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World Hepatitis Summit November 2017

Summary: The World Hepatitis Summit is a public policy three day event bringing together a global audience of civil society groups, WHO and its Member States, patient organisations from the World Hepatitis Alliance’s 249 organisational members, policy-makers, public health scientists and funders.

The World Hepatitis Summit is a large-scale, global biennial event to advance the viral hepatitis agenda. It is a joint initiative between World Health Organization (WHO) and the World Hepatitis Alliance - in collaboration with a different host country for each Summit.

 

Community Voice

The community voice in viral hepatitis is new and needs strengthening. The Summit is designed to fill a gap in an area that has traditionally been saturated by scientific and medical conferences but has lacked a platform for civil society and government to come together for the benefit of hepatitis patients.

In bringing these two audiences together the Summit supports an important clause of WHO Resolution WHA67.6, which urges Member States to promote the involvement of civil society in all aspects of preventing, diagnosing and treating viral hepatitis.

The Summit therefore provides an ideal opportunity to engage the community and to use global media to keep the spotlight firmly on hepatitis. It also functions as a forum for discussions on how to effectively advance public health responses to the disease.

 

National Strategies

Worldwide, viral hepatitis kills approximately 1.34 million people a year and more than 300 million people are chronically infected with hepatitis B or C. Yet, until very recently, there had been a remarkable lack of global action to combat the disease.

In May 2016 an historic commitment to eliminate viral hepatitis by 2030 was made by 194 Member States. At the 69th World Health Assembly, governments unanimously voted to adopt the first ever Global Viral Hepatitis Strategy, signalling the greatest global commitment in viral hepatitis to date. Although the adoption of the strategy demonstrates considerable political will, more work will be needed to make the elimination of viral hepatitis a reality. As of February 2016, only 36 countries had viral hepatitis national plans in place and 33 had plans in development. That means that a dramatic scale up in resources and prioritisation is vital.

The Summit supports this effort by providing a platform that allows Member States to learn from other countries, have access to technical advice from the staff of WHO’s Global Hepatitis Programme as well as discuss the implementation of an intensified national response to the disease with key stakeholders in the field. 

 

Summit Objectives

The World Hepatitis Summit is a public policy three day event bringing together a global audience of civil society groups, WHO and its Member States, patient organisations from the World Hepatitis Alliance’s 249 organisational members, policy-makers, public health scientists and funders. It aims:

1. To increase the number of countries developing practicable viral hepatitis action plans by making use of the latest public health research and technical support from WHO.

2. To improve the implementation of existing viral hepatitis action plans through the sharing of best practice.

3. To support clause 1.3 of WHO’s Resolution WHA67.6 which urges Member States to “promote the involvement of civil society in all aspects of preventing, diagnosing and treating viral hepatitis”.

4. To discuss funding mechanisms for medicines and/or diagnostics through engagement of key stakeholders.

5. To raise the profile of viral hepatitis by engagement of international top-tier media.

6. To encourage and direct public health research to where it is needed by engaging key global funders.

 

WHAT WENT ON

Day one

In today’s opening session, delegates gathered for a welcome address from WHA CEO Raquel Peck and other guest speakers, before the floor was handed to the Honourable Ricardo Barros, Minister of Health for Brazil. Mr Barros told delegates of the host nation’s ambitious plans to eliminate hepatitis by 2030.

Having already provided free vaccination against hepatitis B to all Brazilians regardless of age, Mr Barros announced that Brazil would be aiming to treat and cure all of the estimated 660,000 Brazilians thought to be infected with hepatitis C.

He ended by highlighting that Brazil was one of the first nations to begin the fight against viral hepatitis, being a key player in various WHO resolutions on the disease and the creation of World Hepatitis Day. He concluded: “I hope that this event will be a big step forward in the treatment of viral hepatitis around the world.” 

The session was closely followed by the “Making the Elimination of Viral Hepatitis a Reality”, which was co-chaired by Dr Gottfried Hirnschall, Director of the HIV/Hepatitis Department of the World Health Organization and Raquel Peck, CEO of the World Hepatitis Alliance. Showing truly global representation, 11 ministerial representatives (Brazil, China, Egypt, Georgia, Lesotho, Malta, Mongolia, Pakistan, Sudan, Syria, Uganda plus a video from Australia) took to the stage to share their successes in implementing initiatives to help reach elimination by 2030. Bollywood star and WHO SEARO Goodwill Ambassador Amitabh Bachchan also reiterated his support and commitment to lead the fight to eliminate viral hepatitis. This show of commitment was bolstered by the launch of the NOhep Visionaries Programme, which highlighted six countries (Brazil, Egypt, Mongolia, Bangladesh, The Gambia and Georgia) who are spearheading the elimination of viral hepatitis in their region.

