Elimination Of Hepatitis Research Articles

Universal screening and treatment towards the elimination of chronic hepatitis C in China: an economic evaluation

ObjectivesChina has the largest number of hepatitis C virus (HCV) infection in the world, but current levels of diagnosis and treatment are low. The objective of this study was to assess the cost-effectiveness of various universal HCV screening and treatment strategies in China and inform decisions on health policy. Study designA cost-effectiveness analytical study. MethodsWe developed a Markov model to investigate cost-effectiveness of different HCV screening and treatment strategies in China. We simulated several screening scenarios for Chinese people aged 18–70 years. We estimated incremental cost-effectiveness ratios (ICERs) of different intervention scenarios compared with status quo. ResultsExpanded HCV screening and treatment strategy with prioritisation for high-risk groups (Scenario S5) was the most cost-effective strategy (ICER: USD $11,667.71/quality-adjusted life-year [QALY] gained), which resulted in great reduction in HCV-related diseases and deaths, with a 67.11% reduction in cases of chronic HCV. Universal HCV screening and treatment implementation remains a cost-effective strategy when delayed until 2025 (ICER: USD $17,093.69/QALY), yet the delayed strategy is less effective in reducing HCV-related deaths. ConclusionsExpanded HCV screening and treatment strategy with prioritisation for high-risk groups is the most cost-effective strategy and has lead to a significant reduction in both HCV morbidity and mortality in China, which would essentially eliminate HCV as a public threat.

How Possible Is the Elimination of Viral Hepatitis? An Analysis Based on the Global Burden of Disease from Hepatitis B and C, 1990-2019.

This study assesses the feasibility of hepatitis B (HBV) and C (HCV) elimination using an analysis of trends of epidemiology data (1990-2019) from the Global Burden of Disease Study. Joinpoint regression analysis was used to identify significantly changing points in the trends of Age-standardized Prevalence Rates (ASPR) and Age-standardized Mortality Rates (ASMR) and to estimate the annual percentage changes (APC) and the average annual percentage changes (AAPC) for the period. The Sociodemographic Index (SDI) was used to analyze trends between countries. The total percentage change of the ASPR (2019/1990) was -31.4% and -12.8% for HBV and HCV worldwide, respectively; the rate ratio (HBV/HCV) was 2.5. Mortality had decreased for HBV but not for HCV. The total percentage change for the ASMR (2019/1990) was -26.7% and 10.0% for HBV and HCV, respectively. While the ASMR of HBV decreased, HCV increased during this period. The percentage change in ASMR of HBV was highest in countries with high-middle SDI and lowest in countries with high SDI. For HCV, the percentage change in ASMR was highest in countries with high SDI (increase), and only in countries with low SDI did it decrease. The global HBV and HCV rates have fallen with different AAPCs associated with the SDI. Despite the advances, there is still a long way to go to achieve the 2030 elimination goals. An important challenge is related to finding a way to speed up the yearly rate at which the decline is happening.

A cross-sectional survey of viral hepatitis education within pharmacy curricula in the United States.

The Viral Hepatitis National Strategic Plan emphasizes the importance of a collaborative provider workforce trained in hepatitis prevention and treatment to eliminate viral hepatitis in the United States by 2030. Although pharmacists play a key role in hepatitis management, literature lacks documentation of the amount ofviralhepatitis education provided to pharmacy students. Our study goal was to describe viral hepatitis education provided at United States pharmacy schools. In this cross-sectional survey study, investigators developed a 19-item Qualtrics questionnaire, sent questionnaire links to curricula content experts at 140 accredited pharmacy colleges/schools in May-June 2022, and allotted 28days for completion. Questions assessed the viral hepatitis instruction provided to students and hepatitis instructors' training/experience. We used descriptive statistics for analysis. Forty-eight pharmacy institutions across 29 states/territories responded; 44% had 50-99 students/class, and 58% used lecture and discussion to provide required hepatitis education. Students received more lecture (average = 3.4h, range 0.8-1.6h/hepatitis topic) than discussion (average = 1.7h, range 0.6-0.9h/hepatitis topic), with the most time spent on hepatitis C, followed by hepatitis B virus. Respondents reported 93% of their instructors had post-graduate training/certifications and 67% worked in clinical settings with hepatitis patients. Survey results demonstrate variability in hepatitis education across United States pharmacy curricula. Data offer stakeholders in hepatitis elimination efforts knowledge about the viral hepatitis education provided to Doctor of Pharmacy students. Future directions include consideration of implementation of minimum hepatitis education standards to further support work toward national hepatitis elimination.

