Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030

Abstract

Viral hepatitis affects more than 320 million people globally, leading to significant morbidity and mortality due to liver failure and hepatocellular carcinoma (HCC). More than 248 million people (3.2% globally) are chronically infected with hepatitis B virus (HBV), and an estimated 80 million people (1.1% globally) are chronically infected with hepatitis C virus (HCV). In 2015, more than 700 000 deaths were directly attributable to HBV, and nearly 500 000 deaths were attributable to HCV infection; 2-5% of HBV-infected people develop HCC per annum irrespective of the presence of cirrhosis, whereas 1-5% HCV-infected people with advanced fibrosis develop HCC per annum. The rapidly escalating global mortality related to HBV and HCV related viral hepatitis to be the 7th leading cause of death worldwide in 2013, from 10th leading cause in 1990. Australia, New Zealand, and Pacific Island Countries and Territories fall within the World Health Organization Western Pacific Region, which has a high prevalence of viral hepatitis and related morbidity, particularly HBV. Remarkably, in this region, HBV-related mortality is greater than for tuberculosis, HIV infection, and malaria combined. The region provides a unique contrast in viral hepatitis prevalence, health system resources, and approaches taken to achieve World Health Organization global elimination targets for HBV and HCV infection. This review highlights the latest evidence in viral hepatitis epidemiology and explores the health resources available to combat viral hepatitis, focusing on the major challenges and critical needs to achieve elimination in Australia, New Zealand, and Pacific Island Countries and Territories.

Point-of-Care Tests for Hepatitis B: An Overview

“…Laboratory blood tests are required at every step of the care cascade, including blood tests for hepatitis B serology, quantitative hepatitis B virus (HBV) DNA level by polymerase chain reaction (PCR) and liver function tests ( Figure 1 ). These tests require laboratory resourcing, technology and expertise beyond existing peripheral laboratory capabilities in many low-resource and geographically isolated regions [ 14 , 15 , 16 ]. In many countries, laboratory services are centralised due to high costs and limited skilled technician capacity; however, transport of blood samples from regional to centralised laboratories presents its own challenges in geographically isolated or insecure regions, particularly if cold chain supply must be preserved [ 14 ].…”

Liver fibrosis markers as assessed by ultrasound elastography and serum samples: A large comparative study in hepatitis virus B and C liver diseases

“…Fibrotic change in the liver is part of the functional and structural alterations in chronic liver diseases (CLDs) . Persistent hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection are both closely linked to liver fibrosis (LF) progression . Hepatitis B virus and HCV infection are the main etiologies of liver cirrhosis (LC) and liver disease‐associated complications .…”

A global investment framework for the elimination of hepatitis B

“…GAVI has committed to support birth dose vaccination from 2021(59). Among adults, integration of targeted catch-up immunization programmes with other vaccines such as pertussis reduces costs ( 26 , 60 ). Regional pooled procurement could improve hepatitis B immunoglobulin access in LMICs ( 2 ) and tenofovir (TDF) for pregnant women with high viral loads should be incorporated into the essential medicines list.…”

“…International agencies, multilateral organisations, NGOs and donors can support advocacy to address funding gaps to strengthen the community sector and civil society ( 72 , 80 ), leverage funding from donors, provide technical expertise including guidelines and training modules, support investment case development, and support regional approaches to drug and diagnostics procurement, particularly price negotiations ( 60 ). Tools are available to support national activities including the WHO viral hepatitis continuum of care and the monitoring and evaluation framework ( 13 , 78 ).…”