The “Strategic Information for Focused Action” session provided an overview of the current progress towards elimination, announcing that 82 countries now have viral hepatitis plans in place but highlighting that obstacles to elimination still exist. Underscoring the session was the importance of the patient voice and the critical role people living with viral hepatitis can play in breaking down barriers, finding the undiagnosed and achieving the elimination of viral hepatitis.

“If we had 300 million people demanding action, we would get it" urged Charles Gore, President of the World Hepatitis Alliance.

Overall, the main output of the session was that there is an urgent need for investment in strategic information systems.

Attendees spent the afternoon listening and exchanging best practices at various workshops on HCV elimination in Georgia, how to develop a national plan on viral hepatitis, how to develop an investment case and developing successful awareness campaigns.

The day finished with side meetings on Unitaid's role in the global hepatitis C response and policy as a tool for elimination.

 

Day two

At morning side meetings, early risers learnt about strategies to eliminate hepatitis E, an often-overlooked form of the hepatitis virus, as well as hearing about the liver societies’ role in elimination. The morning plenary session looked at the five core interventions needed to address viral hepatitis: infant vaccination, prevention of mother-to-child-transmission, blood and injection safety, harm reduction, and diagnosis and treatment. 

 

In a presentation from WHO’s Hande Harmanci, the importance of a public health approach to deliver these interventions was stressed. Director for STI, HIV/AIDS and Viral Hepatitis Department of the Ministry of Health of Brazil, Dr Adele Benzaken echoed the Minister’s comments from yesterday on their treatment for all announcement. The session also featured presentations on challenges and opportunities for hepatitis B services in Nigeria from the Ministry of Health, interventions to prevent hepatitis B infection at birth from John Ward of the U.S. Center for Disease Control, hepatitis C prevention and treatment for PWID by Greg Dore of the Kirby Institute and hepatitis services for Indigenous Peoples from Luana Silveira de Faria from the Ministry of Health of Brazil.

 

The “Access to Hepatitis Medicines” session was opened by Portuguese MP Ricardo Leite, who reaffirmed that governments must make access a priority. His speech made a poignant note: “political commitment from governments is a moral and ethical obligation”. This was closely followed by Giten Khwairakpam, amfAR, who provided an overview on how to get generics. His presentation was complemented by Dr. Andrew Hill, Liverpool University, UK, who spoke about the cost and efficacy of generics. His studies have shown that hepatitis C medicine can be purchased for $70 - and, by the end of the year, it could be as low as $50. Both speakers agreed that without greater diagnosis and better linkages to care, the dropping prices won’t make a difference. Dr. Yvan Hutin, World Health Organization, concluded the session by highlighting that price is only one aspect. Access will only be successful when it’s the right product, in the right place, at the right time and for all people who need it.

 

After the session, participants attended workshops to further explore ways on how to overcome barriers to access. Then attendees spent the afternoon taking part in a range of parallel breakout sessions. Topics ranged from treatment interventions, prevention interventions and delivering for equitable services.

 

The “Prevention Interventions” session kicked off with Dr. Amr Kandeel, Ministry of Health, Egypt, discussing how the countries’ adoption of a comprehensive prevention control plan in 2003 that has led to 95% hepatitis B coverage and screening of more than 4 million people for hepatitis C. Dr. Arshad Altaf, World Health Organization, added to this update by focusing on injection safety in Uganda and India, underscoring the importance of awareness activities to educate. Likewise, Dr. Huma Qureshi, Pakistan Health Research Council, discussed injection safety challenges and opportunities in Pakistan. With the highest level of therapeutic injections globally with 13-14 infections per person per year, she discussed their campaign to promote injection safety in 26 facilities across Pakistan, which included needle cutting and training of 1500 healthcare workers.  Dr. Jinlin Hou, Nanfang Hospital, China, focused on activities to prevent mother-to-child transmission and Dr. Marcelo Addas-Carvalho, Blood Center of Campinas/UNICAMP, discussed blood safety. Dr. Niklas Luhmann, Médecins du Monde, looked at prevention amongst people who inject drugs. He used this opportunity to present the declaration on the hepatitis community on decriminalization.

