The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations

Lazarus, Jeffrey V.; Safreed-Harmon, Kelly; Thursz, Mark; Dillon, John; El-Sayed, Manal Hamdy; Elsharkawy, Ahmed M.; Hatzakis, Angelos; Jadoul, Michel; Prestileo, Tullio; Razavi, Homie; Rockstroh, Jürgen K.; Wiktor, Stefan Z.; Colombo, Massimo

doi:10.1055/s-0038-1666841

Cited by 201 publications

(74 citation statements)

References 82 publications

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“…This government funded project saw a remarkable reduction in viraemic prevalence of HCV from 12 to 1% in a correctional facility over 22 months, by providing voluntary testing at entry to all people in prisons, and unrestricted DAA access. Interventions targeting HCV in prison settings are cost-effective [ 42 ] and should be an integral part of any elimination strategy [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action

et al. 2020

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Background Hepatitis C virus (HCV) transmission in the European Union, European Economic Area and United Kingdom is driven by injecting drug use (IDU), which contributes to the high burden of chronic infection among people in prisons. This study aimed to describe the context, epidemiology and response targeting HCV in prisons across the region. Methods We retrieved and collated HCV-related data from the World Health Organization’s Health in Prisons European Database and the European Centre for Disease Prevention and Control’s hepatitis C prevalence database. Prisons population data were obtained from the Council of Europe Annual Penal Statistics on prison populations (SPACE I). Results There were 12 to 93,266 people in prisons, with rates of 31·5 to 234·9 per 100,000 population. Median age was between 31 and 40 years, with up to 72% foreign nationals. Average detention time ranged from one to 31 months. Ministries of Health had sole authority over prisons health, budget administration and funding in 27, 31 and 8% of 26 reporting countries, respectively. Seroprevalence of HCV antibodies ranged from 2·3% to 82·6% while viraemic infections ranged from 5·7% to 8·2%, where reported. Up to 25·8 and 44% reported current and ever IDU, respectively. Eight countries routinely offered HCV screening on an opt-out basis. Needle and syringe programmes were available in three countries. Among the nine countries with data, the annual number of those who had completed HCV treatment ranged between one and 1215 people in prisons. Conclusions HCV burden in prisons remains high, amidst suboptimal levels of interventions. Systematic monitoring at both local and regional levels is warranted, to advance progress towards the elimination of HCV in the region.

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Section: Discussionmentioning

confidence: 99%

Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action

et al. 2020

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“…9 Tailored interventions for these high-risk populations can be implemented to microeliminate hepatitis within the discrete group. 36 It is important to address HBV and HCV-related stigma and discrimination, through identifying the drivers of this discrimination, alongside population-wide health education programmes.…”

Section: Achievements In Hepatitis B and C Control In Chinamentioning

confidence: 99%

Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China

et al. 2020

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China has the highest number of hepatitis B and C cases globally. Despite remarkable achievements, China faces daunting challenges in achieving international targets for hepatitis elimination. As part of a large-scale project assessing China’s progress in achieving health-related Sustainable Development Goals using quantitative, qualitative data and mathematical modelling, this paper summarises the achievements, gaps and challenges, and proposes options for actions for hepatitis B and C control. China has made substantial progress in controlling chronic viral hepatitis. The four most successful strategies have been: (1) hepatitis B virus childhood immunisation; (2) prevention of mother-to-child transmission; (3) full coverage of nucleic acid amplification testing in blood stations and (4) effective financing strategies to support treatment. However, the total number of deaths due to hepatitis B and C is estimated to increase from 434 724 in 2017 to 527 829 in 2030 if there is no implementation of tailored interventions. Many health system barriers, including a fragmented governance system, insufficient funding, inadequate service coverage, unstandardised treatment and flawed information systems, have compromised the effective control of hepatitis B and C in China. We suggest five strategic priority actions to help eliminate hepatitis B and C in China: (1) restructure the viral hepatitis control governance system; (2) optimise health resource allocation and improve funding efficiency; (3) improve access to and the quality of the health benefits package, especially for high-risk groups; (4) strengthen information systems to obtain high-quality hepatitis epidemiological data; (5) increase investment in viral hepatitis research and development.

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“…Around ten population groups are considered at risk for hepatitis C virus (HCV) infection: aboriginal and indigenous communities, children at risk for vertical transmission, specific birth cohorts, hemodialysis patients, individuals coinfected with HCV and human immunodeficiency virus (HIV), people who inject drugs (PWID) [3][4][5], migrants from countries with high HCV prevalence rates, prisoners [6][7][8], people who have received blood products [9][10], war veterans, baby boomers and others [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Modeling the Puzzle of Hepatitis C Epidemiology in Romania: A Pathway to Control

Lopes

Baptista‐Leite

Franco

et al. 2020

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Background and Aims: To combat hepatitis C virus (HCV) and achieve its elimination by 2030, the emphasis should be on public health policies. In this study, we investigated the dynamics of epidemiology of HCV in Romanian risk groups that are characterized by higher occurrence densities with the aid of The Let’s End HepC (LEHC) project. Methods: The LEHC project addressed the modelling of HCV epidemiology, being applied in several countries, one of which is Romania. The model comprised an integrated solution of public health policies focused on the disease, using Adaptive Conjoint Analysis and Markov chains systems. This tool allowed the quantitative evaluation of public health policies‘ impact, for every year until 2030, in five population groups: people who inject drugs (PWID), prisoners, individuals who have received blood products, children at risk for vertical transmission, and the remnant population. Results: It appears that Romania was already making great efforts in the context of public policies, allowing the achievement of HCV elimination by 2028 if current policies were maintained. Through additional work and greater efforts in further implementing public policies, the LEHC model estimated the possibility of anticipating this outcome to 2026. Conclusion: The LEHC model estimated an anticipation of the HCV elimination year in Romania to be 2026 if the twenty-four health policies in the study are fully implemented and consistently maintained over the years.

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The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations

Cited by 201 publications

References 82 publications

Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action

Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action

Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China

Modeling the Puzzle of Hepatitis C Epidemiology in Romania: A Pathway to Control

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