASH Studies

What a Clinician is Looking for in New NASH Tx

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Hepatitis C in the UK – the path to elimination

Rachel Halford
Chief Executive
The Hepatitis C Trust
Tweet @HepatitisCTrust
www.hepctrust.org.uk

Hepatitis C in the UK – the path to elimination
14th November 2018
Following an 11% fall in hepatitis C-related deaths between 2016 and 2017, Rachel Halford makes the case for a national strategy to eliminate hepatitis C in the UK.

In May 2016, the UK joined 193 other countries in committing to eliminate viral hepatitis C globally by 2030, as part of the World Health Organization’s Global Health Sector Strategy on Viral Hepatitis. This commitment marked a watershed moment in the fight against hepatitis C, a blood-borne virus which primarily affects the liver. Earlier this year, NHS England went even further and announced a target of elimination of hepatitis C in the UK by 2025.

Globally, it is estimated that 71 million people are infected with chronic hepatitis C, including around 210,000 in the UK. Hepatitis C disproportionately affects disadvantaged and marginalised communities in the UK, including injecting drug users, homeless people, prisoners and certain migrant communities.
Opportunities and challenges in the fight against hepatitis C in the UK

To monitor the UK’s progress towards eliminating hepatitis C as a major public health threat, Public Health England produces an annual ‘Hepatitis C in the UK’ report. The latest edition, released in August 2018, highlighted some positive developments, with an 11% fall in hepatitis C-related deaths between 2016 and 2017, following on from a 3% fall in deaths the previous year. More people are accessing treatment for hepatitis C in the UK than ever before, with 14,348 accessing treatment in the UK in 2017/18, more than double pre-2015 levels.

This encouraging progress follows the arrival in 2014 of the new direct acting antiviral (DAA) treatments for hepatitis C, which offer a significant improvement on the old, interferon-based treatments. Whereas the old treatments required a course of injections over a 48-week period and had significant side effects and low cure rates, the new DAA treatments are taken orally for 8-12 weeks, have very few side effects and cure around 95% of patients.

The new treatments have revolutionised hepatitis C care, making treatment both more effective and accessible.

However, in other regards the 2018 ‘Hepatitis C in the UK’ report made less encouraging reading. The report revealed no significant reduction in overall prevalence of hepatitis C or in numbers of new infections, which suggests that the WHO target of reducing new cases of chronic hepatitis C by 30% by 2020 and 80% by 2030 represents a significant challenge for UK hepatitis C prevention and treatment services

In addition to the lack of progress in reducing prevalence and incidence rates, it is estimated that around 40-50% of those infected with chronic hepatitis C in the UK remain undiagnosed. As the ‘Hepatitis C in the UK’ report notes, meeting the WHO goal of a 65% reduction in mortality from hepatitis C depends on sustaining the current improvements in the numbers of people accessing treatment, which in turn is dependent on capacity to find and treat those who remain undiagnosed, and to re-engage those diagnosed but not treated.

Addressing these ongoing issues will require a range of actions, and it is The Hepatitis C Trust’s view that a comprehensive, written national hepatitis C elimination strategy is needed to co-ordinate the various actors and actions needed to achieve elimination by 2030 at the latest, a view shared by the All-Party Parliamentary Group on Liver Health, leading clinicians, patient organisations and industry. Such a strategy should cover the approach to raising awareness of hepatitis C, preventing new infections, and increasing testing and treatment rates, with some of the key issues that must be addressed outlined below.
We must boost awareness

It is vital that awareness of hepatitis C transmission risks is increased among at-risk groups and the wider public. A government-led awareness campaign, comparable to the approach taken to HIV in the 1980s, could help to raise awareness of hepatitis C among the general public. The use of peer programmes, whereby former patients deliver talks and provide support to those with a background similar to their own, are a particularly effective way of increasing awareness among at-risk groups, and The Hepatitis C Trust is actively involved in delivering peer support in substance misuse services and prisons. Increasing awareness of hepatitis C transmission risks is a vital tool in both preventing new infections and finding undiagnosed patients.

