Innovative strategies for the elimination of viral hepatitis at a national level: A country case series

Abstract

Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost‐effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence‐gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.

Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis

“…HCV cascade can be improved by nation-wide HCV awareness campaign targeting high-risk groups, reduced drugs prices and establishment of multidisciplinary teams to secure linkage to care [38]. Therefore, HCV treatment by non-specialists is a key-strategy to reduce the burden of HCV infection worldwide [39].…”

A global investment framework for the elimination of hepatitis B

“…Innovative- and blended-financing models should also be employed to augment domestic financing from regular budget sources and sustain the scale up of health programmes. An example of such a model is the use of private-public partnerships to fund roll-out of universal infant vaccination programmes in China with additional support from GAVI ( 25 , 26 ). However, LMICs are constrained by limited health budgets, and have multiple competing health priorities ( 25 ).…”

“…Adequate human resources to scale-up hepatitis B diagnosis and management may already be available through existing programmes such as antenatal care, HIV, tuberculosis and other non-communicable chronic disease programmes, allowing rapid up-scaling of testing and treatment with less financial, infrastructure and training support than would otherwise be needed for new stand-alone hepatitis treatment programmes, substantially offsetting up-front investment. This programme model has been shown to be highly effective in Egypt for hepatitis C screening when combined with community-based diabetes and hypertension screening ( 26 ). Modelling work by Tordrup et al(37) estimated to achieve 2030 elimination targets, additional staff time of 432.3 million days for doctors and 247.8 million days for nurses was required for screening, monitoring and treatment, excluding prevention activities ( 31 , 37 ).…”

Hepatitis C elimination – Macro‐elimination

“…This demands effective linkage to care with methods that are adapted to the different parts of the world. These challenges are easier to overcome in industrialized Western countries such as Iceland with small populations and a small number of infected individuals while they are more difficult in developing regions, eg parts of Eastern Europe, Asia, South America and Africa, where there are more individuals with undiagnosed HCV …”

“…These challenges are easier to overcome in industrialized Western countries such as Iceland with small populations and a small number of infected individuals 4 while they are more difficult in developing regions, eg parts of Eastern Europe, Asia, South America and Africa, where there are more individuals with undiagnosed HCV. 5 One limitation to having a clear view of the progress being made in the worldwide elimination of HCV is suboptimal and lack of standardized reporting in many countries and regions, especially in low-income areas. Recently, Safreed-Harmon et al published an article describing how to implement standard reporting to monitor progress towards the elimination of HCV.…”