Perspective

Nine countries on track to end HCV by 2030, US not among them

Australia, Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands and Qatar are on course to eradicate hepatitis C by 2030, according to data presented at the World Hepatitis Summit in Brazil.

“This new data shows that elimination of hepatitis C is possible. It also shows more must be done to support governments in tackling viral hepatitis,” Charles Gore, president of the World Hepatitis Alliance, said in a press release.

At this year’s summit, Brazil, Egypt, Australia and Georgia were given special attention for their work to eliminate viral hepatitis. Egypt is committed to screening 30 million people for HCV before 2019 and mass produce generic versions of direct-acting antivirals (DAAs) to lower costs of treatment (less than $200 per 12-week course), according to the release.

Brazil has pledged to gradually remove treatment restrictions in 2018, enabling treatment for the entire HCV-infected population instead of restricting treatment to patients with advanced liver disease, according to Adele S. Benzaken, DrPH, director of the Brazilian Ministry of Health’s department of surveillance, prevention and control of STIs, HIV/AIDS and viral hepatitis.

The Australian government invested $1 billion over 5 years to increase access to DAAs and provide treatment to all adults without restriction. In 2016, more than 300,000 people were treated and cured of HCV, according to the release.

Mongolia, Gambia and Bangladesh are also making progress toward the WHO elimination goals. Along with Brazil, Georgia and Egypt, these countries are leading the NOhep Visionaries Program, an initiative made up of medical professionals, government officials and activists seeking to eliminate viral hepatitis by 2030, the release said.

Although some countries are making progress toward WHO’s elimination targets — which include reducing new hepatitis B and HCV infections by 90%, and HBV- and HCV-related mortality by 65% by 2030 — many are unable to keep up, according to the release.

Photo of Michael Ninburg
Michael Ninburg

The United States, for example, is not on track to eliminate HCV for “a variety of reasons,” Michael Ninburg, president-elect of the World Hepatitis Alliance, told Infectious Disease News. These include “restrictions on access to treatment on Medicaid in many states” — although access is improving, he said.

In addition, Ninburg said diagnosis rates in the U.S. are low, with only 55% of people aware of their infection status.

“Also, those who are diagnosed could have been diagnosed years ago and are lost in the system,” he added.

Globally, diagnosis rates remain low, with about 10% for HBV and 20% for HCV, according to the release.

Ninburg said the take-home message for infectious disease clinicians is “to ensure they screen all people with risk factors, especially those aged 50 to 75 years who are at the highest risk overall, and younger people in areas where opioid abuse is common and new infections are escalating due to sharing injecting equipment.” – by Savannah Demko

Disclosures: Gore is president of the World Hepatitis Alliance. Ninburg is president elect of the World Hepatitis Alliance.

Australia, Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands and Qatar are on course to eradicate hepatitis C by 2030, according to data presented at the World Hepatitis Summit in Brazil.

“This new data shows that elimination of hepatitis C is possible. It also shows more must be done to support governments in tackling viral hepatitis,” Charles Gore, president of the World Hepatitis Alliance, said in a press release.

At this year’s summit, Brazil, Egypt, Australia and Georgia were given special attention for their work to eliminate viral hepatitis. Egypt is committed to screening 30 million people for HCV before 2019 and mass produce generic versions of direct-acting antivirals (DAAs) to lower costs of treatment (less than $200 per 12-week course), according to the release.

Brazil has pledged to gradually remove treatment restrictions in 2018, enabling treatment for the entire HCV-infected population instead of restricting treatment to patients with advanced liver disease, according to Adele S. Benzaken, DrPH, director of the Brazilian Ministry of Health’s department of surveillance, prevention and control of STIs, HIV/AIDS and viral hepatitis.

The Australian government invested $1 billion over 5 years to increase access to DAAs and provide treatment to all adults without restriction. In 2016, more than 300,000 people were treated and cured of HCV, according to the release.

Mongolia, Gambia and Bangladesh are also making progress toward the WHO elimination goals. Along with Brazil, Georgia and Egypt, these countries are leading the NOhep Visionaries Program, an initiative made up of medical professionals, government officials and activists seeking to eliminate viral hepatitis by 2030, the release said.

Although some countries are making progress toward WHO’s elimination targets — which include reducing new hepatitis B and HCV infections by 90%, and HBV- and HCV-related mortality by 65% by 2030 — many are unable to keep up, according to the release.

Photo of Michael Ninburg
Michael Ninburg

The United States, for example, is not on track to eliminate HCV for “a variety of reasons,” Michael Ninburg, president-elect of the World Hepatitis Alliance, told Infectious Disease News. These include “restrictions on access to treatment on Medicaid in many states” — although access is improving, he said.

In addition, Ninburg said diagnosis rates in the U.S. are low, with only 55% of people aware of their infection status.

“Also, those who are diagnosed could have been diagnosed years ago and are lost in the system,” he added.

Globally, diagnosis rates remain low, with about 10% for HBV and 20% for HCV, according to the release.

Ninburg said the take-home message for infectious disease clinicians is “to ensure they screen all people with risk factors, especially those aged 50 to 75 years who are at the highest risk overall, and younger people in areas where opioid abuse is common and new infections are escalating due to sharing injecting equipment.” – by Savannah Demko

Disclosures: Gore is president of the World Hepatitis Alliance. Ninburg is president elect of the World Hepatitis Alliance.

    Perspective
    Michael S. Saag

    Michael S. Saag

    These countries should be applauded for their prioritizing elimination of HCV from their countries by 2030, if not before. What does it take to eliminate HCV from a country? First, a will to achieve this objective, and second, the establishment of a public health model of providing HCV treatment as opposed to a “medical model.” A public health model focuses on widespread testing, linkage to care, treatment and follow up as part of a government initiative that provides incentives for the patients, providers and system to be successful. In Australia, for example, the government negotiated a fixed payment to the HCV drug manufacturing company to provide as much drug as would be required to treat as many people as possible over a defined period (eg, 4 years). This incentivizes the system, the providers, and the public to get tested now and treat everyone who tests positive before the time runs out.  This is a true public health approach to HCV eradication.

    • Michael S. Saag, MD
    • Associate dean for global health University of Alabama at Birmingham School of Medicine

    Disclosures: Saag reports research grants from and being a scientific advisor to Bristol-Myers Squibb, Gilead Sciences, Merck, and ViiV Healthcare.