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Eliminating viral hepatitis: no room
for complacency; lack of political will
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Download the PDF here
Feb 14 2024
Commentary
"By far the biggest barrier, however, is a continued lack of political will and resultant inadequate funding for viral hepatitis elimination......viral hepatitis continues to be overlooked, perhaps due to a lack of awareness, but also as a victim of political and social short-termism."
The first Lancet Gastroenterology & Hepatology Commission on the elimination of viral hepatitis,1 published in 2019, gathered a team of experts to assess preparedness for elimination and priorities to accelerate progress towards the 2030 targets that had beenset by WHO in 2016.2 The Commission identified the 20 countries with the highest burden of viral hepatitis, accounting for more than 75% of the global burden, with most countries being of low or middle income. Key factors that were identified to accelerate elimination efforts included the need for greater investment, scale up of diagnosis and prevention measures, and increased access to treatment.
progress towards the 2030 targets has been slower than initially hoped.
Models of care for hepatitis C have been simplified, expanding access to diagnosis and improving linkage to care.
The complexity of care for hepatitis B remains a barrier to progress, and simplification is urgently needed; one hopes that WHO's long-awaited new guidelines in this area emerge soon. Further efforts to develop rapid diagnostics, particularly point-of-care tests, will be crucial to support simplified treatment algorithms, and much can be learned from the response to COVID-19 in terms of the development, adoption, and acceptability of such rapid testing. Simplified treatment eligibility scores-eg, the HEPSANET score7 -could also allow the decentralisation of care in regions without access to costly tests such as HBV DNA quantification or transient elastography. Despite progress in making treatments for viral hepatitis more affordable, restrictions for reimbursement and prescription of pangenotypic direct-acting antivirals for hepatitis C remain.
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