Few countries on track to meet WHO HCV elimination goals

The majority of countries with a high burden of hepatitis C-related deaths have made little progress toward achieving the WHO goal of an at least 10% reduction in hepatitis C-related mortality by 2020, according to research presented at The Liver Meeting Digital Experience.

“In 2016, WHO set hepatitis elimination targets to reduce HCV-related deaths by at least 10% in 2020 and by 65% by 2030. It is important to note that WHO does not specify whether the goals should be defined in terms of death rate or death count,” Abigail Adams, who completed her summer practicum for the University of Georgia with the Coalition for Global Hepatitis Elimination at the Task Force for Global Health, said during a virtual presentation.

In their analysis, Adams and colleagues estimated that approximately 542,000 global HCV-related deaths occurred in 2019, representing a 59% increase since 1990, a 28% increase since 2000 and a 9% increase since 2015.

Notably, only four countries appear to be on track to meet the 2020 WHO mortality target, defined as an at least 10% decline in mortality from 2015 to 2020, Adams said. These countries include Moldova, which has experienced a 15% decline, and the Russian Federation, which has experienced an almost 11% decline. Countries with an at least 10% decline in death count again included Moldova, with an approximate 18% decline, as well as Lithuania, with an approximate 14% decline and Ukraine, with an approximate 11% decline.

The top 20 countries for HCV-related death counts represented about 76% of global deaths in 2019, according to Adams. Of these countries, 25% are in the southeast Asia region and five are high-income, six are upper middle-income, seven are lower-middle-income and two are lower-income countries.

A majority of these high-burden countries have also seen a large increase in death as well as a massive growth in the percent change in HCV-related death counts since 1990, according to Adams. Furthermore, estimated HCV mortality continues to increase for most of these countries, with the Russian Federation being the only country showing a decline in percent change in HCV-related death count from 2015. Adams noted, however, that this may be due to factors beyond scale-up of HCV prevention, testing and treatment.

Additional countries also face a disproportionate rate of mortality — of which 45% are in the European region, according to Adams. This is noteworthy, she said, in that some countries may not be considered high-burden based on death count but should be considered high-burden based on mortality rate.

Similar to those with the highest HCV-related death counts, only two countries of those in the top 20 for HCV-related death rate — Ukraine and Moldova — are on track to reach the 2020 target, with the majority continuing to see an increase in death rate. However, Ukraine is on track to reach the target based on a decline in death count and not rate, Adams noted.

“To conclude, few countries are on track to reach the 2020 HCV elimination goals. Program scale-up of prevention, testing and treatment, especially in high-burden countries, is necessary to ensure future progress,” Adams said.

For their analysis, Adams and colleagues utilized Global Burden of Disease 2019 data to estimate the percent change in national HCV death counts and mortality rates for 1990 to 2019 and 2015 to 2019. In the 2019 Global Burden of Disease study, HCV-related all-age mortality, death count and death rate were aggregated from mortality due to acute HCV, cirrhosis, other chronic liver diseases and primary liver cancer. Mortality was estimated per country for 1990 to 2019 using vital registration, verbal autopsy data, case-series data, predictive covariates and the Global Burden of Disease’s cause of death ensemble model.

“We need to further disseminate the Global Burden of Disease 2019 results and additional primary data are needed to improve the precision of estimates for monitoring progress toward elimination. Unfortunately, the effects of treatment cannot be seen yet, as the impact of HCV curative therapy isn’t fully recognized in the data estimates yet,” Adams said.