 

In the “Testing Interventions” session a panel of four expert speakers reviewed the scientific, logistical, ethical and political processes leading to the implementation of state-of-the-art testing for viral hepatitis. Professor Philippa Easterbrook of World Health Organization said that while there had been much progress in treatment in the past year, there had not been the same progress in testing. But she said that success in increasing testing was possible (following the HIV testing model).

 

Dr Maud Lemoine of Imperial College London discussed the PROLIFICA project (prevention of liver fibrosis and cancer in Africa). In the other presentations, Dr Radi Hammad, Ministry of Health, Egypt, discussed his country’s highly successful screening programme for hepatitis C. Dr Saleem Kamili, US Centers for Disease Control and Prevention, also gave a presentation present and future innovations in diagnostics.

 

“Build your services where they are, and they will come” was the main message in the “Delivering High Quality Hepatitis Services” session. This sentiment was echoed by Abigael Lukhwaro from Medicines du Monde in Kenya. Both countries work with general practitioners within the community and peer groups to provide counselling and prevention education. It was generally agreed that the “just say no” approach does not work, and we must work with the community to address their needs and prevent reinfection.

 

The “Delivering Equitable Services” interactive workshop had delegates working together and applying the PROGRESS framework for equity to imagined country scenarios.

 

The workshop on “Treatment Interventions” shared lessons to be learnt from successful treatment programmes and discussed differences between treatment in the private sector and public sector.

 

Complementing the 200+ posters on display in the Golden Hall, oral presentations took place throughout the afternoon. Selected presenters divulged further details on their posters on the topics of service delivery – models for testing and treatment, modelling and cost effective for global scale up, epidemiology and risk factors from a global perspective and experiences with national scale-up.

 

The day finished with updates on the issue of hepatitis in children where delegates learnt that 52 million children are living with hepatitis B or C. Following this morning’s presentation on Indigenous Peoples, a side meeting examined the challenges of addressing hepatitis D and presented updates from the Indigenous Peoples’ Conference on Viral Hepatitis that took place earlier this year.

 

Day three

Day three kicked-off with a single message – financing does not need to be a barrier to elimination. Chaired by Dr. Amanda Kgomotso Vilakazi Nhlapo, National Department of Health, South Africa and Dr. John Ward, US Centers for Disease Control and Prevention, panelists took to the stage to discuss the various and often innovative ways for countries to finance their hepatitis response. Charles Gore, President of the World Hepatitis Alliance, opened the session highlighting that only 35% of national plans have funding strategies attached to them. WHO estimate that the hepatitis response will cost approx. $6 billion per year for all low-and middle-income countries. This was starkly compared to the 2010 World Cup in South Africa which cost $3 billion and the Commonwealth Games in India which cost $4 billion. The overall point being that money is available but not being used efficiently.

Efficiency was the topic of Dr. Jeremy Lauer’s, WHO, presentation. He highlighted the importance of integration of hepatitis within health systems. There is no reason to think about separating pooling and purchasing arrangement, if it’s already available. If we can build it into purchasing and health benefits, hepatitis can be the solution, not the problem.

Following these presentations, the session opened to a panel discussion chaired by Dr. Eduardo González Pier, Center for Global Development, with speakers from the World Bank, Center for Disease Analysis, Rwanda Biomedical Center and Colombian Ministry of Health. This session reiterated the previous points that domestic funding will be key and the most effective way to do this is through integration. Highlighting the differences between the HIV/AIDS response, panellists highlighted that the world has moved on from focusing on a single disease area and now we must work to develop sustainable universal health coverage systems.

Sustainable financing is intrinsically linked to political will which was another point shared by panellists. Dr. David Wilson, World Bank, highlighted that many countries don’t give enough of the national budget to health. In Pakistan, only 1% of GDP is given to the health budget. As Homie Razavi, Center for Disease Analysis Foundation, highlighted countries will spend less eliminating hepatitis C than doing nothing at all. One country highlighted for their commitment was Colombia. Over the last number of years they have procured hepatitis C treatment for lower costs through PAHO and now have committed to increasing treatment by 500 people each year until 2020.

After a short coffee break the second session of the day continued with "Strategic direction 4: different financing mechanisms for viral hepatitis programmes" which was chaired by Dr Adele Benzaken from the Ministry of Health of Brazil and Dr Philip Duneton of Unitaid. The session reaffirmed the main points from earlier in the day including reinforcing the importance of integration within health services and encouraging Ministers of Finance to invest.