As well as increasing awareness among at-risk groups and the wider public, more needs to be done to increase knowledge of hepatitis C among healthcare professionals. The Hepatitis C Trust’s helpline still too often hears stories of patients going years without being diagnosed, despite presenting to their GP with symptoms that should have led to the offer of a hepatitis C test. To support efforts to increase awareness of hepatitis C among key healthcare professionals, The Hepatitis C Trust co-ordinates HCV Action, a network for hepatitis C professionals, which holds roadshows and public health meetings, produces resources and circulates examples of best practice. However, other measures could help to further support professional knowledge of hepatitis C, such as the circulation of key hepatitis C-related information and resources by Public Health England and clinical commissioning groups and ongoing hepatitis C training opportunities for healthcare professionals.
We must strengthen prevention efforts

Preventing new infections of hepatitis C is also key to achieving the elimination goal. Whilst increased awareness of hepatitis C transmission risks can support prevention efforts, there is also a need for greater harm reduction services for those at risk. For example, the provision of sterilised injecting equipment and support transitioning to opioid substitution treatment (OST) is crucial in reducing transmission between injecting drug users, which accounts for around 95% of new hepatitis C infections in the UK. With the 2018 ‘Hepatitis C in the UK’ report highlighting suboptimal provision of clean injecting equipment across the UK, a greater emphasis on harm reduction is key to preventing new infections and must be supported in the commissioning and funding of services for injecting drug users.

Innovative approaches to preventing new infections should also be explored. Drug consumption rooms, for example, offer the opportunity to support injecting drug users with harm reduction and have been successfully implemented in a number of European countries. Another innovative prevention strategy is the ‘treatment as prevention’ approach, which involves treating large numbers of actively injecting drug users and others still engaged in risky behaviours to halt further transmissions. This approach is currently being trialled by NHS Tayside in Scotland, with models indicating that a reduction of hepatitis C among those injecting drugs from over 30% to below 10% would result in a corresponding decline in transmission from 10% to below 1%, leading to effective elimination of the virus. Should such an approach be proved to be effective, it should be implemented across the UK.
We must improve and prioritise testing and diagnosis

A rapid expansion of testing will also be needed to ensure sufficient numbers of patients are diagnosed and enrolled into treatment. There are a number of measures that can be taken to improve the approach to testing in key settings. For example, ‘opt-out’ testing of clients should be introduced in substance misuse services, with monitoring systems and targets for test offers and uptake included in commissioning contracts. In prisons, another high-prevalence setting, an opt-out testing policy is already in place, but more needs to be done to ensure effective implementation, including guidance and training for prison healthcare teams. Just as importantly, re-testing must take place regularly in high-prevalence settings, to ensure new infections are picked up.

There are a number of other settings in which hepatitis C testing should be prioritised, including pharmacies, homeless hostels, mosques and A&E departments. Pharmacies are a particularly important setting, with many current or former injecting drug users accessing them to collect clean needle and syringes or OST. Interim results from an ongoing pilot project by the London Joint Working Group on Substance Use and Hepatitis C have shown community pharmacies to be an effective setting for finding those with an undiagnosed infection of hepatitis C, with results from the first six weeks of testing in six London pharmacies showing a 50% hepatitis C antibody positive rate among those tested, with 47% of these previously undiagnosed.
We must expand access to treatment

As the ‘Hepatitis C in the UK’ report notes, achieving the WHO target of a 65% reduction in hepatitis C deaths by 2030 will depend upon sustaining current improvements in numbers accessing treatment. With most patients in touch with services having now been treated, there is a pressing need to find undiagnosed patients so that they can receive treatment. In support of its target of elimination by 2025, NHS England is currently engaged in negotiations with industry to agree a new funding approach to hepatitis C treatments. If agreed, such a deal is expected to cap the cost of treatments to the NHS above a certain threshold and include a role for industry in case finding. This is a positive step, but The Hepatitis C Trust believes that there must be central co-ordination to ensure a strategic and equitable approach to case finding and treatment.