Elimination of hepatitis C in Egypt: unprecedented achievement despite challenges.

Elimination of hepatitis C in Egypt: unprecedented achievement despite challenges.

In search of a ‘good number’: knowledge controversy and population estimates in the endgame of hepatitis C elimination

We explore the contentious life of a metric used to assess a country’s progress in relation to global disease elimination targets. Our topic is hepatitis C elimination, and our context...

COMMUNITY BASED MODEL OF HEPATITIS B ELIMINATION IN TRIPURA, NORTH EAST INDIA

Liver can be affected by various virus like Hepatitis A, B, C, D, E. Hepatitiss B and C are blood borne and can cause chronic complications leading to chronic liver disease, cirrhosis and hepatocellular carcinoma. In 1984 Taiwan launched first universal vaccination against Hepatitis B with plasma derived vaccine and they could reduce the burden significantly with in a short period. In 1987 recombinant DNA vaccine become available and hepatitis B vaccination became a target area but the the program did not received proper momentum. A science based social orbanisation, Hepatitis Foundation of Tripura started hepatitis B prevention movement at Tripura, a small state of North East Region of India in 2002. Gradually the program extended following various public heath method. This out of the box model could achieve a great success towards elimination of Hepatitis B. This Tripura model adopted by a social organisation, could act as template for HBV elimination.

Evidence for the elimination of viral hepatitis B and C in Egypt: Results of a nationwide survey in 2022.

Viral hepatitis C (HCV) and B (HBV) were at the top of Egypt's most significant public health challenges, with an estimated 14.7% of its population having antibodies to HCV in 2008. Egypt issued an ambitious action plan in 2014 to eliminate viral hepatitis through strengthening infection control and improving patient care. In 2018, an extensive HCV mass screening campaign was conducted for the entire country's population with treating more than 4 million patients with antivirals. This study aimed to evaluate the current prevalence of viral hepatitis in Egypt after all these efforts. A cross-sectional household cluster survey was conducted in all 27 Egyptian governorates to obtain a representative sample of Egypt's population. Subjects aged 1-70 years were interviewed using a standardised questionnaire that included demographics, viral hepatitis knowledge, previous infection and risk factors data. Laboratory testing was performed for all subjects for anti-HCV and HBsAg using chemiluminescence. Subjects positive for anti-HCV were further tested for HCV-RNA by RT-PCR. Prevalence rates were calculated by demographic groups and compared to the demographic health survey 2015 results. Of 20 881 subjects interviewed, 48.8% were males, 20.2% were children <15 years of age, and 53.7% were residents of rural areas. Of all subjects, 92 (0.4%) were HCV-infected, 1577 (7.6%) were anti-HCV positive and 177 (0.8%) were HBV-chronically infected, including one patient who had mixed HBV and HCV current infection. The prevalence of HCV-current and HBV chronic infections decreased by 93% and 20%, respectively, compared to 2015. Egypt achieved the elimination of the viral hepatitis goal. To maintain low rates of viral hepatitis, community health education, in addition to maintaining infection control and blood safety programs, is essential.

On the role of vaccination, health education, and hygiene compliance in the elimination and control of Hepatitis A Virus: An optimal control approach

A deterministic mathematical model for Hepatitis A infection is established and subsequently examined to optimize control strategies. The model incorporates three time-dependent controls: vaccination, health education, and hygiene compliance, focusing on mitigating disease transmission in the community. The derivation of the basic reproduction number was conducted using the Next-Generation Matrix (NGM) technique, which was subsequently utilized to analyze the stability of the equilibria of the model. The optimal control problem is established and analyzed using Pontryagin’s Maximum principle. The numerical simulation of the optimal control problem is achieved via Runge–Kutta fourth-order schemes (forward and backward sweeps). The numerical findings demonstrate a significant reduction in Hepatitis A cases by implementing at least one control measure. Besides that, it has been established that coupling vaccination, health education and hygiene compliance results in the lowest number of cases, making it an optimal option for eradicating Hepatitis A in the community. However, applying this strategy could be more costlier. As such, the cost-effective analysis was carried out via an incremental cost-effectiveness ratio approach to ascertain the most cost-effective strategy. The findings confirmed that the vaccination strategy was the most cost-effective approach among the strategies under consideration because it offers the minimum number of cases at the minimum cost. This approach is particularly applicable in situations with constrained resources, a circumstance prevalent in many developing nations.

Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis

Global elimination of hepatitis B virus (HBV) requires expanded uptake of antiviral therapy, potentially by simplifying testing algorithms, especially in resource-limited countries. We evaluated the effectiveness, cost-effectiveness, and budget impact of three strategies that determine eligibility for anti-HBV treatment, as compared with the WHO 2015 treatment eligibility criteria, in The Gambia. We developed a microsimulation model of natural history using data from the Prevention of Liver Fibrosis and Cancer in Africa programme (known as PROLIFICA) in The Gambia, for an HBV-infected cohort of individuals aged 20 years. The algorithms included in the model were a conventional strategy using the European Association for the Study of the Liver (EASL) 2017 criteria, a simplified algorithm using hepatitis B e antigen and alanine aminotransferase (the Treatment Eligibility in Africa for the Hepatitis B Virus [TREAT-B] score), a Treat All approach for all HBV-infected individuals, and the WHO 2015 criteria. Outcomes to measure effectiveness were disability-adjusted life years (DALYs) and years of life saved (YLS), which were used to calculate incremental cost-effectiveness ratios (ICERs) with the WHO 2015 criteria as the base-case scenario. Costs were assessed from a modified social perspective. A budget impact analysis was also done. We tested the robustness of results with a range of sensitiviy analyses including probabilistic sensitivity analysis. Compared with the WHO criteria, TREAT-B resulted in 4877 DALYs averted and Treat All resulted in 9352 DALYs averted, whereas the EASL criteria led to an excess of 795 DALYs. TREAT-B was cost-saving, whereas the ICER for Treat All (US$2149 per DALY averted) was higher than the cost-effectiveness threshold for The Gambia (0·5 times the country's gross domestic product per capita: $352). These patterns did not change when YLS was the outcome. In a modelled cohort of 5000 adults (aged 20 years) with chronic HBV infection from The Gambia, the 5-year budget impact was $1·14 million for Treat All, $0·66 million for TREAT-B, $1·03 million for the WHO criteria, and $1·16 million for the EASL criteria. Probabilistic sensitivity analysis indicated that among the Treat All, EASL, and TREAT-B algorithms, Treat All would become the most preferred strategy only with a willingness-to-pay threshold exceeding approximately $72 000 per DALY averted or $110 000 per YLS. Although the Treat All strategy might be the most effective, it is unlikely to be cost-effective in The Gambia. A simplified strategy such as TREAT-B might be a cost-saving alternative. UK Research and Innovation (Medical Research Council). For the French translation of the abstract see Supplementary Materials section.

Prevalence of hepatitis C virus infections among populations in Rohingya refugee camps, Cox’s Bazar, Bangladesh

Purpose: Hepatitis C is a blood-borne virus that particularly affects the liver. The infection often gets early in life and remains an asymptomatic gradually progressive disease. In Bangladesh, the 8th most common cause of death is the liver disease and the age-adjusted death rate is 19.26 % per 100,000 population. The hepatitis C virus can result in acute or chronic infections. The data on the prevalence of HCV in Bangladesh are limited. Study Design: Our recent study is to undertake a pilot study among the general population in the Rohingya refugee camps in Cox’s Bazar, Bangladesh. Our study was conducted with a total of 2,146 samples and tested for anti-HCV among the Rohingya general community in the Camps from January 2022 to December 2022. Results: Out of 2,146 individuals, 35% were positive and 65% were negative. Among the total positive cases, 85% were female and 15% were male. Among all the individuals, the positive cases categorized into old adults, middle-aged adults, and young adults that corresponds to 8%, 33%, and 60%, respectively. The highest number of positive cases were found in June (9.43%), July (15.09%), and August (13.75%). The lowest number of positive cases was found in January (3.37%), April (3.91%), and September (6.60%). Conclusions: Our study has resulted in increased knowledge about the prevalence of hepatitis C in the Rohingya community and there is an urgent need to accelerate the implementation of hepatitis elimination strategies among the Rohingya community and other marginalized populations in Bangladesh.

