Only one in four high-income countries is on track to
eliminate hepatitis C by 2030 and nearly two-thirds will miss the targets by
more than 20 years at current rates of progress, according to an analysis of 45
countries presented this week at the Digital International Liver Congress by
Homie Razavi of the Center for Disease Analysis.
In 2016, World Health Organization (WHO) member states agreed to
work towards elimination of hepatitis B and C by 2030. They set targets of
reducing deaths from hepatitis B and C by 65%, by diagnosing 90% of infections
and treating 80% of eligible people, as well as reducing new infections by 90%
(the previous incidence target was 80%).
The Center for Disease Analysis used the most up-to-date
data on rates of diagnosis and treatment to model reductions in mortality and
hepatitis C incidence for 45 high-income countries.
Updating an analysis presented in 2019, this year’s progress
report shows that eleven countries are on target to achieve elimination by
2030, up from nine in 2019.
Australia, Canada, France, Germany, Iceland, Italy, Japan,
Spain, Switzerland, Sweden and the United Kingdom should reach the targets by
2030.
Canada is now on-track for elimination by 2030 due to strong
progress on diagnosis and treatment in the provinces of British Columbia and
Ontario. A second analysis presented at the conference showed that British
Columbia could achieve elimination by 2025 and Ontario by 2030 if current
levels of diagnosis and treatment can be maintained. Even small reductions in
diagnosis and treatment could delay elimination in Canada by several decades,
the analysis concluded.
Germany has joined the group of high-income countries
on-track for elimination due to improvements in diagnosis, while removal of
restrictions on treatment means that Sweden will hit the WHO target for
treating 65% of eligible people this year, a feat matched only by Iceland and
Spain. Progress has been so rapid in these two countries that they will reach all
elimination targets by 2021.
Across all high-income countries on track to achieve
elimination by 2030, the factor most commonly delaying achievement of all
targets is a delay in meeting the incidence target, implying the need to
improve harm reduction for people who inject drugs and find and treat acute
infections more aggressively in people who inject drugs and men who have sex
with men.
Austria, Malta, the Netherlands, New Zealand and South Korea
should achieve elimination by 2040, and Saudi Arabia by 2050.
Thirty of 45 countries showed little or no change in the
projected time to elimination compared to 2019. Thirty-three countries will
fail to meet the target for incidence reduction, 30 will fail to meet the
mortality, 25 will not meet the treatment coverage target and 23 will not meet
the diagnosis target.
A separate modelling of progress towards elimination in the
United States shows that although the US will meet the national elimination
target by 2037 and 46 states will reduce hepatitis C-related mortality by 65%
by 2030 if current rates of diagnosis and treatment are sustained, huge disparities
in progress are likely.
Only 16 states are likely to have treated 80% of people with
hepatitis C by 2030 and states with a high prevalence of hepatitis C will need
to sustain high levels of hepatitis C treatment for the next decade to reach
this target. Around 30,000 people with hepatitis C will need to be treated each
year in California to achieve the treatment target, along with approximately 13,000
a year in each of Florida, Ohio and Texas. At current rates of progress, only
Florida is likely to achieve the treatment target, while it may not be reached until
2050 in Ohio.