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Are EU/EEA countries ready to monitor progress on hepatitis C programmes?

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ECDC presentation at HepHIV2017 conference, 31 January-2 February 2017, Malta.

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Are EU/EEA countries ready to monitor progress on hepatitis C programmes?

  1. 1. 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, UK 2 Health Protection Scotland, NHS National Services Scotland, Glasgow, UK 3 European Centre for Disease Prevention and Control, Stockholm, Sweden
  2. 2. The evolving hepatitis C political landscape
  3. 3. THE ELIMINATION AGENDA Highly effective, well tolerated direct acting antivirals The evolving hepatitis C political landscape
  4. 4. 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 testing 6. Hepatitis C testing 7. HCV genotyping 8. Viral hepatitis B and C care coverage 9. Equitable access to hepatitis treatment 10. Documentation of treatment effectiveness
  5. 5. Survey Program data Special study Model- ling Case reporting Cohort study Various registries Patient records C1 Prevalence of chronic HCV infection C2 Infra- structure of HCV testing C4 Facility- level injection safety C5 Needle- syringe distri- bution C6 People living with HCV diagnosed C7 Treatment initiation for HCV patients C8 Cure for chronic HCV patients treated C9 Incidence of HCV infection C10 Deaths from HCC, cirrhosis, liver disease attributable to HCV Possible data sources for the generation of HCV-relevant core indicators
  6. 6. 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
  7. 7. 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
  8. 8. 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 reasons One country reported no routine testing  Variation in reported national policies for testing of risk groups
  9. 9. 0 20 40 60 80 100 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 Proportion of countries with policy (%) National policies for the testing of key risk groups 2. Inputs: System infrastructure for testing
  10. 10. Funding of HCV testing 2. Inputs: System infrastructure for testing
  11. 11. 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.
  12. 12. 0 10 20 30 40 50 60 70 Prevalence Number offered a test Tests performed Positive cases Proportion diagnosed Number of people treated Genotype Percentageofcountriesreportingnationaldataavailable3. Outputs and outcomes: Prevention
  13. 13. 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
  14. 14. Monitoring system already exists Additional data collection being set up by ECDC Additional data collection being set up WHO
  15. 15. 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 consumption Promoting standardised serosurveys Improving estimates of hepatitis related mortality  Programme to obtain rolling estimates of prevalence Co-infections Proportion diagnosed
  16. 16. 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
  17. 17. 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
  18. 18. www.ecdc.europa.eu Contact: stihivhep@ecdc.europa.eu

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