A systematic review reveals that African children of 15–17 years demonstrate low hepatitis B vaccine seroprotection rates

Childhood HBV immunization remains globally fundamental to the elimination of hepatitis B virus (HBV). However, monitoring proportions of HBV vaccine seroprotection and their determinants among African Pediatric recipients is crucial. This study sought to verify extent of immune protection accorded by the HBV vaccine in African children of up to 17 years of age by pooling the prevalence of seroprotection reported by primary studies conducted in the Northern, Western, and Southern African regions. We included 19 eligible articles out of the 197 initially downloaded, published from 1999 to 2021 from African Journals Online (AJOL), EMBASE, Scopus, and PubMed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), University of York Centre for Reviews and Dissemination, under the registration number CRD42022361277. Significantly higher (p < 0.0001) proportion of HBV vaccine seroprotection (69.07%) was found among children under 15 years of age than children 15–17 years (32.368%), 95% CI [34.2454–39.0847%]. Whereas successful integration of the HBV vaccine on the extended programs on immunizations (EPI) has been a major achievement in the reduction of HBV infection in Africa, markedly reduced HBV vaccine seroprotection is persistently demonstrated among adolescent children 15–17 years of age. Future studies are required to clarify the need for booster dose vaccination in most at risk populations and age groups.

Anti-hepatitis C antibody carriage and risk of liver impairment in rural-Cameroon: adapting the control of hepatocellular carcinoma for resource-limited settings

BackgroundThe Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS.MethodsA facility-based observational study was conducted from July-August 2021 among individuals attending the “St Monique” Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p < 0.05 considered statistically significant.ResultsOut of 306 eligible participants (negative for HBsAg and HIVAb) enrolled, the mean age was 34.35 ± 3.67 years. 252(82.35%) were female and 129 (42.17%) were single. The overall HCVAb sero-positivity was 15.68%(48/306), with 17.86% (45/252) among women vs. 5.55%(3/54) among men [OR (95%CI) = 3.69(2.11-9.29),p = 0.04]. HCVAb Carriage was greater among participants aged > 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p < 0.000] and in multipartnership [26.67%(12/45)vs.13.79%(36/261) monopartnership, OR (95%CI) = 2.27(1.07-4.80),p = 0.03]. The liver impairment rate (abnormal ALT+AST levels) was 30.39%(93/306), with 40.19%(123/306) of abnormal ALT alone. Moreover, the burden of Liver impairment was significantly with aged> 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p < 0.000). Interestingly, the burden of liver impairment (abnormal AST + ALAT) was significantly higher in HCVAb positive (62.5%, 30/48) versus HCVAb negative (24.42%, 63/258) participants, OR: 3.90 [1.96; 7.79], p = 0.0001.ConclusionsIn this rural health facility, HCVAb is highly endemic and the burden of liver impairment is concerning. Interestingly, HCVAb carriage is associated with abnormal liver levels of enzyme (ALT/AST), especially among the elderly populations. Hence, in the absence of nuclei acid testing, ALT/AST are relevant sentinel markers to screen HCVAb carriers who require monitoring/care for HCV-associated hepatocellular carcinoma in RLS.

Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review

Background and aimsRefugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally.MethodsA literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included.ResultsThere were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance.ConclusionsThis is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.

Towards elimination of hepatitis C in Oslo: Cross-sectional prevalence studies among people who inject drugs

BackgroundNorway aims to eliminate hepatitis C virus (HCV) infection within the end of 2023. Before the introduction of direct-acting antivirals, the prevalence of chronic HCV infection among people who inject drugs (PWID) in Oslo was 40–45 %. The primary aim of the study was to assess changes in HCV prevalence among PWID in Oslo from 2018 to 2021. The secondary aim was to assess change in prevalence in selected subgroups. MethodsPoint prevalence studies were conducted in 2018 and 2021 among PWID attending low-threshold health services in downtown Oslo. Assessments included blood samples analysed for anti-HCV and HCV RNA, and a questionnaire about drug use. Information about previous HCV treatment was only collected in the 2021 cohort. We calculated HCV RNA prevalence estimates for 2018 and 2021 and used logistic regression analysis to identify factors associated with detectable HCV RNA and previous HCV treatment. ResultsA total of 281 and 261 participants were included in 2018 and 2021, respectively. The median age was 40.6 and 44.0 years, 73.7 % and 72.8 % were men, and 74.5 % and 78.6 % reported recent (past four weeks) injecting drug use, respectively. HCV RNA prevalence decreased significantly from 26.3 % (95 % CI 21.3–31.9) in 2018 (74 of 281) to 14.2 % (95 % CI 10.2–19.0) in 2021 (37 of 261). The odds of detectable HCV RNA were significantly lower in 2021 compared to 2018 (aOR 0.41; 95 % CI 0.26–0.67). In the 2021 cohort, detectable HCV RNA was associated with recent amphetamine injecting (aOR 7.21; 95 % CI 1.41–36.95), and mixed heroin/amphetamine injecting (aOR 7.97; 95 % CI 1.55–41.07). The odds of previous treatment were lower among women (aOR 0.52; 95 % CI 0.27–1.00). ConclusionA substantial decrease in HCV RNA prevalence among PWID in Oslo between 2018 and 2021 was observed. To reach elimination, adaptive services must be further developed.

