The global and Regional hepatitis elimination agendaregist2.virology-education.com/presentations/2019/COLDA/...Global Health Sector Strategy on viral hepatitis Rooted in the UHC agenda

Joumana Hermez, Regional Advisor

Hepatitis, AIDS and STI Unit

WHO Eastern Mediterranean Regional Office

The global and Regional hepatitis

elimination agenda

COLDA 2019, Cairo - Egypt

Global Health Sector Strategy on viral hepatitis

Rooted in the UHC agenda

More people covered

More services

Without catastrophic pay

Targets: Eliminaion by 2030

A continuum from prevention to cure or chronic life-time care

Eastern Mediterranean

Region

Regional Action Plan• Vision, goal and targets aligned with GHSS

• Targets:

• 10-fold reduction of new infections and 3-fold reduction of deaths from

chronic hepatitis by 2030.

• Purpose:

• to build and keep momentum among WHO Member States

• and to guide Member States and the WHO Secretariat on a roadmap and

priority actions towards the achievements of national, regional and

global targets.

• Target audience:

• Policy-makers, programme officers, health planners and implementing

agencies, clinicians, civil society organizations, community groups, WHO

partner agencies, the private sector, donors, etc.

HCVHBV

36 million of viral hepatitis in the EMR (both B and C)

Prevalence of HBV infection (HBsAg) in the general population by WHO region

0,7%

1,6%2,0%

3,3%

6,1% 6,2%

0,0%

1,0%

2,0%

3,0%

4,0%

5,0%

6,0%

7,0%

Region of the Americas European Region South-East Asia Region Eastern MediterraneanRegion

African Region Western Pacifi cRegion

Global prevalence: 3.5%(N= 257 million)

Cumulative incidence of chronic HBV infection, 2015 (prevalence of HBsAg in children under 5 years)

0,2%0,4%

0,7%0,9%

1,6%

3,0%

0,0%

0,5%

1,0%

1,5%

2,0%

2,5%

3,0%

3,5%

Region of theAmericas

EuropeanRegion

South-East AsiaRegion

Western Pacific Region

EasternMediterranean

Region

African Region

Estimated number of HBV infectionRegion of the Americas

European Region

South-East Asia Region

Eastern Mediterranean Region (8.1%)

African Region

Western Pacifi c Region

Region of the Americas European Region South-East Asia Region Eastern Mediterranean Region African Region Western Pacifi c Region

21 millions living with HBV

8.1% of the Global burden

Distribution of Hepatitis B cases in the EMR Egypt

9%

Pakistan50%

Somalia6%

Sudan 14%

Yemen6%

Rest of EMR15%

5 countries = 85% of HBV

Pakistan = 50%

Prevalence of HCV infection by WHO region

0,5%0,7% 0,7%

1,0%

1,5%

2,3%

0,0%

0,5%

1,0%

1,5%

2,0%

2,5%

South-East AsiaRegion

Region of theAmericas

Western Pacifi cRegion

African Region EuropeanRegion

EasternMediterranean

Region

Hepatitis C Epidemic in the EMRThe EMR has the highest HCV incidence compared to other WHO regions (63 per 100,000)

High burden countries for HCV

Egypt and

Pakistan80%

Rest of EMR20%

Egypt and Pakistan Rest of EMR

Modes of transmission of viral hepatitis in the EMR

• Unsafe healthcare procedures including weak blood and injection safety, and injecting drug are the most common leading causes of HCV infections in our region.

Proportion of health-care injections given with equipment reused without sterilization, by WHO region

• Proportion of unsafe health injections is at 14%.

Progress in implementation of RAP

countries with national strategies

countries with designated program/focal point

Pakistan pledgeIn 5 years• 140 M to be screened for HCV• 100% blood safety• 100% injection safety

HB-BD vaccine Regional coverage

60 M

HCV tested

> 3 M

HCV treated

Egypt

Cascade of care for HBV and HCV (end 2018)

21

00

0

35

1

1

TOTA L NUMBER ( 000) DIA GNOSED ( 000) TREA TED ( 000)

HEPATITIS B CASCADE OF CARE

Hepatitis B cascade of care

15

3,6

2,5

0

TOTA L NUMBER (M)

D IA GNOSED TREA TED V IRA LLY SUPPRESSED

HEPATITIS C CASCADE OF CARE

Hepatitis C cascade of care

PWID

• Injecting drug use is one of the driving forces of the epidemic, especially in lower prevalence countries

• Large estimate for PWIDs estimated in Pakistan, Iran, ….etc

• Harm reduction services remain very limited

• Target is 200 syringes/person/year

• EMR is at 25 syringes/person/year

In summary

• Ambitious agenda of hepatitis elimination

• EMR challenged by high burden of both HBV and HCV

• Risk factors still high

• Progress mainly driven by Egypt

• Signs of increasing commitment in various countries

• Hepatitis B getting much less attention than hepatitis C

• PWID need attention

Thank you

[email protected]

[email protected]

Joumana.hermez