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

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. The evolving hepatitis C political
landscape

3. THE ELIMINATION AGENDA
Highly effective, well tolerated
direct acting antivirals
The evolving hepatitis C political
landscape

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Funding of HCV testing
2. Inputs: System infrastructure for
testing

12. 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.

13. 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

14. 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

15. Monitoring
system already
exists
Additional data
collection being
set up by ECDC
Additional data
collection being
set up WHO

16. 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

17. 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

18. 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

19. www.ecdc.europa.eu
Contact: stihivhep@ecdc.europa.eu