Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Abstract

investments to support countries with greatest burden of viral hepatitis All heavily burdened countries to have fully funded elimination plans by 2019 Recognition of need to focus on high burden countries and support for national policy development (All) Funding for national elimination plans Creation of fiscal space for new programmes with costed investment programmes Adopt domestic innovative finance tools where appropriate Support national policy makers in their activity (WHO, UNITAID, NGOs) Provide international support for financing measures (UNITAID, GFATM, bilaterial donors) Prevention Ensure all WHO elimination targets addressed in plans Address operational challenges in delivery of birth dose HBV vaccine Ensure provision of harm reduction services and engage with marginalised group (e.g. prisoners, PWIDs). Ensure clear public health messages to encourage testing and treatment Support countries to decriminalise injecting drug use and ensure equitable access to services for all (NGOs, WHO, civil society) Ensure appropriate funding for HBV vaccine, including birth dose (GAVI, WHO) Support R&D into HCV vaccine development (Research funders and pharma) Testing and Models of Care Focus on substantially scaling up testing for HBV and HCV Create and evaluate simplified care pathways relevant to local setting, integrating with existing services. Promote task sharing and decentralisation of care through capacity building, training and removal of Support operational research into simplified pathways (Research funders, UNITAID) requirements for specialised prescribing Diagnostics Ensure testing is integrated into the wider healthcare system, rather than centralised facilties Ensure access to quality diagnostics through Essential Diagnostic List and prequalification (WHO, funders) Support implementation science for models of care and R&D into novel diagnostics suitable for decentralised settings. (Research funders, FIND, industry) Access to treatment Ensure all Essential Medicines for viral hepatitis are included in national programmes, with an emphasis on pan-genotypic regimens Apply comprehensive policy approach to promoting access, including compulsory licensing Ensure all essential medicines are pre-qualified and either available through voluntary licensing or Medicines Patent Pool (WHO, NGOs, civil society, funders) Support shared procurement mechanisms for treatment (PAHO) Monitor Progress National plans need clearly defined, measurable objectives Develop new indices of national progress Progress of individual countries needs to be closely monitored towards elimination goals (Polaris, WHO, Creation of Elimination Index) Develop greater capacity for advocacy in high burden regions (all) Viral hepatitis is one of the leading causes of death in the world. 96% of those deaths are due to hepatitis B and C, which are the focus of this commission. Unlike many other major diseases, the tools exist to eliminate viral hepatitis. A highly effective vaccine is available to prevent hepatitis B, and a revolution in HCV treat...

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

“…In Asia-Pacific, China accounts for a large proportion of the regional burden of viral hepatitis, particularly HBV, with prevalence in 2018 of more than 80 million estimated chronic infections. 4 Nevertheless, the country is moving towards elimination of viral hepatitis 4 via a universal HBV vaccination programme in infants and mandatory screening of blood products for HBV and HCV, 5 and has exceeded WHO's Western Pacific regional target for HBV vaccination and reduction of HBsAg prevalence in children younger than 5 years. 4 According to a 2015 systematic review, 6 the estimated HBsAg endemicity in mainland China decreased from 14·0% in 1957-89 to 5·4% in 1990-2013.…”

“…A greater focus is now needed on prequalification (ie, evaluating diagnostic tests with standardised protocols for their quality, performance, and safety to guide procurement decisions by actors such as WHO Member States or UN agencies) to ensure provision of high-quality diagnostics and clinical evidence for simplified management algorithms in settings where diagnostics are not available. 4 We believe that governments should widely engage with all stakeholders, including individuals and organisations representing at-risk groups (eg, people who inject drugs, prisoners, and individuals with HIV), and also be liberal in approving and implementing new diagnostic devices.…”

“…Several other areas can leverage existing mechanisms that support other disease responses, notably HIV, to improve access to care and treatment for patients with viral hepatitis. 4 We believe that governments should be increasingly accountable and take timely measures toward national viral hepatitis elimination strategies. Adequate enforcement of policies is also needed.…”

In‐field evaluation of Xpert® HCV viral load Fingerstick assay in people who inject drugs in Tanzania

“…As a result, only a handful of countries are currently on track to achieve the ambitious elimination objectives. Thus, a great deal of emphasis has been placed on scaling‐up simplified strategies for HCV screening and linkage‐to‐care …”

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

“…Prevention of HBV MTCT is an underestimated public health issue in Africa and remains a neglected field of research for many years. As underlined in the WHO guidelines for the management of chronic hepatitis B and recent Lancet commission, there is an urgent need for more research into HBV MTCT, particularly in the African region. Currently, strategies for the prevention of HBV MTCT are mainly built on data from Asian and Western studies .…”