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      A global investment framework for the elimination of hepatitis B

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          Abstract

          Background and Aims

          More than 292 million people are living with hepatitis B worldwide and are at risk of death from liver cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals.

          Methods

          To catalyse political commitment and to encourage domestic- and international-financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination.

          Results

          The framework utilizes a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from investment to achieve WHO 2030 elimination targets.

          Conclusion

          Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost-saving by 2030.

          Graphical abstract

          Highlights

          • •

            The WHO has set global targets for elimination of hepatitis B by 2030

          • •

            To date, global investment in hepatitis B elimination activities has been limited

          • •

            We have developed a global investment framework for the elimination of hepatitis B to guide domestic and international investment

          • •

            This Health Policy paper outlines evidence to support the financial returns on investment in hepatitis B elimination, identifies national and international activities to achieve hepatitis B elimination targets and identifies potential funding sources

          • •

            The goal of this investment framework is to pave the way for countries to build the economic case for investment in national hepatitis B elimination programmes.

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          Most cited references45

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          Achieving child survival goals: potential contribution of community health workers.

          Andy Haines, David Sanders, Uta Lehmann … (2007)
          There is renewed interest in the potential contribution of community health workers to child survival. Community health workers can undertake various tasks, including case management of childhood illnesses (eg, pneumonia, malaria, and neonatal sepsis) and delivery of preventive interventions such as immunisation, promotion of healthy behaviour, and mobilisation of communities. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers are not a panacea for weak health systems and will need focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. The introduction of large-scale programmes for community health workers requires evaluation to document the impact on child survival and cost effectiveness and to elucidate factors associated with success and sustainability.
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            Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010.

            Maxine Denniston, Ruth Jiles, Jan Drobeniuc … (2014)
            Knowledge of the number of persons with chronic hepatitis C virus (HCV) infection in the United States is critical for public health and policy planning. To estimate the prevalence of chronic HCV infection between 2003 and 2010 and to identify factors associated with this condition. Nationally representative household survey. U.S. noninstitutionalized civilian population. 30,074 NHANES (National Health and Nutrition Examination Survey) participants between 2003 and 2010. Interviews to ascertain demographic characteristics and possible risks and exposures for HCV infection. Serum samples from participants aged 6 years or older were tested for antibody to HCV; if results were positive or indeterminate, the samples were tested for HCV RNA, which indicates current chronic infection. Based on 273 participants who tested positive for HCV RNA, the estimated prevalence of HCV infection was 1.0% (95% CI, 0.8% to 1.2%), corresponding to 2.7 million chronically infected persons (CI, 2.2 to 3.2 million persons) in the U.S. noninstitutionalized civilian population. Infected persons were more likely to be aged 40 to 59 years, male, and non-Hispanic black and to have less education and lower family income. Factors significantly associated with chronic HCV infection were illicit drug use (including injection drugs) and receipt of a blood transfusion before 1992; 49% of persons with HCV infection did not report either risk factor. Incarcerated and homeless persons were not surveyed. This analysis estimated that approximately 2.7 million U.S. residents in the population sampled by NHANES have chronic HCV infection, about 500,000 fewer than estimated in a similar analysis between 1999 and 2002. These data underscore the urgency of identifying the millions of persons who remain infected and linking them to appropriate care and treatment. None.
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              Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

              Graham Cooke, Isabelle Andrieux-Meyer, Tanya L. Applegate … (2019)
              Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
              Article 0 comments Cited 190 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Hepatol
                Journal ID (iso-abbrev): J. Hepatol
                Title: Journal of Hepatology
                Publisher: European Association for the Study of the Liver. Published by Elsevier B.V.
                ISSN (Print): 0168-8278
                ISSN (Electronic): 1600-0641
                Publication date PMC-release: 22 September 2020
                Publication date (Electronic): 22 September 2020
                Affiliations
                [1 ]Disease Elimination Programme, Burnet Institute, Melbourne, Australia
                [2 ]School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
                [3 ]Department of Medicine, University of Melbourne, Melbourne, Australia
                [4 ]Department of Gastroenterology, St Vincent’s Hospital Melbourne, Australia
                [5 ]Centre for Health Policy, Imperial College London
                [6 ]Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
                [7 ]Universidade Catolica Portuguesa, Lisbon, Portugal
                [8 ]Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
                [9 ]Global Health Unit, University Medical Centre, Groningen, the Netherlands
                [10 ]Medicines Law & Policy, Amsterdam, The Netherlands
                [11 ]School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
                [12 ]Health Protection Scotland, Meridian Court, Cadogan St, Glasgow, UK
                [13 ]Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
                [14 ]World Hepatitis Alliance, London, UK
                [15 ]TREAT Asia/amfAR, Foundation for AIDS Research, Bangkok, Thailand
                [16 ]Department of Hepatology, Imperial College London, London, UK
                [17 ]Department of Medicine, Medicine, College of Medicine, University of Lagos, Nigeria
                [18 ]Division of Gastroenterology and Hepatology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
                [20 ]Department of HIV and Global Hepatitis Programme, World Health Organization
                [21 ]Department of Infectious Diseases, The Alfred and Monash University, Australia
                Author notes
                [∗ ]Corresponding author Jessica Howell, 85 Commercial Rd, Melbourne, 3004, VIC, Australia.
                Article
                Publisher ID: S0168-8278(20)33625-4
                DOI: 10.1016/j.jhep.2020.09.013
                PMC ID: 7505744
                PubMed ID: 32971137
                SO-VID: 0a26e480-e07a-4d9c-8e56-48c70be68d60
                Copyright © © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 30 March 2020
                Date revision received : 28 August 2020
                Date accepted : 14 September 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: viral hepatitis,hepatitis b,disease elimination,health financing,universal health coverage,cost-effectiveness
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: viral hepatitis, hepatitis b, disease elimination, health financing, universal health coverage, cost-effectiveness

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