Global Health Sector Strategy Research Articles

Serum microRNA-122 Levels in Egyptian Patients with Chronic Hepatitis C virus Genotype 4 Infection before and after treatment with Direct Acting Antiviral Drugs

Abstract Background Viral hepatitis was estimated to be the 7th leading cause of mortality globally. About half of this mortality is attributed to HCV, a primary cause for liver fibrosis, cirrhosis and cancer. The recent development of highly efficacious oral DAAs provides opportunities for reducing HCV disease burden and its onward transmission, with the potential for eliminating this blood-borne virus as a public health concern. WHO has recently formulated the ‘Global Health Sector Strategy on Viral Hepatitis, 2016– 2021 with service coverage targets to eliminate HCV as a public health threat by 2030. Objective To asses the possible relation of miRNA 122 to HCC development after HCV therapy with direct antiviral drug. Patients and Methods Previous studies suspect that HCV therapy by DAAS may increase risk of HCC so the aim of our study is to evaluate miR-122level at end of HCV treatment by DAAS and compare the results with miR-122level in HCC patients. The study was performed as a case control study in Ain Shams University hospital and Suez Canal authority hospital (Outpatient Clinic), at Ismailia Egypt in the period between Augusts to October 2018. Results These results revealed an effect of treatment by DAAs in HCV infected patients leading to miRNA 122 reduction and this may be related to hepatocarcinogenesis. However, further studies on a large patients number are needed to clarify this point and determine the diagnostic and possible therapeutic value of miRNA 122 in HCV infected patients. Conclusion Baseline MiR-122 level at cutoff value ≤0.26 was significantly lower in HCC patients than chronic HCV patients and normal controls, with a sensitivity of 80%, a specificity of 70%. MiR-122 was significantly reduced at end of HCV therapy with DAAs and became similar to values in HCC patients. Whether this observed reduction is mechanistically related to hepatocarcinogenesis is still a possibility, to be clarified in furtur large scale studies. The reduction of MiR-122 at the end of HCV therapy with DAAs was significantly observed in (F3,F4) patients than those with early fibrosis stages(F1,F2).This again gives a possible explanation of HCC development in HCV patients with advanced fibrosis(cirrhosis)and raises the question about the diagnostic and therapeutic value of miRNA 122 (and possibly other miRNAs)in the management strategy of HCV infected patients.

Introduction of World Health Organization Strategies and the Technical Advisory Committee actions on viral hepatitis control and status of the elimination of viral hepatitis in China

Viral hepatitis has been causing big threat to public health globally. The number of annual deaths caused by hepatitis surpassed the deaths caused by AIDS, tuberculosis, and malaria. World Health Organization (WHO) issued the global health sector strategy on viral hepatitis 2016-2020 (GHSS) to control its epidemic. It established the Strategies and Technical Advisory Committee on HIV, viral hepatitis, and sexually transmitted infections (STAC). This paper summarizes the GHSS goals and the keynote of the 2020 STAC meeting, analyzes the challenges and opportunities faced by China in eliminating viral hepatitis, and provides the comments on the papers on this issue, which could guide further actions.

702To determine socio-demographic corelates of reproductive tract infection amongst women of reproductive age group

Abstract Background Reproductive tract infection (RTI) is a public health problem, in developing countries like India. The associated odium with it is a stumbling block in seeking health care. So, our aim was to studyprevalence of RTI symptoms and its socio-demographic corelates. Methods A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymousinterview schedule was administered after taking consent. Results The prevalence of self-reported RTI’swas found to be 41.2%.It was more in lower socio-economic classes, and was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association. Conclusions RTI infections were more prevalent among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health. Key messages The relevant and robust data on RTI’s, may be secured by capacity building of health workers. An exemplary drug supply system may be ensured, so that the RTI kits are available at government health institutions. An introduction of affordable point-of-care tests for sexually transmitted infection may be done, as recommended in the WHO Global Health Sector Strategy for the control and prevention of STIs.

