Just 12 countries worldwide on track to eliminate hepatitis C infection by 2030, with United Kingdom, Italy and Spain among those joining the list

New data on the world’s hepatitis C epidemic, presented at this week’s Global Hepatitis Summit in Toronto, Canada (14-17 June) shows that only 12 countries in the world are on track to meet the WHO elimination targets that 194 countries globally signed up to in 2016. The data is presented by Dr Homie Razavi and his team from the Polaris Observatory, Center for Disease Analysis Foundation (CDAF), Lafayette, CO, USA.

Since the last global update in 2017, Italy, Spain, Switzerland, the UK and Mongolia have all been added to the list, thanks to the number of patients they treated in 2017, plus the lifting of treatment restrictions to include all patients with hepatitis C regardless of their degree of liver damage. These countries join the others already on track to eliminate by 2030: Australia, Egypt, France, Georgia, Iceland, Japan and the Netherlands. In all cases, these countries are treating at least 7% of their infected population each year, and have opened treatment up to all those infected.

Two countries previously on-track have now fallen off the list: Germany, which is no longer treating 7% of its patients per year, and Qatar, which has been unable to provide new data to the Polaris Observatory to confirm its progress.

“We use a number of metrics to determine if a country will achieve the elimination targets.  These include implementation of, or already existing harm reduction programs, removal of treatment restrictions, sufficient number of diagnosed patients, and treatment rate required to meet the 2030 targets,” says Dr Razavi, Managing Director of the CDA Foundation who runs the Polaris Observatory.  The observatory tracks progress in more than 100 countries and collaborates with over 1,000 country experts.

Any country that has treatment restrictions in place is automatically excluded from the on-track list.  Unrestricted access is needed to achieve elimination targets and some large countries continue to implement restrictions: for example, the USA continues to be a high-profile country that has treatment restrictions for its Medicaid population in many states.  While host nation Canada is gradually lifting restrictions in most (but not yet all) jurisdictions, nationally it is still treating well below 7% of its infected population per year.

Globally, the total number of treated HCV patients increased from 1.8 million to 2.1 million between 2016 and 2017 but most of that growth occurred in middle income countries.  In high income countries, the number of treated patients actually decreased. “The treatment rate decreased in half of the countries on the 2017 list,” says Dr Razavi.  “These countries are still treating a sufficient number of patients to meet the 2030 targets.  However, if treatment continues to decline, they will not be able to achieve the targets.”

“Screening and diagnosing new patients is the key factor. The drop in treatment is mainly due to those already diagnosed completing treatment, leading to countries running out of patients.  Countries are simply not screening sufficient number of patients to maintain their treatment rate,” explains Dr Razavi.  “The two exceptions are Egypt, which screened 4.5 million individuals in 2017 and recently secured a $200 million loan from the World Bank to screen the rest of its population.  Mongolia, on the other hand, screened everyone aged 41-65 in 2016 and will screen those aged 18-40 in 2017.”

National screening campaigns are the only way to find everyone infected with HCV, says Razavi.  Even countries like Australia, which estimate to have 80% of their HCV infected population diagnosed, are running out of patients.  This is because the national registries do not keep patient identifiers. Thus, unless patients remember they tested positive for HCV and walk into a clinic, there is no way to find them. High-income countries are currently focusing their screening efforts among the high-risk populations, including people who inject drugs (PWID) at opioid substitution centers, needle and syringe exchange centers, and prisons.  However, the Polaris Observatory estimates that these high-risk groups account for less than 20% of all infections. Sooner or later, this strategy will be self-limiting.

Both Egypt (which screened 4.5 million people in one year) and Brazil (which screened 20 million over four years) have proven that national screening is feasible. Cost-effectiveness is slightly more difficult to prove and Dr Razavi’s team are working with various countries to identify what is needed to make a screening program in the general population cost effective, with a demonstration project planned in Africa.

“It is great to see these new countries joining the other on-track countries. It takes an incredible dedication to public health to provide sufficient resources to eliminate hepatitis C by 2030,” explains Dr Razavi.

“We would like to see the list of countries on path to elimination grow exponentially next year.  Sadly, most countries are not going to achieve the 2030 goals if they continue doing what they are doing currently.  We need more screening, removal of restrictions, and increased treatment for countries to achieve what they agreed to do when they signed up to the WHO 2030 Elimination Targets.”

Dr Homie Razavi, Polaris Observatory, Center for Diseases Analysis Foundation, Lafayette, CO, USA.
T) +1 720 890 4848 E) homie.razavi@centerforda.com

Tony Kirby, Media Consultant for the Global Hepatitis Summit.
T)  +44 7834 385827 E) tony@tonykirby.com

 

Notes to editors:

The numbers treated for each country come from the following sources:  National databases, government reports, national experts, or pharma industry sales.

 

Patients treated in on-track countries, 2017 versus 2016

	2016	2017	% Increase (Decrease)
Australia	32,400	22,300	-31%
Egypt	500,000	600,000	20%
France	16,000	19,300	21%
Georgia	21,600	15,400	-29%
Iceland	450	200	-56%
Italy	33,700	43,000	28%
Japan	87,900	38,000	-57%
Mongolia	10,400	15,300	47%
Netherlands	2,000	1,200	-40%
Spain	32,000	29,700	-7%
Switzerland	2,300	3,200	39%
United Kingdom	11,500	14,800	29%

 

Total patients treated , 2016 and 2017

	2016	2017
High income	534,813	484,753
Upper middle income	269,426	337,703
Lower middle income	930,425	1,299,429
Low income	30,586	26,514