The case for simplifying and using absolute targets for viral hepatitis elimination goals

Abstract

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries’ progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1‐year‐olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year‐to‐year decrease in new HCV‐ and HBV‐related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

Burden of chronic hepatitis B and C infections in 2015 and future trends in Japan: A simulation study

“…However, the WHO relative targets disadvantage countries like Japan with an ageing population and a low prevalence of HBV and HCV before 2015. 38 Recently, the WHO issued new guidelines recommending the use of absolute impact targets along with programmatic targets. 39 The use of these targets will better assist in assessing Japan's progress towards eliminating viral hepatitis.…”

Pregnant women’s hepatitis B vaccination coverage in Nigeria: a national pilot cross-sectional study

“…To take action on SDG 3, target 3.3, indicator 3.3.4 on combating hepatitis, the World Health Assembly ratified the global health sector strategy for the elimination of viral hepatitis as a public health threat by 2030, with a target of new infection reduction by 90% and mortality by 65%. 24 Thus, there may be a need for hepatitis B vaccination prior to pregnancy and every pregnant woman should be screened for HBsAg at the initial visit. This is to decrease the mother-to-child transmission of the hepatitis B virus.…”

Changing trends in liver transplantation indications in Saudi Arabia: from hepatitis C virus infection to nonalcoholic fatty liver disease

“…Given this shift in epidemiologic trends, perhaps it is now time to consider prioritization of NASH and start applying lessons and best practices learned from HCV to NASH (i.e., public health awareness campaigns; government-supported policy recommendations—to support and facilitate early screening, identification, and linkage to care; efforts to increase access to care; and pharmacologic and staging advancements). In response to increasing changes in the epidemiology of HCV, not long-ago, international health agencies and countries heavily burdened with HCV responsively and purposefully dedicated clinical and economic resources to combat and control HCV prevalence [ 26 ]. Likewise, efforts to prioritize and highlight the growing burden of NASH have the potential to downturn the prevalence and incidence of LT waitlisting, similar to recent downturns in the prevalence and incidence of HCV-associated morbidity and mortality in SA and other countries abroad.…”