Review

. 2019 Oct;39(10):1818-1836.

doi: 10.1111/liv.14222. Epub 2019 Sep 4.

Innovative strategies for the elimination of viral hepatitis at a national level: A country case series

Sophia E Schröeder^{1

2}, Alisa Pedrana^{1

2}, Nick Scott¹, David Wilson^{1

2}, Christian Kuschel¹, Lisa Aufegger³, Rifat Atun⁴, Ricardo Baptista-Leite^{5

6}, Maia Butsashvili⁷, Manal El-Sayed⁸, Aneley Getahun⁹, Saeed Hamid¹⁰, Radi Hammad¹¹, Ellen 't Hoen^{12

13}, Sharon J Hutchinson^{14

15}, Jeffrey V Lazarus¹⁶, Olufunmilayo Lesi¹⁷, Wangsheng Li¹⁸, Rosmawati Binti Mohamed¹⁹, Sigurdur Olafsson²⁰, Raquel Peck²¹, Annette H Sohn²², Mark Sonderup²³, Catherine W Spearman²³, Tracy Swan²⁴, Mark Thursz²⁵, Tim Walker^{26

27}, Margaret Hellard^{1

2

28

29}, Jessica Howell^{1

30

31}

Affiliations

¹ Burnet Institute, Melbourne, VIC, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
³ Centre for Health Policy, Imperial College London, London, UK.
⁴ Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
⁵ Universidade Catolica Portuguesa, Lisbon, Portugal.
⁶ Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
⁷ Health Research Union, Tbilisi, Georgia.
⁸ Department of Pediatrics and Clinical Research Center, Ain Shams University, Cairo, Egypt.
⁹ School of Public Health and Primary Care, Fiji National University, Suva, Fiji.
¹⁰ Aga Khan University, Karachi, Pakistan.
¹¹ Ministry of Health and Population, Cairo, Egypt.
¹² Global Health Unit, University Medical Centre, Groningen, the Netherlands.
¹³ Medicines Law & Policy, Amsterdam, the Netherlands.
¹⁴ School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
¹⁵ Health Protection Scotland, Meridian Court, Glasgow, UK.
¹⁶ Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain.
¹⁷ University of Lagos, Lagos, Nigeria.
¹⁸ ZeShan Foundation, Wanchai, Hong Kong.
¹⁹ Department of Medicine, University of Malaysia, Kuala Lumpur, Malaysia.
²⁰ Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland.
²¹ World Hepatitis Alliance, London, UK.
²² TREAT Asia/amfAR, Foundation for AIDS Research, Bangkok, Thailand.
²³ Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²⁴ Treatment Action Group, New York, NY, USA.
²⁵ Department of Hepatology, Imperial College London, London, UK.
²⁶ Department of Gastroenterology and General Medicine, Calvary Mater, Newcastle, NSW, Australia.
²⁷ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
²⁸ Hepatitis Services, Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia.
²⁹ Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
³⁰ Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia.
³¹ Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.

PMID: 31433902
PMCID: PMC6790606
DOI: 10.1111/liv.14222

Review

Innovative strategies for the elimination of viral hepatitis at a national level: A country case series

Sophia E Schröeder et al. Liver Int. 2019 Oct.

. 2019 Oct;39(10):1818-1836.

doi: 10.1111/liv.14222. Epub 2019 Sep 4.

Authors

Affiliations

¹ Burnet Institute, Melbourne, VIC, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
³ Centre for Health Policy, Imperial College London, London, UK.
⁴ Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
⁵ Universidade Catolica Portuguesa, Lisbon, Portugal.
⁶ Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
⁷ Health Research Union, Tbilisi, Georgia.
⁸ Department of Pediatrics and Clinical Research Center, Ain Shams University, Cairo, Egypt.
⁹ School of Public Health and Primary Care, Fiji National University, Suva, Fiji.
¹⁰ Aga Khan University, Karachi, Pakistan.
¹¹ Ministry of Health and Population, Cairo, Egypt.
¹² Global Health Unit, University Medical Centre, Groningen, the Netherlands.
¹³ Medicines Law & Policy, Amsterdam, the Netherlands.
¹⁴ School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
¹⁵ Health Protection Scotland, Meridian Court, Glasgow, UK.
¹⁶ Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain.
¹⁷ University of Lagos, Lagos, Nigeria.
¹⁸ ZeShan Foundation, Wanchai, Hong Kong.
¹⁹ Department of Medicine, University of Malaysia, Kuala Lumpur, Malaysia.
²⁰ Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland.
²¹ World Hepatitis Alliance, London, UK.
²² TREAT Asia/amfAR, Foundation for AIDS Research, Bangkok, Thailand.
²³ Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²⁴ Treatment Action Group, New York, NY, USA.
²⁵ Department of Hepatology, Imperial College London, London, UK.
²⁶ Department of Gastroenterology and General Medicine, Calvary Mater, Newcastle, NSW, Australia.
²⁷ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
²⁸ Hepatitis Services, Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia.
²⁹ Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
³⁰ Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia.
³¹ Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.