One of the key issues raised was how to not only work with your Minister of Health but also involve the Ministry of Finance. For Ministers of Finance elimination is not always seen as cost effective; even though research has shown that while there are a lot of upfront costs in the long run, there will be healthcare savings as less people are hospitalised from complications of hepatitis. Homie Razavi likened the upfront costs involved in prevention and treatment to that of buying a house. When you buy a house, you pay more upfront but once the debt is paid off you save more in the long term. Therefore advocacy is critical to the elimination response.

The session ended with a debate between Dr Jeremy Lauer of WHO and Dr Chinburen Jigjidsuren from the Ministry of Health in Mongolia. They discussed the importance of civil society groups to lobby the government for funding. Dr Jigjiksuren stressed the importance of evidence-based research. All panellists agreed that there was no magic solution but that tools do exist for you to make a sustainable plan.

After lunch in the session “Innovation for Acceleration”, Dr Henry Cohen, ECHO Project, Uruguay explained how the project aims to scale up access to hepatitis care by linking expert specialist teams at an academic centre of excellence with primary care clinicians in local communities. He concluded: “Project ECHO is a cost-effective way to treat patients with HCV infection at scale, using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States”

Christian Trepo of INSERM, France, then discussed the outcome of an integrated HIV/hepatitis B research agenda in France, explaining that a lot of the work that created the new DAAs for hepatitis C was based on HIV research. “This common biology between hepatitis B and HIV commands for a combined eradication strategy,” he said, concluding that there are around 50 new drugs in the research pipeline for hepatitis B and several of them are likely to end up being approved.

The Innovation finalists (Freke Zuure, Emalie Huriaux, Anila Goswami, Lien Tran, Momoko Iwamoto, Ammal Metwally) discussed their innovative ways to tackle viral hepatitis. Emalie Huriaux from Project Infrom and CalHep discussed the elimination strategy being devised for San Francisco, based on including all those infected especially marginalised populations.

Anila Goswami, Institute of Liver & Biliary Sciences (ILBS), New Delhi, then discussed the hepatitis nurse coordinator treatment model, introduced at her institution, which remains the only one in India operating such a model. This task-shifting initiative from doctors to nurses has allowed these nurse coordinators to monitor the care for more than 1,500 patients with hepatitis C so far and if scaled up could allow huge treatment expansion in India.

Lien Tran of Hepatitis Victoria, Australia, then discussed the “Little HepB Hero” – the making of children ambassadors for hepatitis in families and the community, and this was followed by Ammal Metwally of Egypt discussing the screening and elimination of hepatitis C from entire villages in Egypt, a key pillar of that country’s elimination strategy.

Freke Zurre, of the Public Health Service of Amsterdam, then presented on home-based HCV-RNA testing for men who have sex with men (MSM) —part of an integrated approach to eliminate HCV infection among this population. Finally, Momoko Iwamoto of the Epicenter, Médecins Sans Frontières, Cambodia, discussed the optimal care model for hepatitis C in Cambodia.

The three-day event closed on a hopeful note with the launch of the São Paulo Declaration on Viral Hepatitis, which was negotiated by government representatives. The Declaration committed to taking a broad and coordinated approach to support implementation of the core interventions outlined in WHO’s Global Hepatitis Strategy. In response, the World Hepatitis Alliance and its 252 member organisations launched the São Paulo Community Declaration on Viral Hepatitis, demanding that governments give viral hepatitis the same priority as HIV/AIDS, malaria and TB, that stigma and discrimination is adequately addressed and that governments will fulfill the commitments of Sustainable Development Goals in so far as ‘that no-one will be left behind’ and that governments ‘will endeavour to reach the furthest behind first.’

“This is not just a piece of paper to us. This is a matter of life and death for more than 300 million people worldwide.” said Charles Gore. “It’s imperative that countries act immediately and decisively to stop the countless number of needless deaths each year”.

The event ended on a poignant note as Gottfried Hirnschall, WHO, and Dr Adele Benzaken, Government of Brazil, paid tribute to Charles’ leadership and vision. This comes ahead of his departure as President of World Hepatitis Alliance at the end of the year. The intense round of applause was testament to the level of support, inspiration and commitment that Charles has brought to people, organisations and governments across the world. Charles will continue his efforts as CEO of the Hepatitis C Trust in the UK.

 

The World Hepatitis Summit is a large-scale, global biennial event to advance the viral hepatitis agenda. It is a joint initiative between World Health Organization (WHO) and the World Hepatitis Alliance - in collaboration with a different host country for each Summit.