New WHO guidance for country validation of viral hepatitis B and C elimination

The 2016 WHO Global Health Sector Strategy (GHSS) on viral hepatitis provided a roadmap for the elimination of viral hepatitis as a public health problem by 2030. 1 WHOGlobal health sector strategy on viral hepatitis 2016–2021: towards ending viral hepatitis. World Health Organization, Geneva2016https://apps.who.int/iris/handle/10665/246177Date accessed: May 20, 2021 Google Scholar Elimination is defined as a 90% reduction in incidence (95% for hepatitis B virus [HBV] and 80% for hepatitis C virus [HCV] infection) and a 65% reduction in mortality by 2030, compared with a 2015 baseline, that can be achieved through scale-up of five key synergistic preventive approaches (HBV birth-dose and infant vaccination, blood and injection safety, and harm reduction measures) alongside testing and treatment interventions. New estimates for viral hepatitis based on data from 130 countries in the latest global progress report on HIV, viral hepatitis, and sexually transmitted infections 2 WHOGlobal progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization, GenevaJuly 15, 2021https://www.who.int/publications/i/item/9789240027077Date accessed: July 26, 2021 Google Scholar show that in 2019 there were 296 million people living with chronic HBV infection and 58 million people living with chronic HCV infection, and 3 million new infections and 1·1 million deaths from viral hepatitis B and C combined. The 2020 Sustainable Development Goals and GHSS target of reducing the incidence of hepatitis B has been met (as measured by a global HBsAg prevalence in 2019 among children younger than 5 years of less than 1%, at 0·94%). 2 WHOGlobal progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization, GenevaJuly 15, 2021https://www.who.int/publications/i/item/9789240027077Date accessed: July 26, 2021 Google Scholar However, most other global 2020 targets have been missed, and accelerated action is needed to reach elimination, especially in access to timely HBV birth-dose vaccination (coverage of 42% in 2019), harm reduction for people who inject drugs, and testing and treatment coverage (testing coverage of 10%, of whom 22% have been treated, for chronic HBV infection, and testing coverage of 21%, of whom 62% have been treated, for chronic HCV infection). 2 WHOGlobal progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization, GenevaJuly 15, 2021https://www.who.int/publications/i/item/9789240027077Date accessed: July 26, 2021 Google Scholar Around 124 countries have developed national viral hepatitis plans 2 WHOGlobal progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization, GenevaJuly 15, 2021https://www.who.int/publications/i/item/9789240027077Date accessed: July 26, 2021 Google Scholar and several countries have already made substantial progress and requested guidance from WHO on criteria and processes for validation of elimination.

Global elimination of viral hepatitis as a public health threat: Promoting diagnosis and treatment is the key to reducing mortality

According to Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 - Accountability for the global health sector strategies 2016-2021: Actions for impact, released by WHO on May 20, 2021, there is still an estimated number of 296 million people with hepatitis B virus (HBV) infection and 58 million people with hepatitis C virus (HCV) infection in 2019. Among the individuals with chronic infections, only 30.4 million (10%) of those with chronic HBV infection were diagnosed, among whom 6.6 million (22%) received antiviral therapy. Globally, 15.2 million (21%) of those with HCV infection have been diagnosed, among whom 9.4 million (62%) received antiviral therapy. Although significant progress has been made in eliminating viral hepatitis globally by 2020, there is still a large gap from the 2030 goal, and global attention should be paid to eliminating viral hepatitis and promoting the diagnosis and treatment of viral hepatitis. WHO and all regions should continue to support the elimination of viral hepatitis, and meanwhile each member state should also actively implement the elimination of viral hepatitis, promote national strategies for diagnosis and treatment as soon as possible, and improve the coverage of diagnosis and treatment.

Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000–20

SummaryBackgroundThe WHO Global Health Sector Strategy aims to reduce worldwide syphilis incidence by 90% between 2018 and 2030. If this goal is to be achieved, interventions that target high-burden groups, including men who have sex with men (MSM), will be required. However, there are no global prevalence estimates of syphilis among MSM to serve as a baseline for monitoring or modelling disease burden. We aimed to assess the global prevalence of syphilis among MSM using the available literature.MethodsIn this global systematic review and meta-analysis, we searched MEDLINE, Embase, LILACS, and AIM databases, and Integrated Bio-Behavioral Surveillance (IBBS) reports between April 23, 2019, and Feb 1, 2020, to identify studies done between Jan 1, 2000, and Feb 1, 2020, with syphilis point prevalence data measured by biological assay among MSM (defined as people who were assigned as male at birth and had oral or anal sex with at least one other man in their lifetime). Studies were excluded if participants were exclusively HIV-infected MSM, injection-drug users, only seeking care for sexually transmitted infections (STIs) or genital symptoms, or routine STI clinic attendees. Data were extracted onto standardised forms and cross-checked for accuracy and validity. We used random-effects models to generate pooled prevalence estimates across the eight regions of the Sustainable Development Goals. We calculated risk of study bias based on the Appraisal tool for Cross-Sectional Studies, and stratified results based on low versus high risk of bias. This systematic review and meta-analysis was registered with PROSPERO, CRD42019144594.FindingsWe reviewed 4339 records, 228 IBBS reports, and ten articles from other sources. Of these, 1301 duplicate records were excluded, 2467 records were excluded after title and abstract screening, and 534 articles were excluded after full-text analysis. We identified 345 prevalence data points from 275 studies across 77 countries, with a total of 606 232 participants. Global pooled prevalence from 2000–20 was 7·5% (95% CI 7·0–8·0%), ranging from 1·9% (1·0–3·1%) in Australia and New Zealand to 10·6% (8·5–12·9%) in Latin America and the Caribbean.InterpretationUnacceptably high syphilis prevalence among MSM warrants urgent action.FundingWellcome Trust.