Point-of-Care Testing for Hepatitis Viruses: A Growing Need.

Viral hepatitis, caused by hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), or hepatitis E virus (HEV), is a major global public health problem. These viruses cause millions of infections each year, and chronic infections with HBV, HCV, or HDV can lead to severe liver complications; however, they are underdiagnosed. Achieving the World Health Organization's viral hepatitis elimination goals by 2030 will require access to simpler, faster, and less expensive diagnostics. The development and implementation of point-of-care (POC) testing methods that can be performed outside of a laboratory for the diagnosis of viral hepatitis infections is a promising approach to facilitate and expedite WHO's elimination targets. While a few markers of viral hepatitis are already available in POC formats, tests for additional markers or using novel technologies need to be developed and validated for clinical use. Potential methods and uses for the POC testing of antibodies, antigens, and nucleic acids that relate to the diagnosis, monitoring, or surveillance of viral hepatitis infections are discussed here. Unmet needs and areas where additional research is needed are also described.

A rapid review of antenatal hepatitis C virus testing in the United Kingdom

BackgroundThe United Kingdom (UK) has committed to the World Health Organization’s viral hepatitis elimination targets. New case finding strategies, such as antenatal testing, may be needed to achieve these targets. We conducted a rapid review to understand hepatitis C-specific antibody (anti-HCV) and HCV RNA test positivity in antenatal settings in the United Kingdom to inform guidance.MethodsArticles and conference abstracts published between January 2000 and June 2022 reporting anti-HCV testing in antenatal settings were identified through PubMed and Web of Science searches. Results were synthesised using a narrative approach.ResultsThe search identified 2,011 publications; 10 studies were included in the final synthesis. Seven studies used anonymous testing methods and three studies used universal opt-out testing. Anti-HCV test positivity ranged from 0.1 to 0.99%, with a median value of 0.38%. Five studies reported HCV RNA positivity, which ranged from 0.1 to 0.57% of the testing population, with a median value of 0.22%. One study reported cost effectiveness of HCV and found it to be cost effective at £9,139 per quality adjusted life years.ConclusionThe relative contribution of universal opt-out antenatal testing for HCV should be reconsidered, as antenatal testing could play an important role in new case-finding and aid achieving elimination targets.

Hepatitis C virus micro-elimination in people who inject drugs: Challenges and chance in Taiwan and worldwide.

With the introduction of direct-acting antivirals, elimination of hepatitis C virus (HCV) infection is becoming possible. People who inject drugs (PWID) represent a population with a high risk for HCV infection, which has been reported as high as 90% in Taiwanese PWID. To reach the goal of HCV elimination, PWID is a key population deserving special attention. Barriers in HCV care cascade still exist in PWID, and interventions to promote access to HCV diagnosis, link-to-care, treatment, and prevention for PWID are warranted. Although HCV micro-elimination can be achieved in some prisons and opioid substitution therapy (OST) centers by a multidisciplinary team and integrated care in Taiwan, there are still several unmet needs for HCV elimination in PWID. Continuous efforts, such as the participation of OST specialists and the continuum of care for HCV among PWID, are needed to achieve HCV elimination in Taiwan. In addition, the combination of harm reduction services, treatment as prevention and regular posttreatment HCV surveillance is critical to substantially reduce HCV transmission and prevalence in PWID.