Community Voice

The community voice in viral hepatitis is new and needs strengthening. The Summit is designed to fill a gap in an area that has traditionally been saturated by scientific and medical conferences but has lacked a platform for civil society and government to come together for the benefit of hepatitis patients.

In bringing these two audiences together the Summit supports an important clause of WHO Resolution WHA67.6, which urges Member States to promote the involvement of civil society in all aspects of preventing, diagnosing and treating viral hepatitis.

The Summit therefore provides an ideal opportunity to engage the community and to use global media to keep the spotlight firmly on hepatitis. It also functions as a forum for discussions on how to effectively advance public health responses to the disease.

National Strategies

Worldwide, viral hepatitis kills approximately 1.34 million people a year and more than 300 million people are chronically infected with hepatitis B or C. Yet, until very recently, there had been a remarkable lack of global action to combat the disease.

In May 2016 an historic commitment to eliminate viral hepatitis by 2030 was made by 194 Member States. At the 69th World Health Assembly, governments unanimously voted to adopt the first ever Global Viral Hepatitis Strategy, signalling the greatest global commitment in viral hepatitis to date. Although the adoption of the strategy demonstrates considerable political will, more work will be needed to make the elimination of viral hepatitis a reality. As of February 2016, only 36 countries had viral hepatitis national plans in place and 33 had plans in development. That means that a dramatic scale up in resources and prioritisation is vital.

The Summit supports this effort by providing a platform that allows Member States to learn from other countries, have access to technical advice from the staff of WHO’s Global Hepatitis Programme as well as discuss the implementation of an intensified national response to the disease with key stakeholders in the field.

Summit Objectives

The World Hepatitis Summit is a public policy three day event bringing together a global audience of civil society groups, WHO and its Member States, patient organisations from the World Hepatitis Alliance’s 249 organisational members, policy-makers, public health scientists and funders. It aims:

1. To increase the number of countries developing practicable viral hepatitis action plans by making use of the latest public health research and technical support from WHO.

2. To improve the implementation of existing viral hepatitis action plans through the sharing of best practice.

3. To support clause 1.3 of WHO’s Resolution WHA67.6 which urges Member States to “promote the involvement of civil society in all aspects of preventing, diagnosing and treating viral hepatitis”.

4. To discuss funding mechanisms for medicines and/or diagnostics through engagement of key stakeholders.

5. To raise the profile of viral hepatitis by engagement of international top-tier media.

6. To encourage and direct public health research to where it is needed by engaging key global funders.

WHAT WENT ON

Day one

In today’s opening session, delegates gathered for a welcome address from WHA CEO Raquel Peck and other guest speakers, before the floor was handed to the Honourable Ricardo Barros, Minister of Health for Brazil. Mr Barros told delegates of the host nation’s ambitious plans to eliminate hepatitis by 2030.

Having already provided free vaccination against hepatitis B to all Brazilians regardless of age, Mr Barros announced that Brazil would be aiming to treat and cure all of the estimated 660,000 Brazilians thought to be infected with hepatitis C.

He ended by highlighting that Brazil was one of the first nations to begin the fight against viral hepatitis, being a key player in various WHO resolutions on the disease and the creation of World Hepatitis Day. He concluded: “I hope that this event will be a big step forward in the treatment of viral hepatitis around the world.” 

The session was closely followed by the “Making the Elimination of Viral Hepatitis a Reality”, which was co-chaired by Dr Gottfried Hirnschall, Director of the HIV/Hepatitis Department of the World Health Organization and Raquel Peck, CEO of the World Hepatitis Alliance. Showing truly global representation, 11 ministerial representatives (Brazil, China, Egypt, Georgia, Lesotho, Malta, Mongolia, Pakistan, Sudan, Syria, Uganda plus a video from Australia) took to the stage to share their successes in implementing initiatives to help reach elimination by 2030. Bollywood star and WHO SEARO Goodwill Ambassador Amitabh Bachchan also reiterated his support and commitment to lead the fight to eliminate viral hepatitis. This show of commitment was bolstered by the launch of the NOhep Visionaries Programme, which highlighted six countries (Brazil, Egypt, Mongolia, Bangladesh, The Gambia and Georgia) who are spearheading the elimination of viral hepatitis in their region.

The “Strategic Information for Focused Action” session provided an overview of the current progress towards elimination, announcing that 82 countries now have viral hepatitis plans in place but highlighting that obstacles to elimination still exist. Underscoring the session was the importance of the patient voice and the critical role people living with viral hepatitis can play in breaking down barriers, finding the undiagnosed and achieving the elimination of viral hepatitis.