Risk factors associated with hepatitis B virus infection among pregnant women attending the antenatal care unit of the Bamenda Regional Hospital

ObjectivesApproximately 257 million people are infected with hepatitis B virus (HBV) especially in the middle and low-income countries, despite the Global Health Sector Strategy on viral hepatitis 2016–2021 which aims to eliminate viral hepatitis as a public health threat by 2030. Hepatitis B virus (HBV) remains a common public health problem in Cameroon with a high prevalence among pregnant women. Therefore, this study was designed to assess risk factors associated with hepatitis B virus infection among pregnant women attending the antenatal care unit of the Bamenda Regional Hospital. Study designThe study was a health facility-based cross-sectional study carried out from March to May 2020. The inclusion criteria were all pregnant women who came for their first visit. MethodsA well-structured questionnaire and laboratory test methods were used to collect data from 221 pregnant women who were consecutively enrolled in the study. The OnSite HBsAg Rapid Test (source: CTK Biotech, Inc. REF: R0040), was used to detect HBsAg in serum. Both descriptive statistics and Chi-square (and Fisher's exact) test were used for data analysis. ResultsThe prevalence of HBV infection among pregnant women was 4.98% (11/221). Although knowledge, attitude and practice towards HBV by pregnant women were not significantly associated with the risk of infection, there were higher odds of poor practice (P = 0.0152) and attitudes (P = 0.0016) among those without knowledge on HBV infection. ConclusionsFree of charge vaccination for those with negative HBsAg test results and extensive health education campaigns against HBV is recommended among pregnant women attending the antenatal care unit of the Bamenda Regional Hospital.

COVID-19 pandemic and its implications on elimination of hepatitis by 2030: Current and future prospects

Purpose: The purpose of this paper was to discuss the challenges and difficulties faced by health agencies in meeting the WHO objective of eliminating hepatitis amid the COVID-19 pandemic. In addition, this paper also elucidates the various solutions to these problems, so that a realistic way forward can be determined in order to deal with this chronic problem in an effective and timely manner. 
 Methodology: This was a theoretical paper.
 Findings: The present world is witnessing an unprecedented global calamity in the form of COVID-19 pandemic. The impact of the contagion is so immense and wide-spread that it has practically brought the best economies and healthcare systems of the world to the verge of collapse. With the entire world focusing on the pandemic itself and its consequences, the emphasis on other major health issues has dwindled considerably. One of those essential and magnanimous tasks is the universal campaign for the elimination of hepatitis. The Global Health Sector Strategy (under the umbrella of WHO) has identified five key areas in which significant efforts are required in order to eliminate hepatitis from the world by 2030, which will be discussed in detail in this paper.
 Recommendations: Amid the COVID-19 pandemic, a targeted effort is required by health agencies and other stake holders in order to eliminate hepatitis from the world by 2030. This would include satellite (point of care) testing for chronic viral hepatitis, application of telecommunications technology for treatment and follow-up, and practically educating primary care physicians to treat non-emergent and uncomplicated cases instead of referring them to specialist clinic.

Epidemiological projections of viral-induced hepatocellular carcinoma in the perspective of WHO global hepatitis elimination.