1804. A Hospital System Utilization of EMR towards New Jersey’s Goal of Viral Hepatitis and HIV Elimination

Abstract Background New Jersey plans to reduce 75% of new HIV infections and promote access to testing and linkage-to-care (LTC) to end the HIV epidemic by 2025. In the US, CDC 2020 hepatitis surveillance report indicated cases of hepatitis C in 2020 corresponded to a 124% increase from 2013. Globally, if the HBV effort remains unchanged, the annual deaths from HBV are projected to increase by 39% from 2015 to 2030. We implemented an electronic medical record (EMR) based screening algorithm to scale up HBV, HCV, and HIV screening and provide LTC. Methods In March 2018, the EMR was modified at Cooperman Barnabas Medical Center in the Emergency Department (ED) to start automated screening, we expanded the screening criteria to boost identifying the undiagnosed. Subsequently, the program expanded to Somerset Medical Center and Rahway Hospital. Patient Navigators receive a real-time alert of positive results to contact patients and arrange LTC, the multidisciplinary team offers evaluation and treatment.Figure 1.Expanding Automated Screening Program Results We found HIV prevalence in CBMC is 1.5%, close to 5 times the NJ statewide 397.2 per 100,000 population. HBV infection rates varied in three hospitals, representative of the diverse population in their service areas. The HBV patients we confirmed came from more than 170 countries with different insurance statuses, the majority are immigrants from endemic countries or with high-risk behaviors identified. From Aug 2022, new HbsAg + cases reflex to HDVAb test, where 5% resulted HDVAb+ and no HDVRNA+. HCV prevalence rates are more consistent among the three sites, however, the percentages of the birth cohort (1945-1965) are varied. LTC rates are higher in HBV patients than HCV, thus far, 41 patients were cured of HCV from our team.Figure 2.Total Numbers of HBV, HCV &amp; HIV Tested, Prevalence &amp; LTC Conclusion EMR automated screening significantly scales up the diagnosis of HBV, HCV and HIV, as well as identifying HIV at-risk patients to receive comprehensive preventative services. HBV, HCV and HIV share similar risks, LTC is crucial to treat current infections and is beneficial to prevent transmission and potential exposure. In summary, automated screening and LTC work robustly toward elimination. Disclosures All Authors: No reported disclosures

Current Status and Challenges in Anti-Hepatitis B Virus Agents Based on Inactivation/Inhibition or Elimination of Hepatitis B Virus Covalently Closed Circular DNA.

There has been over half a century since the discovery of hepatitis B virus (HBV) to now, but approximately 300 million patients with chronic hepatitis B (CHB) still live in the world, resulting in about one million deaths every year. Although currently approved antivirals (e.g., nucleoside analogues) are effective at reducing HBV replication, they have almost no impact on the existing HBV covalently closed circular DNA (cccDNA) reservoir. HBV cccDNA is a critical obstacle to the complete elimination of the virus via antiviral therapy. The true cure of HBV infection requires the eradication of viral cccDNA from HBV-infected cells; thus, the development of new agents directly or indirectly targeting HBV cccDNA is urgently needed due to the limitations of current available drugs against HBV infection. In this regard, it is the major focus of current anti-HBV research worldwide via different mechanisms to either inactivate/inhibit (functional cure) or eliminate (complete cure) HBV cccDNA. Therefore, this review discussed and summarized recent advances and challenges in efforts to inactivate/silence or eliminate viral cccDNA using anti-HBV agents from different sources, such as small molecules (including epigenetic drugs) and polypeptides/proteins, and siRNA or gene-editing approaches targeting/attenuating HBV cccDNA via different mechanisms, as well as future directions that may be considered in efforts to truly cure chronic HBV infection. In conclusion, no breakthrough has been made yet in attenuating HBV cccDNA, although a number of candidates have advanced into the phase of clinical trials. Furthermore, the overwhelming majority of the candidates function to indirectly target HBV cccDNA. No outstanding candidate directly targets HBV cccDNA. Relatively speaking, CCC_R08 and nitazoxanide may be some of the most promising agents to clear HBV infection in small molecule compounds. Additionally, CRISPR-Cas9 systems can directly target HBV cccDNA for decay and demonstrate significant anti-HBV activity. Consequently, gene-editing approaches targeting HBV cccDNA may be one of the most promising means to achieve the core goal of anti-HBV therapeutic strategies. In short, more basic studies on HBV infection need to be carried out to overcome these challenges.

Impact of COVID-19 on the Strategy for the Prevention and Elimination of Hepatitis B and Hepatitis C

The COVID-19 pandemic, since SARS-CoV2 was discovered in December 2019, has resulted in significant morbidity and mortality. Since then, several countries have witnessed the collapse of the health care system due to the great need to treat patients with COVID-19. At the global level, drastic measures have been taken to combat the spread of the virus. However, these measures have led to disruptions in other aspects of health care, diagnosis and treatment of other diseases and conditions. There is also a stalemate in achieving the ambitious goal set by the World Health Organization to eliminate viral hepatitis as a threat to public health by 2030. Hepatitis B and C are chronic conditions with a significant global burden, and COVID-19 has slowed or stopped many hepatitis elimination programs.