While progress is made on other global health issues, hepatitis-related deaths continue to increase — a situation that campaigners are calling attention to on World Hepatitis Day.
Between 2000 and 2015, deaths from HIV, tuberculosis and malaria all fell by at least a fifth — and as much as half in the case of malaria. But deaths from viral hepatitis increased by 22 percent to 1.43 million, and that figure is expected to climb further if current policies on surveillance, diagnosis and treatment are not improved, according to this year’s World Health Organization global hepatitis report.
Many of the additional deaths have been among individuals suffering from cirrhosis and liver cancer, conditions that can occur when hepatitis goes untreated over a long period of time. A recently-published survey conducted in Asia by the Centre for Global Health at the Chinese University of Hong Kong, and supported by the Coalition to Eradicate Viral Hepatitis in Asia Pacific, found that while routine screening of pregnant women for hepatitis B and vaccinations for children are mostly available, few countries extend this to adults and high-risk groups, such as patients and health care workers frequently exposed to blood, and persons injecting drugs.
Further, of the 13 countries and territories surveyed, less than half offer routine screening for hepatitis C infection among pregnant women; and few provide generalist health care workers with training on chronic hepatitis management, making referral pathways from diagnosis to care even more disconnected.
But one of the most critical results of the survey relates to cost: In only Australia, Hong Kong, Japan and Taiwan can patients access tests and treatment for hepatitis without having to pay out of pocket. Even in Hong Kong, free tests are limited to those admitted to hospital with abnormal liver functions and limited funding is available for direct acting antivirals, or DAA, the treatment for hepatitis C infections.
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WHO has recently prequalified Sofosbuvir, a generic version of DAA, meaning it has met quality, safety and efficacy benchmarks. United Nations agencies can now procure the drug for their programs, and countries will have access to hepatitis treatment options at a lower cost. But even in countries where cheaper DAA has been available — such as Indonesia and the Philippines — households continue to cover the cost of treatment. The average price of a three-month treatment course using Sofosbuvir is between $260 and $280, according to WHO. Although this is just a fraction of the cost compared to a few years ago — before the drug was prequalified — it still puts it out of the reach of many.
The question of cost is at the core of the push for universal health coverage under the Sustainable Development Goals, ensuring that people have access to the health services they need without suffering financial hardship.
However, the results of the survey were mostly expected, said Professor Tammy Meyers from the Chinese University of Hong Kong and lead author of the report.
“By and large, the results were not surprising. For example, as we expected, most countries have strategic plans, but not the data or budget to support these,” she told Devex.
Meyers did point to a few positive results. For example, Japan and Taiwan are extending the scope of their screening programs to individuals over the age of 40 and 45, respectively.
But she also expressed concern about the lack of antidiscrimination legislation in most countries to help protect citizens with hepatitis from being refused employment and education; about poor surveillance resulting to low quality data; and about a lack of investment in case analyses to help inform policy and financial decisionmaking.
A recent WHO report on UHC investments did not include hepatitis due to a lack of models that could inform an estimate on how much countries need to invest in hepatitis management and treatment to eliminate it by 2030.
“There are better surveillance infrastructures in place for other diseases, in addition to greater financial support. Both these elements are lacking with regards to hepatitis and thus hinder rigorous cost analysis,” Meyers said. Without such analysis, it’s difficult to convince governments to commit funding for hepatitis initiatives, she added.
This is where external donor funding could come in, she said — funding economic and social research to identify the cost of hepatitis to households and the economy, as well as how much would be needed for early intervention to prevent hepatitis progressing to cancer or end-stage liver disease. Funding could also support campaigns to raise awareness about hepatitis, particularly among people who may not be aware that they have it — as symptoms often do not show in the early years of infection — and to tackle stigma and discrimination.
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