Engaging more patients in treatment will also require treatment to be made available in settings most convenient to patients. Making treatment available in community settings such as pharmacies, substance misuse services, sexual health clinics, homeless hostels and GP surgeries supports patients to engage with treatment and can be particularly beneficial for patients who traditionally have difficulty accessing secondary care services.

Elimination is possible, but more action is needed

Considerable progress has been made in relation to hepatitis C in recent years. Achieving elimination by 2030 (or even by 2025) is feasible, but it will require the mobilisation and co-ordination of a range of actors. Despite this, the government maintains that it has no plans to publish an elimination strategy. With the prospect of a new funding deal offering the opportunity to treat many more patients, it essential that a national strategy is developed and implemented to ensure the opportunity to eliminate hepatitis C as a public health threat in the UK is seized.

Rachel Halford
Chief Executive
The Hepatitis C Trust
Tweet @HepatitisCTrust
www.hepctrust.org.uk

Egyptian experience, achievements and limitations towards HCV elimination

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In The Journals 
World J Gastroenterol. Oct 14, 2018; 24(38): 4330-4340
Published online Oct 14, 2018. doi: 10.3748/wjg.v24.i38.4330

Towards hepatitis C virus elimination: Egyptian experience, achievements and limitations
Dalia Omran, Mohamed Alboraie, Rania A Zayed, Mohamed-Naguib Wifi, Mervat Naguib, Mohamed Eltabbakh, Mohamed Abdellah, Ahmed Fouad Sherief, Sahar Maklad, Heba Hamdy Eldemellawy, Omar Khalid Saad, Doaa Mohamed Khamiss, Mohamed El Kassas

Worldwide, more than one million people die each year from hepatitis C virus (HCV) related diseases, and over 300 million people are chronically infected with hepatitis B or C. Egypt used to be on the top of the countries with heavy HCV burden. Some countries are making advances in elimination of HCV, yet multiple factors preventing progress; remain for the majority. These factors include lack of global funding sources for treatment, late diagnosis, poor data, and inadequate screening. Treatment of HCV in Egypt has become one of the top national priorities since 2007. Egypt started a national treatment program intending to provide cure for Egyptian HCV-infected patients. Mass HCV treatment program had started using Pegylated interferon and ribavirin between 2007 and 2014. Yet, with the development of highly-effective direct acting antivirals (DAAs) for HCV, elimination of viral hepatitis has become a real possibility. The Egyptian National Committee for the Control of Viral Hepatitis did its best to provide Egyptian HCV patients with DAAs. Egypt adopted a strategy that represents a model of care that could help other countries with high HCV prevalence rate in their battle against HCV. This review covers the effects of HCV management in Egyptian real life settings and the outcome of different treatment protocols. Also, it deals with the current and future strategies for HCV prevention and screening as well as the challenges facing HCV elimination and the prospect of future eradication of HCV.

Full-text article-

https://www.wjgnet.com/1007-9327/full/v24/i38/4330.htm

Localized US Efforts to Eliminate Hepatitis C

Localized US Efforts to Eliminate Hepatitis C
https://doi.org/10.1016/j.idc.2018.02.009 

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Elimination of Hepatitis C Virus in Australia: Laying the Foundation

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Elimination of Hepatitis C Virus in Australia: Laying the Foundation
Gregory J. Dore BSc, MBBS, MPH, FRACP, PhD Behzad Hajarizadeh MD, MPH, PhD

https://doi.org/10.1016/j.idc.2018.02.006

INTRODUCTION
The development of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is one of the great advances in clinical medicine in recent decades. Involving simple (once daily oral dosing), tolerable, short duration (8–12weeks), and highly efficacious (cure rates of >95%) regimens, DAA therapy has the potential to markedly increase HCV treatment uptake and turn around the escalating global disease burden associated with chronic HCV infection.1 The transformative nature of DAA therapy underpinned the development of World Health Organization(WHO) goals to eliminate HCV as a public health threat, which include 80% of eligible patients treated, a 65% decrease in HCV-related mortality, and an 80% decrease in new HCV infections by 2030.