Hepatitis B is an eminent risk factor for hepatocellular carcinoma (HCC) in Southeast Asia and sub-Saharan Africa, whereas hepatitis C is a key risk factor for HCC in Western Europe and North America. Increased awareness of the global burden of viral hepatitis resulted, in May 2016, in the adoption of the first global health sector strategy on viral hepatitis by the World Health Assembly, which calls for the elimination of viral hepatitis as a public health threat by 2030. Although the incidence of liver cancer resulting from viral infections has increased since the 1990s, the implementation of public health interventions, such as hepatitis B vaccination and antiviral therapies might have reduced the global burdens of HCC. Hepatitis B immunization in infancy has been associated with a reduction in the risk of infant fulminant hepatitis, chronic liver disease, and HCC in Taiwan. Achieving viral hepatitis elimination by 2030 can be accelerated by improving the access to HCC screening programs. HCC surveillance programs in developed countries must be refined to increase an access to personalized surveillance program, whereas the limited access to surveillance and treatment of HCC in developing countries remains a significant public health issue.

The role of sexually transmitted infections (STI) prevention and control programs in reducing gender, sexual and STI-related stigma.

The role of sexually transmitted infections (STI) prevention and control programs in reducing gender, sexual and STI-related stigma.

Hepatitis B virus infection in EU/EEA and United Kingdom prisons: a descriptive analysis.

People in prison are disproportionately affected by viral hepatitis. To examine the current epidemiology of and responses targeting hepatitis B virus (HBV) in prisons across the European Union, European Economic Area and United Kingdom, we analysed HBV-specific data from the World Health Organization's Health in Prisons European Database and the European Centre for Disease Prevention and Control's hepatitis B prevalence database. Hepatitis B surface antigen seroprevalence ranged from 0% in a maximum-security prison in United Kingdom to 25.2% in two Bulgarian juvenile detention centres. Universal HBV screening on opt-out basis and vaccination were reported available in 31% and 85% of 25 countries, respectively. Disinfectants, condoms and lubricants were offered free of charge in all prisons in the country by 26%, 46% and 15% of 26 countries, respectively. In 38% of reporting countries, unsupervised partner visits with the possibility for sexual intercourse was available in all prisons. The findings are suggestive of high HBV prevalence amidst suboptimal coverage of interventions in prisons. A harmonised monitoring system and robust data at national and regional levels are needed to better understand the HBV situation in prisons within the framework of the European action plan and Global Health Sector Strategy on viral hepatitis.

The case for simplifying and using absolute targets for viral hepatitis elimination goals.

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

Hospital discharges of hepatocellular carcinoma and non-alcohol related cirrhosis in the EU/EEA and United Kingdom: a descriptive analysis of 2004–2015 data

Background Viral hepatitis is a leading cause of mortality globally, comparable to that of HIV and TB. Most hepatitis deaths are related to liver cirrhosis and hepatocellular carcinoma (HCC) associated with chronic hepatitis B and C infections. To examine the progress towards the elimination goals set in the global health sector strategy for viral hepatitis, we aimed to assess the impact of mortality-indicative morbidity. Methods We retrieved inpatients and day cases hospital discharges data from the Eurostat hospital activities database, and analysed ICD-10 and ICD-9 specific codes related to primary HCC and non-alcohol related cirrhosis registered by European Union/European Economic Area (EU/EEA) countries and United Kingdom (UK) for 2004 to 2015. Results In 2015, 20 countries (45.7% of total EU/EEA/UK population) reported 13,236 (Range 0–6294) day cases and 36,012 (4–9097) inpatients discharges of HCC. Romania, Croatia, Luxembourg and UK reported increasing day cases discharge rates between 2004 and 2015; while HCC inpatients discharge rates increased overall during this period. There were 13,865 (0–5918) day cases and 56,176 (3–29,118) inpatients discharges reported for cirrhosis across the 20 countries in 2015. Over the 12 years, day cases discharge rates for cirrhosis increased in Romania, Croatia and UK. Though higher than for day cases, cirrhosis inpatients discharge rates remained stable. Conclusions The hospital burden of HCC and cirrhosis is high, with considerable inpatient load including sustained increasing trends in HCC discharge rates. Further interpretation in light of local health system contexts, and more robust harmonised data are needed to better understand the impact of the viral hepatitis epidemic in the region.

Accelerating the elimination of hepatitis C in Kuwait: An expert opinion.

