The Toronto Declaration – Where are we now?

Jordan J. Feld MD MPH

Toronto Centre for Liver Disease Sandra Rotman Centre for Global Health

University of Toronto

Strategies to address viral hepatitis globally with specific targets for HBV and HCV, related to:

1. Development National Action Plans 2. Epidemiology 3. Disease Prevention 4. Diagnosis 5. Disease Management

What has happened since last year? • A lot! • Continued progress on new therapies…but a lot

more

UN Sustainable Development Summit 2015

17 Sustainable Development Goals with 169 ‘targets’ to be achieved by 2030

Hepatitis is on the map!

“They chose to combat the only epidemic that they might actually be able to end”

Dave Thomas, Johns Hopkins

hepatitis ^

WHO Guidelines

To be updated for 2016

Extremely useful tools for all with a focus on resource limited settings

HCV HBV

• 90 Countries represented in Glasgow • Major participation from civil society & people living with hepatitis

New WHO Targets by 2020 1. Prevention

- 90% reduction in new cases of HBV & HCV

2. Treatment - 80% of treatment-eligible individuals with chronic HBV

and HCV treated

3. Mortality - 65% reduction in deaths from HBV & HCV

Gottfried Hirnschall Director, WHO Global Hepatitis Programme

• Medicines Patent Pool expands its mandate to hepatitis C treatment (Nov 2015)

• Hepatitis meds add to the list of Essential Medicines

Improving access to medications

Development of Elimination Plans

Georgia partnership with CDC & Gilead Targets

Other countries well on their way • Egypt

– Major progress – Diagnosis & treatment – More to come…

• Mongolia - National Programme on Combatting Viral Hepatitis

Update to the US Department of Health & Human Services Viral Hepatitis Action Plan (March 2015)

By 2020: • Increase in the proportion of persons who are aware of their hepatitis B virus infection, from 33% to 66% • Increase in the proportion of persons who are aware of their hepatitis C virus

infection, from 45% to 66% • Reduce by 25% the number of new cases of HCV infection • Eliminate mother-to-child transmission of HBV

Revisions to the Toronto Declaration 1. The present declaration outlines specific public health policies and interventions with tangible but achievable goals that we hope will help guide WHO and national governments as they continue to develop strategies to address viral hepatitis locally, nationally and ultimately end, not just combat, the epidemic on a global scale. 2. Ensure equitable and prompt access (<6 months) to direct-acting antiviral-based HCV therapy for all patients with advanced fibrosis (F3 or F4) and those with severe extra-hepatic disease (symptomatic cryoglobulinemia, porphyria cutanea tarda, lymphoma) or other urgent reasons for therapy

2. Ensure equitable and universal access to direct-acting antiviral-based HCV therapy for all patients with HCV infection

• Therapy should be made available immediately (within 6 months) for all individuals with advanced fibrosis (F3 or F4) and those with severe extra-hepatic disease (symptomatic cryoglobulinemia, porphyria cutanea tarda, lymphoma) or other urgent reasons for therapy

• Develop a clear strategy for universal treatment access for all individuals with

HCV infection regardless of disease stage and without limitations based on drug/alcohol use, with defined plans for local/regional HCV elimination

Putting it into action • Quebec

– 2015 - Access to those with F3/F4 or extra-hepatic manifestations

– 2016/17 – Expand to include F2 and higher – 2018 – Access for all infected individuals

• Helpful for clinicians and individuals living with HCV • We would like to treat everyone immediately, but at

least knowing when you will be treated is very helpful for those without ‘urgent’ need for treatment now

Welcome to Toronto for the Global Hepatitis

Summit June 15-18 2017