KEY POINTS
-Australia has laid the foundation for hepatitis C virus elimination within the next decade.
-Key aspects of this foundation include high levels of screening and diagnosis, unrestricted access to direct-acting antiviral therapy, a diverse range of models of care, and high coverage of harm reduction strategies.
-Key features include government risk-sharing arrangement with the pharmaceutical companies, minimal out-of-pocket cost, no restrictions based on liver disease stage or drug/ alcohol use, prescribing authorization for all registered medical practitioners; and retreatment is allowed.
-Although initial uptake of direct-acting antiviral therapy was high, more efforts are required to continue the momentum.
-An hepatitis C virus elimination monitoring and evaluation program is in progress to inform further strategies required to achieve hepatitis C virus elimination targets

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Hepatitis C: Key elements for successful European and national strategies to eliminate HCV in Europe

J Viral Hepat. 2018 Mar;25 Suppl 1:6-17. doi: 10.1111/jvh.12875.

Special Issue: Summit review: HCV Policy Summit Hepatitis C: The Beginning of the End - Key elements for successful European and national strategies to eliminate HCV in Europe

COMMISSIONED REVIEW
Hepatitis C: The beginning of the end—key elements for successful European and national strategies to eliminate HCV in Europe
Authors G. V. Papatheodoridis, A. Hatzakis, E. Cholongitas, R. Baptista-Leite, I. Baskozos, J. Chhatwal, M. Colombo, H. Cortez-Pinto, A. Craxi, D. Goldberg, C. Gore, A. Kautz, J. V. Lazarus, L. Mendão, M. Peck-Radosavljevic, H. Razavi, E. Schatz, N. Tözün, P. van Damme, H. Wedemeyer, Y. Yazdanpanah, F. Zuure, M. P. Manns

First published: 6 March 2018
Full publication history DOI: 10.1111/jvh.12875

Full Text
http://onlinelibrary.wiley.com/doi/10.1111/jvh.12875/full

Abstract
Hepatitis C virus (HCV) infection is a major public health problem in the European Union (EU). An estimated 5.6 million Europeans are chronically infected with a wide range of variation in prevalence across European Union countries. Although HCV continues to spread as a largely "silent pandemic," its elimination is made possible through the availability of the new antiviral drugs and the implementation of prevention practices. On 17 February 2016, the Hepatitis B & C Public Policy Association held the first EU HCV Policy Summit in Brussels. This summit was an historic event as it was the first high-level conference focusing on the elimination of HCV at the European Union level. The meeting brought together the main stakeholders in the field of HCV: clinicians, patient advocacy groups, representatives of key institutions and regional bodies from across European Union; it served as a platform for one of the most significant disease elimination campaigns in Europe and culminated in the presentation of the HCV Elimination Manifesto, calling for the elimination of HCV in Europe by 2030. The launch of the Elimination Manifesto provides a starting point for action in order to make HCV and its elimination in Europe an explicit public health priority, to ensure that patients, civil society groups and other relevant stakeholders will be directly involved in developing and implementing HCV elimination strategies, to pay particular attention to the links between hepatitis C and social marginalization and to introduce a European Hepatitis Awareness Week.

For Viral Hepatitis Elimination One Size Does Not Fit All

Health Is Global

A blog about Global Health. An open space for discussing equitable access to health for everyone, everywhere.

For Viral Hepatitis Elimination One Size Does Not Fit All
Jeffrey Lazarus

12 February 2018

“For elimination, one size does not fit all” was a refrain repeated in a number of different ways throughout the presentations and discussions at the European Association for the Study of the Liver (EASL) Monothematic conference on “Striving towards the elimination of HCV infection” that has just come to a close in Berlin.

