How far are we from viral hepatitis elimination service coverage targets?

Abstract

IntroductionIn 2016, the Global Health Sector Strategy (GHSS) on viral hepatitis called for elimination of viral hepatitis as a major public health threat by 2030 (i.e. 90% reduction in incidence and 65% in mortality). In 2017, WHO's first‐ever Global Hepatitis Report presented the baseline values for each of the core indicators of the strategy. We review the challenges and opportunities that lie ahead in order to reach the 2030 service coverage targets.DiscussionThree‐dose coverage of hepatitis B vaccine in infancy reached 84% in 2015 (2030 target: 90%); however, only 39% received the timely birth dose (2030 target: 90%). Blood safety (97% of blood units screened with quality assurance, 2030 target: 100%) and injection safety (5% unsafe injections, 2030 target: 0%) had made substantial progress while harm reduction fell short (27 syringe and needle sets distributed per person who injects drugs per year, 2030 target: 300). Worldwide, 9% and 20% of the HBV‐ and HCV‐infected population respectively, were aware of their status (2030 targets: 90%). In the short term, to reach the 2020 target of diagnosing 50% of those infected, 107 million HBV infected persons and 15 million HCV infected persons should be urgently diagnosed. Overall, in 2015, less than 10% of known infected persons were on HBV treatment or had started HCV treatment (2030 targets: 80%).ConclusionsThe prevention component of elimination is on track with respect to hepatitis B vaccination, blood safety, and injection safety. However, coverage of the hepatitis B vaccine timely birth dose requires a substantial increase, particularly in sub‐Saharan Africa, and harm reduction needs to be taken to scale as injecting drug use accounts for a third of mortality from HCV infection. A promising but limited start in hepatitis testing and treatment needs to be followed by immediate and sustained action so that we reach the service coverage targets required to achieve elimination by 2030. Treating persons coinfected with HIV and hepatitis viruses is particularly urgent and needs to be promoted in the context of the HIV response.

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“…Hepatitis B virus (HBV) is a major causative agent of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC) . With an estimated 257 million chronic carriers worldwide, HBV infection remains to be one of the major health problems. HBV belongs to the Hepadnavividae family and contains different forms of genome in virions.…”

Mother‐to‐child transmission of hepatitis B: What more needs to be done to eliminate it around the world?

“…The timely BDV poses many logistical challenges; its global coverage is still estimated to be only 40% and is highly heterogeneous between regions. The Western Pacific region managed to increase the coverage of BDV from 2% in 2000 to 83% in 2015, which was credited to a regional commitment and goal for control of HBV infection . In sharp contrast, in the African region, only 12 countries have integrated BDV into national policy with reported regional coverage level of only 10%.…”

“…The Western Pacific region managed to increase the coverage of BDV from 2% in 2000 to 83% in 2015, which was credited to a regional commitment and goal for control of HBV infection. 38 In sharp contrast, in the African region, only 12 countries have integrated BDV into national policy with reported regional coverage level of only 10%. Moreover, even in countries that integrated BDV, studies have revealed the lack of compliance with the timeliness.…”