In 2016, the World Health Organization (WHO) set targets to eliminate HCV infection as a public health threat by 2030. The targets include:5

an 80% reduction in HCV infections,

a 65% reduction in HCV-related mortality,

90% of patients with HCV diagnosed, and

80% of patients with HCV treated.

The introduction of well-tolerated, all-oral direct-acting antivirals (DAAs) has the potential to significantly facilitate global elimination efforts, particularly HCV-related mortality and morbidity.4,6,7 Indeed, the availability of DAAs has prompted changes to the WHO guidelines, in terms of when to treat and which treatments to use. The guidelines now recommend:8

offering treatment to all patients diagnosed with HCV infection who are 12 years of age or older,* irrespective of disease stage, and

the use of pangenotypic DAA regimens for the treatment of patients with chronic HCV infection aged 18 years and above.

*With the exception of pregnant women.

The Guidelines Development Group defined pangenotypic regimens as those leading to a sustained virological response (SVR) rate >85% across all six major HCV genotypes.

In order to facilitate a ‘treat all’ approach and adoption of pangenotypic DAA regimens, the WHO recommend community-based HCV management via the implementation of simplified models of service delivery. These include:8

  • Comprehensive national planning for the elimination of HCV infection
  • Simple and standardised algorithms across the continuum of care
  • Integration of hepatitis testing, care and treatment with other services
  • Strategies to strengthen linkage from testing to care, treatment and prevention
  • Decentralised services, supported by task-sharing
  • Community engagement and peer support to address stigma and discrimination, and reach vulnerable or disadvantaged communities
  • Efficient procurement and supply management of medicines and diagnostics
  • Data systems to monitor the quality of individual care and the cascade of care

References

  1. European Union HCV Collaborators. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol 2017;2:325–336.
  2. The Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastro Hepatol 2017;2:161-176.
  3. Hajarizadeh B, et al. Epidemiology and natural history of HCV infection. Nature reviews Gastroenterology & hepatology 2013;10:553-562.
  4. Gane E, et al. Strategies to manage hepatitis C virus (HCV) infection disease burden – volume 2. Journal of viral hepatitis 2015;22(Suppl 1):46-73.
  5. World Health Organization. Global health sector strategy on viral hepatitis 2016-2021. Towards ending viral hepatitis. June 2016. Available at: http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ (accessed January 2019).
  6. Wedemeyer H, et al. Estimates on HCV disease burden worldwide—filling the gaps. J Viral Hepat 2015;22(suppl 1):1–5.
  7. Nahon P, et al. Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-liver complications. Gastroenterology 2017;152:142–56.
  8. World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection 2018. Available at: https://www.who.int/hepatitis/publications/hepatitis-c-guidelines-2018/en/ (accessed January 2019).

LID/IHQ/18-12//1048b Date of preparation: January 2019