Whether in discussions about prevention, interventions in drug users, improving linkage to care, or treatment itself, attendees agreed that there is no golden ticket for hepatitis C elimination. However, there are a number of evidence-based strategies for impact that were presented very effectively by over 30 speakers in the six thematic panel sessions.

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England could become first country to eradicate Hepatitis C in 2025

England could become first country to eradicate Hepatitis C in 2025

England could be the first country in the world to eliminate Hepatitis C, under ambitious plans announced by the NHS today.

NHS leaders today called on the pharmaceutical industry to work with them to provide best value for money for treatments so that in its 70th year, the NHS can commit to eliminating Hepatitis C in England at least five years earlier than the World Health Organisation goal of 2030.

Hepatitis C is currently a significant public health issue globally, accounting for around 400,000 deaths per year. Most recent figures show that Hepatitis C is affecting 160,000 people in England.

The NHS has invested in Hepatitis C treatment each year as new treatments became available to improve outcomes for people with the virus but doctors, patient groups and NHS leaders believe it is possible to go further and is encouraging pharma companies to work with them to meet this more ambitious target.

The next round of procurement, which launches in February, is the single largest medicines procurement ever done by the NHS, and NHS England expects to see more new treatments curing even more patients by October. Over 25,000 patients have already been treated to date and this number is expected to rise to 30,000 later this year, prioritising the sickest patients first.

Part of the new agreements between NHS England and drug companies will involve collaboration to identify more people who are living with Hepatitis C who need to be treated. Experts have predicted that this approach, combined with the NHS sustaining the same level of investment and the best new treatments being used could undoubtedly lead to Hepatitis C being eradicated as a major public health concern in the very near future.

England is one of few countries in Europe where numbers of patients receiving new oral treatments for Hepatitis C are already increasing year on year, enabled by deals previously agreed with industry. The deals, including ‘pay per cure’ where the NHS only pays when a patient is cured and a focus on prioritising the sickest patients, have led to a 10% reduction in the number of deaths and the numbers of patients needing a liver transplant have reduced by 50%.

Further progress to date in the treatment of Hepatitis C includes:
The creation of 22 ‘operational delivery networks’ in each area in England – driving improvements in treatment in local areas, ensuring all patients can access the treatment they need, regardless of where they live. This will enable improvements in areas with historically low service provision.
In 2017 a National Hepatitis C patient registry was established – making it possible to record and monitor treatment uptake, outcomes and increased diagnosis rates in real time.

Professor Graham Foster, National Clinical Chair for Hepatitis C, NHS England, said:

“The progress made in the treatment of Hepatitis C has transformed the lives of many of my patients and has been made possible by NHS England working closely with industry to bring prices down and expand treatment options. Yet we have the opportunity to do so much more. Over the last seven decades, the NHS has been at the forefront of medical innovation – to be able to commit to a world first in the year of the NHS’ 70th anniversary would be another remarkable and truly historic achievement.”

Peter Huskinson, National Commercial Director, NHS England, said:

“The NHS has made major headway in the last three years in the treatment of Hepatitis C, which has enabled a once in a generation opportunity to eliminate a major disease. With the right response from pharma companies in the coming months, we can strike the most competitive deal possible – improving the future for patients with Hep C alongside securing the best value for money for taxpayers.”

Charles Gore, CEO of The Hepatitis C Trust, the national Hepatitis C charity, said:

“This is wonderful news. It is exactly what is needed. The proposed deal will galvanise the action we must take to find all those living with Hepatitis C who have not yet been diagnosed so that we can cure them. It will prevent the liver cancer that Hepatitis C causes. It will save lives. In the current environment we applaud NHS England’s ambition to be a world leader.”

