Should WHO change its elimination targets for viral hepatitis?
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The COVID-19 pandemic has further disrupted WHO’s global hepatitis elimination strategy, which aims to reduce new cases of chronic HBV and HCV infection by 90% and reduce deaths from the infections by 65% by 2030.
We asked Nancy S. Reau, MD, FAASLD, AGAF, the Richard B. Capps Chair of Hepatology at Rush University in Chicago, Illinois, if WHO should change its elimination targets for viral hepatitis.
Despite the pandemic, WHO has not yet changed its elimination targets for viral hepatitis, nor should it.
Before the pandemic, most countries were significantly off track to achieve the 2030 goals, which has only been exponentially increased by COVID-19. Not only has this sidetracked the target, but the pandemic has also taken cancer screening and preventive strategies such as vaccination two steps backward. One would naturally think that alone should result in a revised timeline; however, consider the innovation the pandemic forced the medical community to embrace.
No one could have dreamed that a vaccine could be developed and produced in record time, let alone several vaccines using multiple technologies all with amazing efficacy. No one would have thought it possible that sluggish academic institutions could switch to telehealth platforms in a matter of days. No one would have wagered that policy would be developed supporting virtual visits as a form of health care for most insured patient populations. No one could have imagined the FDA approving multiple agents and vaccines for emergency use in real time concomitant with the studies demonstrating effectiveness.
Still, the naysayers would point out, these rapid changes were accomplished in resource-rich settings, and that is both fair and accurate. But innovation that changes standard of care is established where funding is available, and though poor countries have people with disease (a major research resource), conducting research in resource-poor countries is ethically challenging. Further, what is learned in one environment can be applied elsewhere.
So, instead consider the COVID-19 pandemic an opportunity to push efficiency and innovation in other areas of health care.
Use the incredible public awareness of COVID-19 screening, diagnosis and prevention to sell a similar story for care cascade of viral hepatitis. Never before has a population been so aware of scientific discovery and its application. The messaging for SARS-CoV-2 is not that different than that for HBV and HCV. We can build on this viral campaign.
Tag screening for viral hepatitis to COVID-19 screening. For every individual seeking screening for COVID-19 an opportunity lies to screen for other underlying health issues. It would not be that difficult to also screen for viral hepatitis, HIV, diabetes and hypertension, especially if results could be communicated at that visit. Technology already exists to obtain samples remotely without venipuncture. Point of care screening and use of dried blood spot have been proposed to increase access even prior to COVID-19.
Capitalize on prevention at the time of COVID-19 vaccination. This is a great time to offer other vaccinations.
Extend access and capacity via telehealth. The pandemic revolutionized the patient experience challenging previous norms. Yet, the traditional model of HBV and HCV care was already being contested. The MINMON study supports providing all drugs upfront and minimal monitoring throughout therapy. Several studies demonstrate the success of virtual hepatitis clinics. Much of the hesitancy to engage in virtual care has centered on reimbursement not on quality of care.
It is beyond dispute that the COVID-19 pandemic has hampered every step in the viral hepatitis care cascade. The impact on preventive measures such as vaccination and liver cancer surveillance will continue to be felt for years. Yet, these impediments should not result in compliancy but rather encourage innovation as we work toward elimination of viral hepatitis.
- References:
- Chevialiez S, et al. Open Forum Infect Dis. 2020;doi:10.1093/ofid/ofaa196.
- Chuan VT, et al. Research in resource-poor countries. https://www.thehastingscenter.org/briefingbook/multinational-research/. Accessed April 13, 2021.
- Coats JT, et al. Int J Drug Policy. 2015;doi:10.1016/j.drugpo.2015.05.001.
- Corrigall D, et al. Gut. 2018;doi:10.1136/gutjnl-2018-BSGAbstracts.242.
Click here to read the Cover Story, "COVID-19 impacts global targets to eliminate viral hepatitis."
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