Universal access to testing and treatment is key to eliminating viral hepatitis

WHO

Viral hepatitis is a public health threat that affects tens of millions in the WHO European Region, more than two thirds of whom live in eastern Europe and central Asia. Every day, thousands of people still become infected, due to exposure through unsafe injection practices and insufficient information and tools for prevention.

Of the 5 main hepatitis viruses that cause acute and/or chronic infection, referred to as types A, B, C, D and E, chronic hepatitis B and C are responsible for approximately 98% of all deaths due to viral hepatitis in the European Region. An estimated 170 000 people die from causes related to hepatitis B and C each year.

Hepatitis B and C prevalence ranges from less than 0.5% in western, northern and central Europe to 3–8% in eastern Europe and central Asia.

Timely testing and treatment of hepatitis B and C can save lives

Chronic viral hepatitis B and C can lead to severe diseases such as cirrhosis and liver cancer. These infections may not show symptoms for a long time, sometimes decades, and slowly damage the liver. Globally, at least 60% of liver cancer cases are due to late testing and treatment of viral hepatitis B and C.

Testing is important to diagnose chronic hepatitis B and C infection and begin treatment, if needed. Hepatitis B can be effectively treated, when treatment is necessary. Treatment of hepatitis C virus infection has greatly improved in recent years. Direct-acting antivirals (DAAs) can cure the infection in more than 95% of cases, including at a late stage of the liver disease, with a treatment period that usually lasts 12 weeks.

WHO recommendations and goals on testing and treatment

WHO recommends that all people at risk of hepatitis B and C should be offered testing. People diagnosed with chronic hepatitis B virus infection need to be regularly checked and assessed, and offered treatment when needed. New WHO hepatitis C guidelines recommend that all people diagnosed with chronic hepatitis C should be offered treatment with DAAs. Countries in the European Region have made substantial progress on prevention, but many of them need to scale up action towards universal access to testing and treatment.

In 2016, Member States in the European Region adopted the Action Plan for the Health Sector Response to Viral Hepatitis in the WHO European Region. They also committed to the global goal of eliminating viral hepatitis as a public health threat by 2030, in line with the United Nations 2030 Agenda for Sustainable Development.

Since then, many countries have demonstrated increasing commitment in scaling up the response to viral hepatitis and setting national elimination goals. The WHO Regional Office for Europe is working closely with several Member States to develop national action plans. The Regional Office is also supporting countries to raise awareness, strengthen surveillance and laboratory capacity, and update national treatment and care guidelines.

Romania: moving towards universal access to testing and treatment

Romania faces a high burden of chronic viral hepatitis in the general population. Insufficient infection control in health-care settings decades ago was the cause of increased infections. A national survey among adults estimated a prevalence about double the regional average for hepatitis C (at 3.2%), or triple the average for hepatitis B (at 4.4%). Low testing rates and insufficient awareness about chronic viral hepatitis contributed to limited access to treatment and care.

To address this situation, the Ministry of Health has committed to establishing sustainable programmes that ensure universal coverage for testing, diagnosis, and access to cost-effective treatment for all those affected by hepatitis B and C.

  • To increase testing rates, Romania began in May 2018 to provide free viral hepatitis testing upon referral from a general practitioner. In addition, it will start implementing large-scale testing programmes in 4 regions to pilot the set-up of a national infrastructure and a national testing strategy. The sustainability of these programmes, started with initial funds from the European Union, will be ensured through a shift to domestic funding.
  • Since 2017, more than 12 000 hepatitis C patients belonging to selected groups have been treated with DAAs, doubling the number of those treated in 2015. Romania is planning a major effort to extend treatment coverage to all those affected, estimated to be more than 500 000, using domestic funds.

National large-scale testing and treatment interventions are part of a comprehensive action plan for the elimination of viral hepatitis. The plan is being developed by the Ministry of Health of Romania with technical support from WHO and the European Centre for Disease Prevention and Control (ECDC) and through extensive consultations with stakeholders.