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      The hepatitis C virus in Iran: health policy, historical, ethical issues and future challenges

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          Summary

          Background

          Hepatitis C infection (HCV) can have a harmful effect on the health of people and can impose relevant healthcare costs. The World Health Organization has identified the elimination of Hepatitis C by 2030 as an important goal for all countries. This study aimed to identify the HCV-related policies in Iran.

          Methods

          A qualitative approach was used for this study. Data was collected through a comprehensive search of documents and interviews with different stakeholders related to the HCV program. Data was analyzed and validated using content analysis based on the policy triangle framework.

          Results

          Our findings highlighted that certain social and cultural issues related to stigma can impact on awareness-raising processes. It is also necessary to consider HCV directly in the context of government policies. All relevant stakeholders should be included. Continued talks and interactions need to be made between them for the active participation of all actors.

          Conclusion

          The findings of this study can provide useful information for improving, supporting and developing policy processes. Healthcare providers should address all aspects of the disease by 2030 in order to achieve the goal of HCV elimination. Evidence-based planning, support for up-to-date policies and resource mobilization are needed to achieve this ambitious goal.

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          Most cited references43

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          Reforming the health sector in developing countries: the central role of policy analysis

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            The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

            This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern to support policy change.
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              Chronic Hepatitis C Virus (HCV) Disease Burden and Cost in the United States

              Hepatitis C virus (HCV) infection is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation. A better understanding of HCV disease progression and the associated cost can help the medical community manage HCV and develop treatment strategies in light of the emergence of several potent anti-HCV therapies. A system dynamic model with 36 cohorts was used to provide maximum flexibility and improved forecasting. New infections incidence of 16,020 (95% confidence interval, 13,510-19,510) was estimated in 2010. HCV viremic prevalence peaked in 1994 at 3.3 (2.8-4.0) million, but it is expected to decline by two-thirds by 2030. The prevalence of more advanced liver disease, however, is expected to increase, as well as the total cost associated with chronic HCV infection. Today, the total cost is estimated at $6.5 ($4.3-$8.4) billion and it will peak in 2024 at $9.1 ($6.4-$13.3) billion. The lifetime cost of an individual infected with HCV in 2011 was estimated at $64,490. However, this cost is significantly higher among individuals with a longer life expectancy. Conclusion This analysis demonstrates that US HCV prevalence is in decline due to a lower incidence of infections. However, the prevalence of advanced liver disease will continue to increase as well as the corresponding healthcare costs. Lifetime healthcare costs for an HCV-infected person are significantly higher than for noninfected persons. In addition, it is possible to substantially reduce HCV infection through active management.
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                Author and article information

                Journal
                J Prev Med Hyg
                J Prev Med Hyg
                JPMH
                Journal of Preventive Medicine and Hygiene
                Pacini Editore Srl
                1121-2233
                2421-4248
                02 April 2020
                March 2020
                : 61
                : 1
                : E109-E118
                Affiliations
                [1 ] Social Determinants of Health Research Center, Lorestan University of Medical Sciences , Khorramabad, Iran
                [2 ] Health Management and Economics Research Center, Iran University of Medical Sciences , Tehran, Iran
                [3 ] Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences , Tehran, Iran
                [4 ] Department of Health Sciences (DISSAL), University of Genoa , Italy
                [5 ] UNESCO CHAIR “Anthropology of Health - Biosphere and Healing System”, University of Genoa , Italy
                [6 ] York University , Toronto, Canada
                Author notes
                Correspondence: Hasan Abolghasem Gorji, Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Rashid Yasemi Street, Vali-e-asr Avenue Tehran, Iran -Tel. +2188883334 - E-mail: gorjiha@ 123456yahoo.com

                * Both authors contributed equally to this manuscript

                Article
                10.15167/2421-4248/jpmh2020.61.1.1438
                7225642
                32490276
                2c7f5e5b-69c4-4a4b-abeb-74c0dd20fa9f
                ©2020 Pacini Editore SRL, Pisa, Italy

                This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-Non-Commercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en

                History
                : 25 November 2019
                : 24 December 2019
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 52, Pages: 10
                Categories
                Review

                hepatitis c virus,policy analysis,ethical features,stigma,policy triangle framework

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