“If we had 300 million people demanding action, we would get it" urged Charles Gore, President of the World Hepatitis Alliance.

Overall, the main output of the session was that there is an urgent need for investment in strategic information systems.

Attendees spent the afternoon listening and exchanging best practices at various workshops on HCV elimination in Georgia, how to develop a national plan on viral hepatitis, how to develop an investment case and developing successful awareness campaigns.

The day finished with side meetings on Unitaid's role in the global hepatitis C response and policy as a tool for elimination.

Day two

At morning side meetings, early risers learnt about strategies to eliminate hepatitis E, an often-overlooked form of the hepatitis virus, as well as hearing about the liver societies’ role in elimination. The morning plenary session looked at the five core interventions needed to address viral hepatitis: infant vaccination, prevention of mother-to-child-transmission, blood and injection safety, harm reduction, and diagnosis and treatment.

In a presentation from WHO’s Hande Harmanci, the importance of a public health approach to deliver these interventions was stressed. Director for STI, HIV/AIDS and Viral Hepatitis Department of the Ministry of Health of Brazil, Dr Adele Benzaken echoed the Minister’s comments from yesterday on their treatment for all announcement. The session also featured presentations on challenges and opportunities for hepatitis B services in Nigeria from the Ministry of Health, interventions to prevent hepatitis B infection at birth from John Ward of the U.S. Center for Disease Control, hepatitis C prevention and treatment for PWID by Greg Dore of the Kirby Institute and hepatitis services for Indigenous Peoples from Luana Silveira de Faria from the Ministry of Health of Brazil.


The “Access to Hepatitis Medicines” session was opened by Portuguese MP Ricardo Leite, who reaffirmed that governments must make access a priority. His speech made a poignant note: “political commitment from governments is a moral and ethical obligation”. This was closely followed by Giten Khwairakpam, amfAR, who provided an overview on how to get generics. His presentation was complemented by Dr. Andrew Hill, Liverpool University, UK, who spoke about the cost and efficacy of generics. His studies have shown that hepatitis C medicine can be purchased for $70 - and, by the end of the year, it could be as low as $50. Both speakers agreed that without greater diagnosis and better linkages to care, the dropping prices won’t make a difference. Dr. Yvan Hutin, World Health Organization, concluded the session by highlighting that price is only one aspect. Access will only be successful when it’s the right product, in the right place, at the right time and for all people who need it.

After the session, participants attended workshops to further explore ways on how to overcome barriers to access. Then attendees spent the afternoon taking part in a range of parallel breakout sessions. Topics ranged from treatment interventions, prevention interventions and delivering for equitable services.

The “Prevention Interventions” session kicked off with Dr. Amr Kandeel, Ministry of Health, Egypt, discussing how the countries’ adoption of a comprehensive prevention control plan in 2003 that has led to 95% hepatitis B coverage and screening of more than 4 million people for hepatitis C. Dr. Arshad Altaf, World Health Organization, added to this update by focusing on injection safety in Uganda and India, underscoring the importance of awareness activities to educate. Likewise, Dr. Huma Qureshi, Pakistan Health Research Council, discussed injection safety challenges and opportunities in Pakistan. With the highest level of therapeutic injections globally with 13-14 infections per person per year, she discussed their campaign to promote injection safety in 26 facilities across Pakistan, which included needle cutting and training of 1500 healthcare workers.  Dr. Jinlin Hou, Nanfang Hospital, China, focused on activities to prevent mother-to-child transmission and Dr. Marcelo Addas-Carvalho, Blood Center of Campinas/UNICAMP, discussed blood safety. Dr. Niklas Luhmann, Médecins du Monde, looked at prevention amongst people who inject drugs. He used this opportunity to present the declaration on the hepatitis community on decriminalization.

In the “Testing Interventions” session a panel of four expert speakers reviewed the scientific, logistical, ethical and political processes leading to the implementation of state-of-the-art testing for viral hepatitis. Professor Philippa Easterbrook of World Health Organization said that while there had been much progress in treatment in the past year, there had not been the same progress in testing. But she said that success in increasing testing was possible (following the HIV testing model).

Dr Maud Lemoine of Imperial College London discussed the PROLIFICA project (prevention of liver fibrosis and cancer in Africa). In the other presentations, Dr Radi Hammad, Ministry of Health, Egypt, discussed his country’s highly successful screening programme for hepatitis C. Dr Saleem Kamili, US Centers for Disease Control and Prevention, also gave a presentation present and future innovations in diagnostics.