The hepatitis C virus (HCV) is estimated to affect 71 million people worldwide. In 2016, the World Health Organization adopted the first global health sector strategy to eliminate viral hepatitis as a public health threat by 2030. In December 2018, the European Association for the Study of the Liver, International Liver Foundation convened an expert panel to address the elimination of HCV in Kuwait. Several steps have already been taken to eliminate HCV in Kuwait, including free HCV treatment for Kuwait’s citizens, high blood safety standards, and the implementation of screening and awareness programs. The expert panel made several recommendations aimed at accelerating the elimination of HCV in Kuwait: The development of a national strategy and action plan to guide all HCV elimination activities; the formation of a coordination mechanism to support collaboration between hepatitis working committees; the prioritization of micro-elimination at primary, secondary or tertiary facilities, in prisons and rehabilitation centers; and ensuring the involvement of multiple stakeholders – including relevant civil society groups – in all activities. Enhanced screening and linkage to care should be prioritized in Kuwait, with the expansion of the prescriber base to primary healthcare providers and nurse practitioners to be considered. Raising awareness and educating people about HCV infection also remain essential to achieve the goal of HCV elimination. Lastly, a national HCV registry should be developed to help monitor the implementation of viral hepatitis plans and progress towards achieving national and international targets.

HepCare Ireland-a service innovation project.

Hepatitis C virus (HCV) remains a major cause of morbidity and death worldwide, with prevalence highest among people who inject drugs (PWID), homeless populations and prisoners. The World Health Organization has published targets to be achieved by 2030 as part of its global health sector strategy to eliminate viral hepatitis. Recent innovations in testing and treatment of HCV mean such goals are achievable with effective infrastructure, political will and funding. 'HepCare Europe' was a 3-year, EU-funded project involving four member states. It sought to develop, implement and evaluate interventions to improve HCV outcomes through multiple-level interventions, running between 2016 and 2019. This paper aims to summarize the methods and present the aggregate cascade of care figures for the Irish components of HepCare. 'HepCare Ireland' contained five integrated work packages: HepCheck, HepLink, HepFriend, HepEd and HepCost. Interventions included intensified screening, community-based assessment, linkage to specialist care, peer training and support, multidisciplinary educational resources and cost-effectiveness analysis. A total of 812 participants were recruited across the three clinical work packages in Ireland. Two hundred and fifty-seven (31.7%) of the tested participants had an HCV antibody-positive result, with 162 (63.0%) testing positive for HCV RNA. At the time of writing (6th of November 2019), 57 (54.8%) of participants put on treatment had achieved SVR12, with 44 (42.3%) still undergoing treatment. In HepCheck, HepLink. HepEd and HepFriend, we demonstrate a series of interventions to improve Irish HCV outcomes. Our findings highlight the benefits of multilevel interventions in HCV care.

Progress Toward Hepatitis B Control - South-East Asia Region, 2016-2019.

In 2015, the World Health Organization (WHO) South-East Asia Region (SEAR)* reported an estimated 40 million persons living with chronic hepatitis B virus (HBV) infection and 285,000 deaths from complications of chronic infection, cirrhosis, and hepatocellular carcinoma (1). Most chronic HBV infections, indicated by the presence of hepatitis B surface antigen (HBsAg) on serologic testing, are acquired in infancy through perinatal or early childhood transmission (2). To prevent perinatal and childhood infections, WHO recommends that all infants receive at least 3 doses of hepatitis B vaccine (HepB), including a timely birth dose (HepB-BD)† (1). In 2016, the SEAR Immunization Technical Advisory Group endorsed a regional hepatitis B control goal with a target of achieving hepatitis B surface antigen (HBsAg) seroprevalence of ≤1% among children aged ≥5 years by 2020, which is in line with the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 (2,3). The South-East Asia Regional Vaccine Action Plan 2016-2020 (SEARVAP) (4) identified the acceleration of hepatitis B control as one of the eight regional goals for immunization. The plan outlined four main strategies for achieving hepatitis B control: 1) achieving ≥90% coverage with 3 doses of HepB (HepB3), 2) providing timely vaccination with a HepB birth dose (HepB-BD), 3) providing catch-up vaccination of older children, and 4) vaccinating adult populations at high risk and health care workers (1,4). In 2019, SEAR established a regional expert panel on hepatitis B to assess countries' HBV control status. This report describes the progress made toward hepatitis B control in SEAR during 2016-2019. By 2016, all 11 countries in the region had introduced HepB in their national immunization programs, and eight countries had introduced HepB-BD. During 2016-2019, regional HepB3 coverage increased from 89% to 91%, and HepB-BD coverage increased from 34% to 54%. In 2019, nine countries in the region achieved ≥90% HepB3 coverage, and three of the eight countries that provide HepB-BD achieved ≥90% HepB-BD coverage. By December 2019, four countries had been verified to have achieved the hepatitis B control goal. Countries in the region can make further progress toward hepatitis B control by using proven strategies to improve HepB-BD and HepB3 coverage rates. Conducting nationally representative hepatitis B serosurveys among children will be key to tracking and verifying the regional control targets.

