Are EU/EEA countries ready to monitor progress on hepatitis C programmes?
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Transcript of Are EU/EEA countries ready to monitor progress on hepatitis C programmes?
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Are EU/EEA countries ready to monitor progress on HCV programmes?Aspinall EJ 1, 2, Goldberg DJ 2, 1, Duffell E 3, Hutchinson SJ 1, 2, Valerio H 1, 2 & Tavoschi L 3 1 School of Health and Life Sciences, Glasgow Caledonian University, UK2 Health Protection Scotland, NHS National Services Scotland, Glasgow, UK3 European Centre for Disease Prevention and Control, Stockholm, Sweden
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The evolving hepatitis C political landscape
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THE ELIMINATION AGENDA
Highly effective, well tolerated direct acting antivirals
The evolving hepatitis C political landscape
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Additional indicators:1. HCV coinfection
among people with HBV
2. Experience with discrimination
3. Availability of essential medicines
4. National system for viral hepatitis surveillance
5. Hepatitis B testing6. Hepatitis C testing7. HCV genotyping8. Viral hepatitis B and
C care coverage9. Equitable access to
hepatitis treatment10. Documentation of
treatment effectiveness
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Survey Program data
Special study
Model-ling
Case reporting
Cohort study
Various registries
Patient records
C1Prevalence of chronic
HCV infection
C2Infra-
structure of HCV testing
C4Facility-
level injection
safety
C5Needle-syringe distri-bution
C6People
living with HCV
diagnosed
C7Treatment initiation for HCV patients
C8Cure for chronic
HCV patients treated
C9Incidence
of HCV infection
C10Deaths from
HCC, cirrhosis,
liver disease attributable
to HCV
Possible data sources for the generation of HCV-relevant core indicators
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ECDC assessment of available monitoring data across EU/EEA countries
ECDC survey of the 31 EU/EEA countries on HCV data: Testing Treatment Mortality
Respondents: 20/31 (68%) countries (separate responses from England and Scotland)
Survey findings merged with information on regional data sources previously collated by ECDC
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1. Context: Epidemic
Review identified estimates of prevalence in the general population from 13 countries
Further 6 studies identified by MS survey 2016
Many studies are of weak methodological design: Subnational samples Convenience sampling Variety in study
populations
ECDC systematic review: Anti-HCV prevalence in the general population, EU/EEA, 2005–2015
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2. Inputs: System infrastructure for testing
10 countries (48%) have dedicated national HCV testing guidance
Eight (38%) reported routine offer of HCV testing to all prisoners 12 (57%) reported HCV testing offered to prisoners only on
basis of risk factors or for medical reasonsOne country reported no routine testing
Variation in reported national policies for testing of risk groups
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People donating blood/blood products
People who inject drugs
Abnormal liver function tests
People who formerly injected drugs
Children of mothers with HCV
People in prison
Healthcare workers
Migrants
Pregnant women
Men who have sex with men
Commercial sex workers
Homeless
General population
0 10 20 30 40 50 60 70 80 90 100
Proportion of countries with policy (%)
National policies for the testing of key risk groups
2. Inputs: System infrastructure for testing
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Funding of HCV testing
2. Inputs: System infrastructure for testing
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3. Outputs and outcomes: Prevention
EMCDDA collect data on syringes: Available in 2016 for 24 EU/EEA countries
– 14/24 also report estimates of the size of the PWID population
WHO collect data on HBV vaccination coverage collected from countries with universal programmes:
Data from 23 countries were available in 2016
No systematic data collection of testing facilities or facility level injection safety in EU/EEA countries.
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0
10
20
30
40
50
60
70
Perc
enta
ge o
f cou
ntrie
s rep
ortin
g na
tiona
l dat
a av
aila
ble
3. Outputs and outcomes: Prevention
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4. Impact: Elimination mortality
18 (86%) countries have data available on mortality due to liver cirrhosis and all countries have data for liver cancer
HCV status only recorded by a few countries: – 5 for cirrhosis – 6 for liver cancer
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Monitoring system already exists
Additional data collection beingset up by ECDC
Additional data collection beingset up WHO
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ECDC’s priorities for supporting countries monitoring hepatitis C
Improve the estimated burden of disease by: Supporting countries to help improve existing surveillance
systems for hepatitis notifications and antiviral consumptionPromoting standardised serosurveys Improving estimates of hepatitis related mortality
Programme to obtain rolling estimates of prevalenceCo-infections Proportion diagnosed
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Key conclusions
Data for the monitoring of HCV programmes in EU/EEA countries is limited
Gaps in the availability and robustness of testing and mortality data
Existing monitoring infrastructure may provide opportunities for expanding data collections
Collaboration important to support countries and address data gaps
Opportunities exist for the sharing best practices from countries with developed monitoring programmes and TB/HIV programmes
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Acknowledgements
Project team from Glasgow Caledonian University/Health Protection Scotland
ECDC National Member State focal points
The European Hepatitis B and C Network and Coordination Committee
ECDC: Andrew Amato-Gauci, Teymur Noori
WHO: Antons Mozalevskis