“Build your services where they are, and they will come” was the main message in the “Delivering High Quality Hepatitis Services” session. This sentiment was echoed by Abigael Lukhwaro from Medicines du Monde in Kenya. Both countries work with general practitioners within the community and peer groups to provide counselling and prevention education. It was generally agreed that the “just say no” approach does not work, and we must work with the community to address their needs and prevent reinfection.

The “Delivering Equitable Services” interactive workshop had delegates working together and applying the PROGRESS framework for equity to imagined country scenarios.

The workshop on “Treatment Interventions” shared lessons to be learnt from successful treatment programmes and discussed differences between treatment in the private sector and public sector.

Complementing the 200+ posters on display in the Golden Hall, oral presentations took place throughout the afternoon. Selected presenters divulged further details on their posters on the topics of service delivery – models for testing and treatment, modelling and cost effective for global scale up, epidemiology and risk factors from a global perspective and experiences with national scale-up.

The day finished with updates on the issue of hepatitis in children where delegates learnt that 52 million children are living with hepatitis B or C. Following this morning’s presentation on Indigenous Peoples, a side meeting examined the challenges of addressing hepatitis D and presented updates from the Indigenous Peoples’ Conference on Viral Hepatitis that took place earlier this year.

Day three

Day three kicked-off with a single message – financing does not need to be a barrier to elimination. Chaired by Dr. Amanda Kgomotso Vilakazi Nhlapo, National Department of Health, South Africa and Dr. John Ward, US Centers for Disease Control and Prevention, panelists took to the stage to discuss the various and often innovative ways for countries to finance their hepatitis response. Charles Gore, President of the World Hepatitis Alliance, opened the session highlighting that only 35% of national plans have funding strategies attached to them. WHO estimate that the hepatitis response will cost approx. $6 billion per year for all low-and middle-income countries. This was starkly compared to the 2010 World Cup in South Africa which cost $3 billion and the Commonwealth Games in India which cost $4 billion. The overall point being that money is available but not being used efficiently.

Efficiency was the topic of Dr. Jeremy Lauer’s, WHO, presentation. He highlighted the importance of integration of hepatitis within health systems. There is no reason to think about separating pooling and purchasing arrangement, if it’s already available. If we can build it into purchasing and health benefits, hepatitis can be the solution, not the problem.

Following these presentations, the session opened to a panel discussion chaired by Dr. Eduardo González Pier, Center for Global Development, with speakers from the World Bank, Center for Disease Analysis, Rwanda Biomedical Center and Colombian Ministry of Health. This session reiterated the previous points that domestic funding will be key and the most effective way to do this is through integration. Highlighting the differences between the HIV/AIDS response, panellists highlighted that the world has moved on from focusing on a single disease area and now we must work to develop sustainable universal health coverage systems.

Sustainable financing is intrinsically linked to political will which was another point shared by panellists. Dr. David Wilson, World Bank, highlighted that many countries don’t give enough of the national budget to health. In Pakistan, only 1% of GDP is given to the health budget. As Homie Razavi, Center for Disease Analysis Foundation, highlighted countries will spend less eliminating hepatitis C than doing nothing at all. One country highlighted for their commitment was Colombia. Over the last number of years they have procured hepatitis C treatment for lower costs through PAHO and now have committed to increasing treatment by 500 people each year until 2020.

After a short coffee break the second session of the day continued with "Strategic direction 4: different financing mechanisms for viral hepatitis programmes" which was chaired by Dr Adele Benzaken from the Ministry of Health of Brazil and Dr Philip Duneton of Unitaid. The session reaffirmed the main points from earlier in the day including reinforcing the importance of integration within health services and encouraging Ministers of Finance to invest.

One of the key issues raised was how to not only work with your Minister of Health but also involve the Ministry of Finance. For Ministers of Finance elimination is not always seen as cost effective; even though research has shown that while there are a lot of upfront costs in the long run, there will be healthcare savings as less people are hospitalised from complications of hepatitis. Homie Razavi likened the upfront costs involved in prevention and treatment to that of buying a house. When you buy a house, you pay more upfront but once the debt is paid off you save more in the long term. Therefore advocacy is critical to the elimination response.

