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Goal to eliminate HCV by 2030 will be ‘narrowly missed’

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February 4, 2019

As defined by WHO targets, the goal to eliminate hepatitis C virus globally by 2030 will be “narrowly missed,” but is possible by 2032 using new tools and “ambitious, integrated interventions,” study findings showed.

If the goal is achieved, it would prevent 15.1 million new HCV infections and 1.5 million deaths, researchers reported in The Lancet.

“Even though it narrowly falls short of the WHO targets for 2030, the impact our estimates suggest would be a tremendous stride forwards,” Alastair Heffernan, a PhD student at Imperial College London, said in a news release. “Eliminating hepatitis C virus is an extremely challenging aim that requires improved prevention interventions and screening, particularly in high-burden countries such as China, India and Pakistan.”

Heffernan and colleagues created a mathematic model to project the future course of the global HCV epidemic. They calibrated the model to 190 countries, and incorporated data on demographics, people who inject drugs (PWID), current coverage of treatment and prevention programs, the history of the disease, HCV prevalence and HCV-attributable mortality. They then estimated the impact of scaling up interventions.

The researchers found that by 2030, interventions to reduce transmission risk in the non-PWID population by 80% and increase coverage of harm reductions services to 40% in the same population could avoid 14.1 million new HCV infections. They found that the addition of direct-acting antivirals (DAAs) could prevent 640,000 deaths from cirrhosis and liver cancer, and noted that a comprehensive prevention, screening and treatment intervention package could avoid 15.1 million new HCV infections and 1.5 million deaths related to cirrhosis and liver cancer, which would correspond to an 81% reduction in incidence and 61% reduction in mortality when compared with a 2015 baseline, meeting one 2030 goal but falling short of another.

“This reaches the WHO HCV incidence reduction target of 80% but is just short of the mortality reduction target of 65%, which could be reached in 2032,” the researchers wrote.

In an accompanying editorial, Stefan Wiktor, MD, MPH, acting professor of global health in the University of Washington Schools of Medicine and Public Health, wrote, “The concept of eliminating hepatitis is gaining traction with the adoption of the WHO strategy, mention of ‘combating hepatitis’ in the Sustainable Development Goals, and expansion of hepatitis services in some countries. Thus, it is encouraging that the analysis by Heffernan and colleges shows that this concept is achievable.”

“However,” he wrote, “their analysis also indicates that the road to elimination will be difficult. ... The authors do not address the cost of elimination but WHO estimated that implementing its strategy would cost $11.9 billion for the period 2016-2021. Identifying these resources will be particularly difficult at a time of reduced investment in global health and shift in focus toward universal health coverage rather than disease-specific programs.” – by Bruce Thiel

Disclosures: Heffernan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Wiktor reports no relevant financial disclosures.

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