WHO urges countries to invest in eliminating hepatitis

On World Hepatitis Day (28 July), the World Health Organization (WHO) called on countries to take advantage of recent reductions in the costs of diagnosing and treating viral hepatitis and invest in disease elimination.

A new study by WHO, published in The Lancet Global Health, has found that investing US$6 billion per year in eliminating hepatitis in 67 low- and middle-income countries would avert 4.5 million premature deaths by 2030, and more than 26 million deaths beyond that target date.

A total of US$58.7 billion is needed to eliminate viral hepatitis as a public health threat in these 67 countries by 2030. This means reducing new hepatitis infections by 90% and deaths by 65%.

WHO called on all countries to “Invest in eliminating hepatitis” through costing, budgeting and financing of elimination services within their universal health coverage plans. While there has been broad support among WHO Member States in adopting the WHO hepatitis elimination strategy, with 124 out of 194 countries developing hepatitis plans, over 40% of country plans lack dedicated budget lines to support elimination efforts.

WHO has also released online calculators (www.hepccalculator.org and www.hepbcalculator.org) designed to help decision makers to evaluate the cost-effectiveness of their hepatitis treatment programmes.

15 million affected by hepatitis in Pakistan

Pakistan has 5 million people living with hepatitis B and 10 million people living with hepatitis C, the World Health Organization (WHO) estimates.

To curb the huge disease burden, the government has announced Prime Minister Imran Khan’s new ambitious plan to eliminate viral hepatitis B and C infections in the country by 2030. The programme aims to provide leadership and co-ordination to provincial programmes in scaling up hepatitis prevention, testing and treatment services.

Infection control and testing will be major priorities. The high levels of unnecessary injections and injections by unqualified people have led to a national plan for injection safety. Outbreaks of hepatitis C and HIV due to poor injection safety in medical facilities are frequent, according to evidence presented at the 10th International AIDS Society Conference on HIV Science in Mexico earlier this month.

Although Pakistan produces cheaper medicines to cure hepatitis C infection, with a very low cost of US$20 per cure within three months, very few people in the country know of their infection, and therefore do not access testing and treatment services.

Prevention of late diagnosis of viral hepatitis would reduce the burden of liver disease in Pakistan. According to WHO, 23,720 people died of hepatitis-related causes in Pakistan in 2016. Many of these deaths will have resulted in catastrophic medical costs for the families of the deceased.

World Hepatitis Day masterclasses

The World Hepatitis Alliance offered a series of masterclasses through its World Hepatitis Day website, in which organisations share case studies of successful advocacy and outreach activities. These included:

  • Running a testing event, by Chennai Liver Foundation
  • Running a campaign, by Action Hepatitis Canada
  • Engaging at-risk communities, by National Liver Foundation, Bangladesh
  • Working with celebrities, by L’Association pour la Lutte contre les Hépatites Virales (ALHV), Burundi
  • Holding a press conference, by SOS Hépatites Burkina.

Take a look at the masterclass reports for lots of useful tips and find many more case studies on the World Hepatitis Day website.

Treatment in primary care improves the uptake of treatment in people who inject drugs

Providing treatment for hepatitis C in the primary care setting significantly improves the uptake of treatment and cure rates in people who inject drugs, a randomised study conducted in Australia and New Zealand has found.

The study authors say their study participants reflect the real-world population of people in need of treatment – not linked to specialist hepatology clinics, current or recent injectors and highly likely to be receiving opioid substitution therapy. Providing on-site assessment of liver fibrosis in primary care is key to engaging this population in treatment.

“To attain the WHO [World Health Organization] hepatitis C elimination target of an 80% decrease in incident hepatitis C, it is critical to increase treatment uptake in PWID [people who inject drugs] […] Providing treatment in primary care is an essential component of engaging PWID in hepatitis C treatment,” the study authors conclude.

UK Pharmacy Minister urged to allow pharmacist dispensing of DAAs

Doctors and voluntary organisations in London have asked the government minister responsible for pharmacy regulations to allow pharmacies to dispense direct-acting antivirals (DAAs). The request follows a two-phase pilot scheme in London in which pharmacies offered rapid oral testing for hepatitis C to users of needle exchange services located in community pharmacies. People who tested positive were referred to secondary care. In the second phase, community pharmacies also offered hepatitis C RNA testing to people who tested positive, to diagnose chronic infection. Again, people who tested positive were referred to secondary care.

Seventy-five per cent of people who were tested in the second phase said they would prefer to obtain hepatitis C medication from a community pharmacy and would be more likely to complete the course of treatment as a result. The previous health minister told Parliament last year that he was 'impatient' to see the service expanded.

Current NHS regulations stand in the way of dispensing DAAs in pharmacies, as any drugs funded by NHS England’s specialist drugs budget must be dispensed by hospitals.

The case provides an example of the types of structural barriers that need to be overcome in many countries in order to bring testing and treatment closer to people with hepatitis C, especially people who inject drugs.

Heart disease and cancers in people with HIV and hepatitis C co-infection

Hepatitis C co-infection does not increase the risk of cardiovascular disease or non-AIDS cancers in people with HIV, an analysis of the large EuroSIDA cohort published in Clinical Infectious Diseases has found. This result contradicts earlier findings from other studies.

Elevated rates of some cancers and cardiovascular disease have been observed in some cohorts of people with hepatitis C monoinfection as well as hepatitis C and HIV co-infection. HIV infection increases the risk of cardiovascular disease, regardless of other risk factors such as smoking or high cholesterol levels.

The EuroSIDA cohort analysis compared rates of non-AIDS cancers and cardiovascular disease in people with HIV alone and people with co-infection (a total of 16,818 people).

The new study found that after adjusting for established risk factors for cardiovascular disease such as smoking and high blood pressure, co-infection did not increase the rates of non-AIDS cancers or cardiovascular disease, but also found that being cured of hepatitis C did not reduce the risk either. Longer-term follow-up may be needed to determine the impact of curing hepatitis C in people with HIV.

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