Together We Can Eliminate Viral Hepatitis
Global ambition to eliminate viral hepatitis
Globally, an estimated 71 million people have chronic hepatitis C virus (HCV) infection, and the number is increasing, despite the existence of curative treatments.1,2
Approximately 14 million (1 in 50) Europeans are chronically infected with HCV – about 20% of the global total.3
HCV is transferred through contact with infected blood and is commonly transmitted through:
• Injectable drug use
• Inadequate sterilisation of medical equipment
• Transfusion of unscreened blood and blood products.1
People who inject drugs are at increased risk of acquiring HCV due to sharing syringes, needles and other injecting equipment.1
Estimates suggest that in 2015 there were 1.75 million new HCV infections worldwide and the number of deaths from viral hepatitis infection is increasing.1,4
Figure 1: Global burden of disease in 20165
In 2016, the World Health Organization (WHO) set the goal
of eliminating viral hepatitis as a major public health threat by 20302
2014: a new class of medicines, the direct acting antivirals (DAAs) became available as a cure for patients living with chronic HCV infection, achieving cure rates of over 90%.6
The introduction of DAAs has contributed to reductions in:7-10
May 2016: the WHO recognised the opportunity of the new DAAs and released its first global strategy on viral hepatitis.2 It called for the elimination of viral hepatitis as a major public health threat by 2030.
The strategy provides a vision of a world where viral hepatitis transmission is halted and everyone living with viral hepatitis has access to safe, affordable and effective care and treatment.2
Specifically, the strategy defines elimination as:2
An 80% reduction in new HCV infections and
A 65% reduction in HCV mortality
Ambition is not enough: Your role in supporting elimination
Elimination is now more possible than ever.
Currently only 12 countries are on track to achieve the goal and a further 18 which are working towards elimination. This is based on estimates from a global registry, the Polaris Observatory, which provides epidemiological data, modelling tools, and decision analytics in viral hepatitis to support the WHO elimination goal.11
Progress is being made, but there is still more to do. Each and every person who is involved in the care for people living with HCV has a role to play:
Elimination will not happen unless we all work together – everyone has a role to play and every action helps to move towards the WHO goal.
New frontiers in HCV care
The transformative nature of direct-acting antiviral (DAA) therapy means that healthcare professionals now have the capacity to cure a chronic condition that is associated with significant morbidity.12 However, the elimination goals set by the World Health Organization (WHO) are ambitious,13 and at the time of writing, only nine high-income countries (Australia, France, Iceland, Italy, Japan, South Korea, Spain, Switzerland and the United Kingdom) are on track to eliminate hepatitis C virus (HCV) by 2030.14
It is unlikely that the ambitious targets set by WHO can be achieved if elimination strategies are limited to existing medicines, technologies and service delivery approaches. For example, slow scale-up will only serve to perpetuate the epidemic over decades and the major health gains associated with HCV treatment will be thwarted. Moreover, the momentum that has been built in response to the WHO call to action may be squandered as other important health, social and environmental needs inevitably eclipse this cause.15
Elimination of HCV requires each country to look critically at its cascade of care – prevention, diagnosis, treatment and care services – and develop innovative strategies to amplify performance at each step. Below is a list of novel, country-specific initiatives designed to improve identification and linkage to care for at risk patient populations. Such examples can be used to inform options for establishing or scaling-up HCV testing and treatment interventions in other countries.
Toulouse mobile liver disease team.
A service offering onsite screening for HCV, liver disease assessment, pre-treatment counselling and follow-up.
Andalusia one-step diagnosis.
Reflex testing for HCV has been incorporated into all microbiology laboratories in Andalusia, Spain.
Models of care
Caserta model of integrated HCV care.
A simplified care pathway between hospitals, addiction units and prisons in a high prevalence area.
Duffy Health Center shared medical appointments
A shared medical appointment model for vulnerable patients provided by non-specialist providers.
Villa Maraini Foundation integrated HCV care
Collaboration between a low-threshold service and tertiary institution to facilitate linkage to care for hard-to-reach HCV patients.
SAFE remote HCV screening project
Increasing linkage to care for PWUD using remote methods of education and screening.
The Catalan model of hepatitis care, a special approach in prisons
An initiative to introduce systematic screening for HCV for all individuals admitted to prison.
HCV care in a low threshold setting in Oslo
A primary care, low-threshold HCV clinic with a network-based, flexible, ambulant model of care.
Kombi Clinic outreach model of GP care
A GP-led, mobile hepatitis clinic engaging with disenfranchised, disempowered and socially isolated populations.
ARISTOTLE HCV-HIV project: peer support
A community-based, peer-driven referral process to increase linkage to care and treatment among PWID.
Cool Aid Community Health Centre nurse-led model of HCV care
A nurse-led ‘seek and treat’ approach to identify high-risk patients in supportive housing centres.
From HCV testing to treatment in social relief centres in Amsterdam
HCV screening and linkage to care in social relief shelters and walk-in centres across Amsterdam.
Regional HCV elimination plan in Veneto
A test and treat ‘point of care’ HCV strategy among addiction services and prisons.
Holistic HCV elimination in Tenerife
A local initiative with the collaboration of multiple stakeholders to improve linkage to care in Tenerife, Spain.
The Catalan model of hepatitis care
Broad multi-stakeholder engagement, with the aim of eliminating HCV as a public health threat.
Gilead actively supports the efforts of governments and partners with professional organisations, patient advocacy groups, payers and healthcare professionals around the world who have declared their intention and commitment to work towards the WHO goal of elimination of viral hepatitis by 2030.
Projects: Elimination is happening here
Information on Australia’s approach to elimination of HCV
On course to being the first country worldwide to eliminate HCV
HCV elimination in resource-limited communities
- World Health Organization (WHO). Media Centre Hepatitis C Fact sheet. July 2018. Available at: http://www.who.int/mediacentre/factsheets/fs164/en/ (accessed February 2019).
- World Health Organization (WHO). Global health sector strategy on viral hepatitis 2016–2021.June 2016. Available at: http://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf?sequence=1 (accessed February 2019).
- World Health Organization (WHO). Hepatitis C in the WHO European Region FACT SHEET. July 2018. Available at: http://www.euro.who.int/__data/assets/pdf_file/0009/377253/fact-sheet-hepatitis-c-eng.pdf?ua=1 (accessed February 2019).
- World Health Organization (WHO). Combating hepatitis b and c to reach elimination by 2030. May 2016. Available at: http://apps.who.int/iris/bitstream/handle/10665/206453/WHO_HIV_2016.04_eng.pdf?sequence=1 (accessed February 2019).
- GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151–210.
- Solbach P and Wedemeyer H. The New Era of Interferon-Free Treatment of Chronic Hepatitis C. Viszeralmedizin 2015;31:290–6.
- Olafsson S, et al. Treatment as Prevention for Hepatitis C (TraP Hep C) – a nationwide elimination programme in Iceland using direct-acting antiviral agents. J Intern Med 2018;283:500–7.
- Turnes J, et al. Value and innovation of direct-acting antivirals: long-term health outcomes of the strategic plan for the management of hepatitis C in Spain. Rev Esp Enferm Dig 2017;109:809–17.
- Carrat F, et al. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet 2019. doi: https://doi.org/10.1016/S0140-6736(18)32111-1.
- Duberg S-F, et al. The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies. Scand J Gastroenterol 2015;50:233–44.
- The POLARIS Observatory. Available at: http://cdafound.org/polaris/ (accessed February 2019).
IHQ/LVD/2020-03//0001 • Date of Preparation: May 2020