Judi Rhys, Chief Executive of the British Liver Trust, said:

“We are delighted that NHS England are playing a leading role in tackling Hepatitis C and eliminating this deadly virus. A key challenge will be the fact that hep C often has no symptoms in the early stages and it is thought that less than half of those living with the virus have been diagnosed. It is therefore vital that anyone who is at risk asks to be tested.”

https://www.england.nhs.uk/2018/01/hepatitis-c-2/

The Hepatitis C Trust launches 'Eliminating Hepatitis C in Scotland' report

The Hepatitis C Trust has today launched a new report, ‘Eliminating Hepatitis C in Scotland: A Call to Action’. The report follows an inquiry conducted by The Hepatitis C Trust and the cross-party Scottish Hepatitis C Parliamentary Champions group over the course of 2017, which involved oral evidence sessions and the submission of written evidence by individuals and organisations working across the hepatitis C patient pathway.

On the basis of this evidence, The Hepatitis C Trust produced the ‘Eliminating Hepatitis C in Scotland’ report, which looks in detail at Scotland’s approach to hepatitis C, including:

• Elimination strategy

• Awareness

• Prevention

• Testing and diagnosis

• Linkage to care

• Access to treatment

• Funding

The report calls on the Scottish Government to produce a hepatitis C elimination strategy, with ambitious targets to decrease national incidence, mortality and overall prevalence. Additional recommendations on awareness-raising, prevention, testing and treatment are contained in the report, and include calls for:

• An introduction of opt-out testing for hepatitis C in substance misuse services, with commissioning contracts stipulating clear mechanisms to hold services to account for failures to meet testing targets.
• National guidance to be issued on effective implementation of opt-out testing in prisons.
• Treatment cost reductions to be reinvested into additional treatments or services to ensure access to treatment is available to all who need it.
• The Scottish Government to explore alternative treatment funding models offering the opportunity to rapidly increase the number of patients receiving treatment.

Charles Gore, Chief Executive of The Hepatitis C Trust said: “Without renewed efforts to find and treat the thousands of undiagnosed patients living with hepatitis C, Scotland may no longer be considered a world leader in tackling this deadly virus.

Eliminating a public health issue that disproportionately affects some of the poorest and most marginalised groups in our society is an extraordinary and eminently achievable opportunity which should be seized with both hands.”

The full report can be accessed here. 

How the elimination of HCV in England could become a reality

PharmaTimes

How the elimination of HCV in England could become a reality

Dr Andrew Ustianowski

Hepatitis C virus (HCV) infection is a significant public health issue in England, but one which the World Health Organization (WHO) has announced can be eliminated within a generation. New direct-acting antiviral curative treatments have been available in the UK since 2015, which means that theoretically it is possible to meet the WHO target and eliminate a disease which currently is a heavy burden on patients, carers and the health system. However, although England has pledged support for the WHO initiative, without a formal elimination strategy in place it is going to be difficult to meet this aim.

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Hepatitis C: analysis of cures versus new infections in 91 countries

Review

The road to elimination of hepatitis C: analysis of cures versus new infections in 91 countries
Andrew M Hill, Sanjay Nath, Bryony Simmons 

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Published July, 2017

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Abstract
Background

Hepatitis C (HCV) can only be eradicated if annual rates of cure (SVR) are consistently and significantly higher than new HCV infections, across many countries. In 2016, the WHO called for a 90% reduction in new HCV infection by 2030. Direct-acting antivirals (DAA) can cure the majority of those treated, at around 90% in most populations, at potentially very low prices. We compared the net annual change in epidemic size across 91 countries using data on SVR, new HCV infections, and deaths. In a further 109 countries, we projected this figure using regional averages of epidemic size.

Methods

Epidemiological data for 2016 were extracted from national reports, publications and the Polaris Observatory. There were 91/210 countries with data on SVR, HCV-related deaths and new infections available for analysis; 109 countries had net change in epidemic size projected from the regional prevalence of HCV, extrapolated to their population size. ‘Net cure’ was defined as the number of people with SVR, minus new HCV infections, plus HCV-related deaths in 2016.

