The global and Regional hepatitis elimination...
21
Joumana Hermez, Regional Advisor Hepatitis, AIDS and STI Unit WHO Eastern Mediterranean Regional Office The global and Regional hepatitis elimination agenda COLDA 2019, Cairo - Egypt
Transcript of The global and Regional hepatitis elimination...
Joumana Hermez, Regional Advisor
Hepatitis, AIDS and STI Unit
WHO Eastern Mediterranean Regional Office
The global and Regional hepatitis
elimination agenda
COLDA 2019, Cairo - Egypt
Global Health Sector Strategy on viral hepatitis
Rooted in the UHC agenda
More people covered
More services
Without catastrophic pay
Targets: Eliminaion by 2030
A continuum from prevention to cure or chronic life-time care
Eastern Mediterranean
Region
Regional Action Plan• Vision, goal and targets aligned with GHSS
• Targets:
• 10-fold reduction of new infections and 3-fold reduction of deaths from
chronic hepatitis by 2030.
• Purpose:
• to build and keep momentum among WHO Member States
• and to guide Member States and the WHO Secretariat on a roadmap and
priority actions towards the achievements of national, regional and
global targets.
• Target audience:
• Policy-makers, programme officers, health planners and implementing
agencies, clinicians, civil society organizations, community groups, WHO
partner agencies, the private sector, donors, etc.
HCVHBV
36 million of viral hepatitis in the EMR (both B and C)
Prevalence of HBV infection (HBsAg) in the general population by WHO region
0,7%
1,6%2,0%
3,3%
6,1% 6,2%
0,0%
1,0%
2,0%
3,0%
4,0%
5,0%
6,0%
7,0%
Region of the Americas European Region South-East Asia Region Eastern MediterraneanRegion
African Region Western Pacifi cRegion
Global prevalence: 3.5%(N= 257 million)
Cumulative incidence of chronic HBV infection, 2015 (prevalence of HBsAg in children under 5 years)
0,2%0,4%
0,7%0,9%
1,6%
3,0%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
3,5%
Region of theAmericas
EuropeanRegion
South-East AsiaRegion
Western Pacific Region
EasternMediterranean
Region
African Region
Estimated number of HBV infectionRegion of the Americas
European Region
South-East Asia Region
Eastern Mediterranean Region (8.1%)
African Region
Western Pacifi c Region
Region of the Americas European Region South-East Asia Region Eastern Mediterranean Region African Region Western Pacifi c Region
21 millions living with HBV
8.1% of the Global burden
Distribution of Hepatitis B cases in the EMR Egypt
9%
Pakistan50%
Somalia6%
Sudan 14%
Yemen6%
Rest of EMR15%
5 countries = 85% of HBV
Pakistan = 50%
Prevalence of HCV infection by WHO region
0,5%0,7% 0,7%
1,0%
1,5%
2,3%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
South-East AsiaRegion
Region of theAmericas
Western Pacifi cRegion
African Region EuropeanRegion
EasternMediterranean
Region
Hepatitis C Epidemic in the EMRThe EMR has the highest HCV incidence compared to other WHO regions (63 per 100,000)
High burden countries for HCV
Egypt and
Pakistan80%
Rest of EMR20%
Egypt and Pakistan Rest of EMR
Modes of transmission of viral hepatitis in the EMR
• Unsafe healthcare procedures including weak blood and injection safety, and injecting drug are the most common leading causes of HCV infections in our region.
Proportion of health-care injections given with equipment reused without sterilization, by WHO region
• Proportion of unsafe health injections is at 14%.
Progress in implementation of RAP
countries with national strategies
countries with designated program/focal point
Pakistan pledgeIn 5 years• 140 M to be screened for HCV• 100% blood safety• 100% injection safety
HB-BD vaccine Regional coverage
60 M
HCV tested
> 3 M
HCV treated
Egypt
Cascade of care for HBV and HCV (end 2018)
21
00
0
35
1
1
TOTA L NUMBER ( 000) DIA GNOSED ( 000) TREA TED ( 000)
HEPATITIS B CASCADE OF CARE
Hepatitis B cascade of care
15
3,6
2,5
0
TOTA L NUMBER (M)
D IA GNOSED TREA TED V IRA LLY SUPPRESSED
HEPATITIS C CASCADE OF CARE
Hepatitis C cascade of care
PWID
• Injecting drug use is one of the driving forces of the epidemic, especially in lower prevalence countries
• Large estimate for PWIDs estimated in Pakistan, Iran, ….etc
• Harm reduction services remain very limited
• Target is 200 syringes/person/year
• EMR is at 25 syringes/person/year
In summary
• Ambitious agenda of hepatitis elimination
• EMR challenged by high burden of both HBV and HCV
• Risk factors still high
• Progress mainly driven by Egypt
• Signs of increasing commitment in various countries
• Hepatitis B getting much less attention than hepatitis C
• PWID need attention
Thank you
Joumana.hermez
