Eradicating HCV Globally by 2030
The World Health Organization (WHO) has set an initiative to eliminate hepatitis C by 2030.1 They are calling on countries around the globe to achieve a reduction rate of new viral hepatitis infections by 90% and mortality by 65%.2,3 There are different types of viral hepatitis infections, including A, B, and C, however, hepatitis C has high incidence rates and is yet to have a vaccine.
Hepatitis C affects more than 150 million people worldwide, with a mortality rate of 500,000 per year.4 The main challenges preventing the eradication of hepatitis C are a severe need for public awareness and education, and accessibility of treatments. Hepatitis C can inflict serious damage to the liver and manifests in two forms, acute and chronic, with differing severity in symptoms. Acute hepatitis C usually passes without consequence, but for those who develop chronic hepatitis C, years of infection could result in significant damage to the liver, including cirrhosis and liver failure, and can even present an increased risk for the development of liver cancer.5 Hepatitis C virus (HCV) is spread via blood-to-blood contact but it is not transmissible through hugging, kissing, or sharing eating utensils. Hepatitis C often presents no symptoms, and if so, they are generally nonspecific (i.e., fatigue or discomfort in the abdomen). However, blood tests are available for screening. Treatment of the disease includes a combination of lifestyle modifications, such as limiting alcohol intake, and curative therapies of oral antiviral medications. In fact, recent advancements have boosted cure rates to greater than 95% for nearly all individuals.
Challenges
Regardless of the availability of cost-effective prevention methods, diagnostic tools, and curative therapies for hepatitis C, there remains high incidence rates due to a number of barriers that inhibit timely access to treatment, such as a lack of education and awareness, stigma, monitoring issues, and availability. Researchers and advocates have called for the addition of HCV testing in patients’ continuum of care. This consists of guidelines for clinical practice, with appropriate triage of care for high risk populations, such as anyone born between 1945 and 1975 and individuals who use drugs, are in prison, or are of indigenous descent.
Canada’s Efforts
Healthcare experts have established models of care to address these roadblocks. These include integrated care in the community (i.e., substance use disorder treatment programs), and partnerships between healthcare professionals to encourage streamlined care, such as the ability of non-specialists to deliver treatment for most cases of hepatitis C. Complex cases may require support from a specialist. Of considerable note is the Blueprint to inform hepatitis C elimination efforts in Canada, published by the Canadian Network on Hepatitis C (CanHepC).6 They designed this document to assist provinces and territories in the development of action plans for their jurisdictions, filled with options and flexibility for demographic, geographic, societal and cultural contexts from prevention and screening, diagnosis, care, and treatment. In addition, the Public Health Agency of Canada released guidelines for all healthcare stakeholders. Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030 aims to provide ways in which multidisciplinary partnerships between healthcare practitioners, members of the public and private sectors, and all levels of government can collaborate to meet the global 2030 target of eliminating HCV.7
Want to do your part? Ask your doctor about a hepatitis C test!
The GI Society will continue to raise awareness and work with all healthcare stakeholders to promote education about HCV.
First published in the Inside Tract® newsletter issue 212 – 2019
1. World Health Organization. “Combating Hepatitis B and C to Reach Elimination by 2030.” May 2016. Available at: https://apps.who.int/iris/bitstream/handle/10665/206453/WHO_HIV_2016.04_eng.pdf?sequence=1. Accessed 2019-10-29.
2. Hutin Yvan et al. How far are we from viral hepatitis elimination service coverage targets? Journal of the International AIDS Society. April 2018.
3. This global strategy also includes the elimination of Hepatitis B (HBV), which is another viral hepatitis infection. However, due to the limitations of this article we will only discuss Hepatitis C (HCV).
4. Health Canada. Surveillance of hepatitis C. Available at: https://www.canada.ca/en/public-health/services/diseases/hepatitis-c/surveillance-hepatitis-c.html. Accessed 2019-10-29.
5. World Health Organization. Hepatitis C. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. Accessed 2019-10-29.
6. The Canadian Network on Hepatitis C Blueprint Writing Committee and Working Groups. Blueprint to inform hepatitis C elimination efforts in Canada. May 2019. Montreal, QC. Available at: http://www.canhepc.ca/sites/default/files/media/documents/blueprint_hcv_2019_05.pdf. Accessed 2019-10-29.
7. Public Health Agency of Canada. “Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030: a pan-Canadian STBBI framework for action.” Government of Canada page. Available at: https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/reports-publications/sexually-transmitted-blood-borne-infections-action-framework.html#targetText=The%20Pan%2DCanadian%20STBBI%20Framework%20for%20Action%20provides%20a%20roadmap,infections%20as%20major%20health%20concerns. Accessed 2019-10-29.
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