The session ended with a debate between Dr Jeremy Lauer of WHO and Dr Chinburen Jigjidsuren from the Ministry of Health in Mongolia. They discussed the importance of civil society groups to lobby the government for funding. Dr Jigjiksuren stressed the importance of evidence-based research. All panellists agreed that there was no magic solution but that tools do exist for you to make a sustainable plan.

After lunch in the session “Innovation for Acceleration”, Dr Henry Cohen, ECHO Project, Uruguay explained how the project aims to scale up access to hepatitis care by linking expert specialist teams at an academic centre of excellence with primary care clinicians in local communities. He concluded: “Project ECHO is a cost-effective way to treat patients with HCV infection at scale, using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States”

Christian Trepo of INSERM, France, then discussed the outcome of an integrated HIV/hepatitis B research agenda in France, explaining that a lot of the work that created the new DAAs for hepatitis C was based on HIV research. “This common biology between hepatitis B and HIV commands for a combined eradication strategy,” he said, concluding that there are around 50 new drugs in the research pipeline for hepatitis B and several of them are likely to end up being approved.

The Innovation finalists (Freke Zuure, Emalie Huriaux, Anila Goswami, Lien Tran, Momoko Iwamoto, Ammal Metwally) discussed their innovative ways to tackle viral hepatitis. Emalie Huriaux from Project Infrom and CalHep discussed the elimination strategy being devised for San Francisco, based on including all those infected especially marginalised populations.

Anila Goswami, Institute of Liver & Biliary Sciences (ILBS), New Delhi, then discussed the hepatitis nurse coordinator treatment model, introduced at her institution, which remains the only one in India operating such a model. This task-shifting initiative from doctors to nurses has allowed these nurse coordinators to monitor the care for more than 1,500 patients with hepatitis C so far and if scaled up could allow huge treatment expansion in India.

Lien Tran of Hepatitis Victoria, Australia, then discussed the “Little HepB Hero” – the making of children ambassadors for hepatitis in families and the community, and this was followed by Ammal Metwally of Egypt discussing the screening and elimination of hepatitis C from entire villages in Egypt, a key pillar of that country’s elimination strategy.

Freke Zurre, of the Public Health Service of Amsterdam, then presented on home-based HCV-RNA testing for men who have sex with men (MSM) —part of an integrated approach to eliminate HCV infection among this population. Finally, Momoko Iwamoto of the Epicenter, Médecins Sans Frontières, Cambodia, discussed the optimal care model for hepatitis C in Cambodia.

The three-day event closed on a hopeful note with the launch of the São Paulo Declaration on Viral Hepatitis, which was negotiated by government representatives. The Declaration committed to taking a broad and coordinated approach to support implementation of the core interventions outlined in WHO’s Global Hepatitis Strategy. In response, the World Hepatitis Alliance and its 252 member organisations launched the São Paulo Community Declaration on Viral Hepatitis, demanding that governments give viral hepatitis the same priority as HIV/AIDS, malaria and TB, that stigma and discrimination is adequately addressed and that governments will fulfill the commitments of Sustainable Development Goals in so far as ‘that no-one will be left behind’ and that governments ‘will endeavour to reach the furthest behind first.’

“This is not just a piece of paper to us. This is a matter of life and death for more than 300 million people worldwide.” said Charles Gore. “It’s imperative that countries act immediately and decisively to stop the countless number of needless deaths each year”.

The event ended on a poignant note as Gottfried Hirnschall, WHO, and Dr Adele Benzaken, Government of Brazil, paid tribute to Charles’ leadership and vision. This comes ahead of his departure as President of World Hepatitis Alliance at the end of the year. The intense round of applause was testament to the level of support, inspiration and commitment that Charles has brought to people, organisations and governments across the world. Charles will continue his efforts as CEO of the Hepatitis C Trust in the UK.

Twitter Updates

BBV Review RT @HenryEChang: Sustainable Development Goals for HBV elimination in South Africa: challenges, progress & the road ahead→https://t.co/TCu…
Wednesday, 22 May 2019 09:04
BBV Review RT @grahamscooke: Two helpful pieces on HCV reinfection from @GregDore2 @ProfJohnDillon at a time when we're trying to get access to retrea…
Sunday, 05 May 2019 13:34
BBV Review RT @HenryEChang: Biological basis for functional cure of chronic hepatitis B→https://t.co/vGzHbrJkbs via Drs. MG Martinez, Barbara Testoni…
Sunday, 05 May 2019 13:33
BBV Review RT @HenryEChang: Prevalence, incidence, & outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review & meta-anal…
Sunday, 05 May 2019 13:31

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