PMID: 31433902
PMCID: PMC6790606
DOI: 10.1111/liv.14222

Abstract

Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.

Keywords: developing countries; disease elimination; hepatitis B; hepatitis C; investment case; organizational case studies.

PubMed Disclaimer

Conflict of interest statement

AHS reports grants and travel funding to her institution from ViiV Healthcare. ETH is the former director of the Medicines Patent Pool. NS has received investigator‐initiated research funding from Gilead Sciences. JVL reports grants and personal fees from AbbVie, Gilead Sciences and MSD, personal fees from CEPHEID and Janssen outside the submitted work. MES is principal investigator in an investigator‐initiated trial sponsored by Gilead Sciences (received no PI fees, trial closed April 17th 2019) and reports an educational grant to travel to EASL 2019 (Gilead Sciences). SJH received honoraria from Gilead, unrelated to submitted work. MH's institute receives investigator‐initiated research funding from Gilead Sciences, Abbvie and BMS. JH received the Gilead Sciences Australia fellowship (2017). DW, CK, RA, RBL, MB, LA, AG, SH, RH, WL, RBM, SO, RP, MS, CWS, TS, MT, TW and ESS have nothing to declare.

Figures

**Figure 1**
Investment framework for viral hepatitis elimination

**Figure 2**
Timeline of national activities, Portugal

**Figure 3**
Timeline of national activities, Pakistan (A), Fiji (B), and Iceland (C)

**Figure 4**
Timeline of national activities, Malaysia

**Figure 5**
Timeline of national activities, Georgia (A), South Africa (B), and Scotland (C)

**Figure 6**
Timeline of national activities, Brazil (A), China (B), and Egypt (C)

**Figure 7**
Timeline of national activities, Rwanda (A) and Australia (B)

See this image and copyright information in PMC

Comment in

Colombian experience in the management of hepatitis C.
Gomez-Aldana AJ, Tapias M, Rosselli D. Gomez-Aldana AJ, et al. Liver Int. 2020 Dec;40(12):3143. doi: 10.1111/liv.14582. Epub 2020 Jul 12. Liver Int. 2020. PMID: 32602224 No abstract available.
Authors' response to Letter to the Editor: 'Colombian experience in the management of hepatitis C'.
Schroeder S, Pedrana A, Scott N, Hellard M. Schroeder S, et al. Liver Int. 2020 Dec;40(12):3142-3143. doi: 10.1111/liv.14653. Liver Int. 2020. PMID: 32875663 No abstract available.

References

1. World Health Organization . Global Hepatitis Report 2017. Geneva, Switzerland: World Health Organization; 2017.
1. Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386:1546‐1555. - PubMed
1. GBD 2015 Mortality and Causes of Death Collaborators . Global, regional, and national life expectancy, all‐cause mortality, and cause‐specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388:1459‐1544. - PMC - PubMed
1. World Health Organization . Global Hepatitis Report 2017. Geneva: WHO; 2017. [updated 2017; cited 2018 24 March]; Available from: http://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng....
1. Edmunds WJ, Medley GF, Nokes DJ, et al. Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areas. Epidemiol Infect. 1996;117:313‐325. - PMC - PubMed

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Innovative strategies for the elimination of viral hepatitis at a national level: A country case series

Affiliations

Innovative strategies for the elimination of viral hepatitis at a national level: A country case series

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

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