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  

The evolving hepatitis C political landscape

THE ELIMINATION AGENDA

Highly effective, well tolerated direct acting antivirals

The evolving hepatitis C political landscape

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

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

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

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

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

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

Funding of HCV testing

2. Inputs: System infrastructure for testing

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.

0

10

20

30

40

50

60

70

Perc

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f cou

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ble

3. Outputs and outcomes: Prevention

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

Monitoring system already exists

Additional data collection beingset up by ECDC

Additional data collection beingset up WHO

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

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

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

www.ecdc.europa.eu

Contact: stihivhep@ecdc.europa.eu