Futuring a world without disease: visualising the elimination of hepatitis C

ABSTRACT Informed by work on futurity in science and technology studies, we trace how global disease elimination targets perform a world without disease through their translations in visual advocacy campaigns. Treating disease elimination targets and their visualisations as performative, we take the case of hepatitis C elimination to interrogate how futuring practices in public health govern the present and make effects. We focus specifically on how World Health Organization targets in the Global Health Sector Strategy on Viral Hepatitis entangle with visual resources produced by the World Hepatitis Alliance NOhep advocacy campaign. Targets and their visual representations in campaigns perform a disease elimination future which is set apart from the present, and yet urges action in-the-now. It enacts global health citizens but separates them from localised experiences of living with, and being cured of, disease. This disease elimination future relies heavily on instrumental rationalities and logics of the present, including the privileging of biomedical technoscientific knowledge, implementation science and global health governance, to the exclusion of other matters of concern, flattening out complexity to perform its certain achievability. These enactments raise political questions about how disease elimination futures might be made in a different mode.

Eliminating Hepatitis B from Bangladesh by the Year 2030

Worldwide, hepatitis B virus (HBV) infection is still a major public health problem. Bangladesh having a large burden of HBV infection, should be a major contributor towards it’s elimination by 2030. The country has been making progress in reducing incidence of HBV infection during the past decades. The progresses are mainly due to large vaccination coverage among children and large coverage of timely birthdose vaccine for prevention of mother-to-child transmission of HBV. However, Bangladesh still faces challenges in achieving target of reduction in mortality from HBV. On the basis of targets of the WHO’s Global health sector strategy on viral hepatitis 2016–2021, we highlight priorities for action towards HBV elimination. To attain the target of reduced mortality we propose that, the service coverage targets of diagnosis and treatment should be prioritized along with vaccination. Firstly, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Secondly, the government needs to reduce the costs of health care. Thirdly, better coordination is needed across existing national program and resources to establish an integrated system for prevention, screening, diagnosis and treatment of HBV infection. In this way, we can make progress towards achieving the target of eliminating HBV from Bangladesh by 2030
 J Bangladesh Coll Phys Surg 2020; 38(3): 145-149

A micro-elimination approach to addressing hepatitis C in Turkey

BackgroundIn 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination.MethodsLiterature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015–2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030.ResultsAt the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10–25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45–70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80–85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable.ConclusionsTo meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.

How far is Mexico from Viral Hepatitis Global Health Sector Strategy 2030 targets

In 2016 WHO member states endorsed the 69th World Health Assembly's Global Health Sector Strategies (GHSS) towards eliminating Hepatitis B (HBV) infections by 2030. Substantial progress has been made in Mexico regarding HBV vaccination, blood safety and health-care setting injection safety but minor progress has been identified regarding timely HBV birth-dose coverage, access to diagnostic testing and treatment. Most importantly, Mexico's lack of a national plan for the fight against viral hepatitis was identified as a major obstacle for the development and implementation of actions and procuring funding. Insight of these deficiencies, we propose six actions that are in line with GHSS strategic directions to better allow Mexico to reach the goal of eliminating viral hepatitis by 2030. 1) the creation of a National Viral Hepatitis Task Group capable of providing direction, recommendations as well as innovative solutions in the fight against viral hepatitis in Mexico; 2) the drafting of a National Plan for viral hepatitis; 3) establishing a national viral hepatitis information database; 4) development of Clinical Practice Guidelines; 5) appeal for governmental responsibility and accountability; 6) promote basic, applied science projects as well as clinical research to determine the viral, epidemiological, genomic, ethnic and cultural peculiarities of viral hepatitis infections in Mexico. These basic actions will better equip Mexico to meet GHSS targets, lead to high-impact health interventions and ultimately enhance the cascade of care, from diagnosis to chronic care. Political commitment is a requirement to the implementation of these actions but civil society involvement is also seen to be crucial.