Viral hepatitis leads to around 1.3 million deaths a year, approximately 257 million people are living with hepatitis B virus (HBV) and 71 million with hepatitis C virus (HCV). Viral hepatitis is one of the leading causes of infectious disease and in 2016 the World Health Organization set targets for elimination of viral hepatitis by 2030, including a 65% reduction in mortality and a 90% reduction in new infections.
The Lancet Gastroenterology & Hepatology Commission on Accelerating the Elimination of Viral Hepatitis brought together experts from all continents to look at how progress towards the elimination targets could be supported and speeded up.
The Commission published its recommendations earlier this month in the journal The Lancet Gastroenterology & Hepatology.
The Commission identified several major challenges in achieving elimination:
- The need to scale up testing and ensure access to affordable diagnostics.
- Access to affordable medicines.
- The need for a shift from an individualised to a public health approach to treatment and care; treatment needs to be simplified and decentralised in the same way that HIV treatment has been successfully simplified and scaled up.
- Sustaining and expanding adult & birth-dose vaccination against hepatitis B.
- The need to scale up and sustain harm reduction services and deliver testing and treatment for people who inject drugs.
- Identifying and mobilising sources of funding to support diagnosis and treatment in lower-income countries.
- National plans for elimination of viral hepatitis are needed, together with a stronger role for civil society in monitoring progress and developing policy.
The Commission recommends:
- A greater focus on promoting universal coverage of childhood vaccines (including HBV) at international and national levels, including international procurement and funding of birth-dose vaccination.
- Promotion of expanded harm reduction services and decriminalisation of drug use and engagement with drug services by people who inject drugs.
- Greater provision of health services in prisons that include testing and treatment for viral hepatitis.
- Improve infection control, reduce the use of medical injections, promote the use of single-use needles and syringes and improve the screening of blood donation.
- Improved access to diagnostics for viral hepatitis and reduced reliance on diagnostics by use of pangenotypic regimens for HCV treatment.
- Develop point-of-care tests, including dried blood spot sampling, for screening and treatment monitoring.
- Development of national screening and patient-centred treatment programmes based on sound epidemiological data.
- Develop local capacity, evidence, and guidance to inform scale up of services and simplified protocols suitable for task sharing.
- Engage healthcare workers, civil society, and governments by raising awareness and education and reduce discrimination.
- Consider compulsory licensing for hepatitis medicines for countries that cannot otherwise access generics to achieve affordable prices, and ensure access policies that meet the needs of low-income and middle-income countries.
- Develop the investment case for eliminating viral hepatitis and develop innovative financing mechanisms to help low-income, high-burden countries achieve their elimination goals.
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