Results

For the 91 countries analysed, there were 57.3 million people with chronic HCV infection in 2016. In the remaining 109 countries, the projected epidemic size was 12.2 million, giving a global epidemic size of 69.6 million. Across the 91 countries, there was a fall from 57.3 to 56.9 million people in 2017, a 0.7% reduction. The projected global net change was from 69.6 to 69.3 million, a 0.4% reduction. Ten countries had at least five times more people reaching SVR than new HCV infections, including Egypt and USA. In 47/91 countries, there were more HCV infections than SVR in 2016.

Conclusion

Very few countries are on target to achieve elimination of HCV as a public health problem by 2030. While the North American, North African/Middle East and Western European regions have shown small declines in prevalence, the epidemic is growing in sub-Saharan Africa and Eastern Europe. Far higher rates of DAA treatment are required for worldwide elimination of HCV.

Full text article online

Taking stock: Where does Europe stand in the elimination of hepatitis B and C?

Taking stock: Where does Europe stand in the elimination of hepatitis B and C?
02 Mar 2017
In 2016, a regional action plan for Europe contributing to the implementation of the global viral hepatitis elimination strategy was developed by the WHO Regional Office for Europe. In an article published today in Eurosurveillance, the authors take a closer look how Europe is doing according to the ten indicators and targets outlined in this plan. In short: Europe still has some way to go if it wants to eliminate viral hepatitis by 2030.

Core indicators for the World Health Organization’s monitoring and evaluation framework for hepatitis B and hepatitis C virus elimination 2016–2021

Around 10 million Europeans live with chronic hepatitis B or C
It is estimated that just under 10 million Europeans from European Union and European Economic Area (EU/EEA) countries are infected with chronic hepatitis B and C infection - most of them without knowing it as viral hepatitis is largely asymptomatic. In light of this, the regional WHO action plan from 2016 can be an important driver to help European countries in their fight against the hepatitis B and C epidemics.

The authors of the article "Towards elimination of hepatitis B and C in European Union and European Economic Area countries: monitoring the World Health Organization's global health sector strategy core indicators and scaling up key interventions" agree that "European countries have already made progress in recent years implementing primary and secondary prevention measures. Indeed, measures aimed at reducing injecting-drug-related harm among people who inject drugs, such as OST (opioid substitution treatment) and NSP (needle and syringe programmes), now reach many of those who need them [such as people who inject drugs, migrants or men who have sex with men] and most countries have in place a hepatitis B vaccination programme with high levels of coverage (95%). These measures have had an impact on the epidemiology of hepatitis B and C." This impact mainly affects the incidence of new infections argues the article.

But only if those that are already infected with viral hepatitis are identified and linked to treatment and care will a drop in mortality also be possible - at a time when an estimated 96 000 Europeans die from hepatitis-related liver disease each year.

Learning from HIV continuum of care?
However, the authors from ECDC, the European Centre for Drugs and Drug Addiction (EMCDDA) and the WHO Regional Office for Europe found in their analysis of the epidemiological and programmatic indicators of the action plan "that current data sources in most EU/EEA countries are insufficient, particularly for assessing the epidemiological burden and for monitoring the different steps along the cascade of care". Which hampers the successful monitoring of Europe's progress toward elimination of viral hepatitis.

ECDC has been working with the EU/EEA countries to improve the quality of the epidemiological data to get a clearer picture of the burden of viral hepatitis across Europe. Screening, care and treatment of the disease could learn from existing models in HIV, the authors find. With a monitoring approach for interventions including diagnosis and treatment along the continuum of care.

The full article will be published in Eurosurveillance on 2 March 2017.
Provided by: European Centre for Disease Prevention and Control (ECDC)

Duffell EF, Hedrich D, Mardh O, Mozalevskis A.

Towards elimination of hepatitis B and C in European Union and European Economic Area countries: monitoring the World Health Organization’s global health sector strategy core indicators and scaling up key interventions. Euro Surveill. 2017;22(9):pii=30476.

DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.9.30476

Article Source

More information:
Systematic review on hepatitis B and C prevalence in the EU/EEA
ECDC Surveillance Atlas of Infectious Diseases: hepatitis B
ECDC Surveillance Atlas of Infectious Diseases: hepatitis C