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      Hepatitis elimination by 2030: Progress and challenges

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          Abstract

          Globally, over 300 million people are living with viral hepatitis with approximately 1.3 million deaths per year. In 2016, World Health Assembly adopted the Global Health Sector Strategy on viral hepatitis to eliminate hepatitis by 2030. Different World Health Organization member countries are working on hepatitis control strategies to achieve hepatitis elimination. So far, only 12 countries are on track to achieve hepatitis elimination targets. The aim of the study was to give an update about the progress and challenges to achieving hepatitis elimination by 2030. According to the latest data, 87% of infants had received the three doses of hepatitis B virus (HBV) vaccination in the first year of their life and 46% of infants had received a timely birth dose of HBV vaccination. There is a strong need to improve blood and injection safety. Rates of hepatitis B and C diagnosis are very low and only 11% of hepatitis B and C cases are diagnosed. There is a dire need to speed up hepatitis diagnosis and find the missing millions of people living with viral hepatitis. Up to 2016, only 3 million hepatitis C cases have been treated. Pricing of hepatitis C virus drugs is also reduced in many countries. The major hurdle to achieve hepatitis elimination is lack of finances to support hepatitis programs. None of the major global donors are committed to invest in the fight against hepatitis. It will be very difficult for the low and middle-income countries to fund their hepatitis control program. Hepatitis elimination needs strong financial and political commitment, support from civil societies, and support from pharmaceutical and medical companies around the globe.

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          How far are we from viral hepatitis elimination service coverage targets?

          Abstract Introduction In 2016, the Global Health Sector Strategy (GHSS) on viral hepatitis called for elimination of viral hepatitis as a major public health threat by 2030 (i.e. 90% reduction in incidence and 65% in mortality). In 2017, WHO's first‐ever Global Hepatitis Report presented the baseline values for each of the core indicators of the strategy. We review the challenges and opportunities that lie ahead in order to reach the 2030 service coverage targets. Discussion Three‐dose coverage of hepatitis B vaccine in infancy reached 84% in 2015 (2030 target: 90%); however, only 39% received the timely birth dose (2030 target: 90%). Blood safety (97% of blood units screened with quality assurance, 2030 target: 100%) and injection safety (5% unsafe injections, 2030 target: 0%) had made substantial progress while harm reduction fell short (27 syringe and needle sets distributed per person who injects drugs per year, 2030 target: 300). Worldwide, 9% and 20% of the HBV‐ and HCV‐infected population respectively, were aware of their status (2030 targets: 90%). In the short term, to reach the 2020 target of diagnosing 50% of those infected, 107 million HBV infected persons and 15 million HCV infected persons should be urgently diagnosed. Overall, in 2015, less than 10% of known infected persons were on HBV treatment or had started HCV treatment (2030 targets: 80%). Conclusions The prevention component of elimination is on track with respect to hepatitis B vaccination, blood safety, and injection safety. However, coverage of the hepatitis B vaccine timely birth dose requires a substantial increase, particularly in sub‐Saharan Africa, and harm reduction needs to be taken to scale as injecting drug use accounts for a third of mortality from HCV infection. A promising but limited start in hepatitis testing and treatment needs to be followed by immediate and sustained action so that we reach the service coverage targets required to achieve elimination by 2030. Treating persons coinfected with HIV and hepatitis viruses is particularly urgent and needs to be promoted in the context of the HIV response.
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            Elimination of hepatitis from Pakistan by 2030: is it possible?

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              Transition from millennium development goals to sustainable development goals and hepatitis

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                Author and article information

                Contributors
                Journal
                World J Gastroenterol
                World J. Gastroenterol
                WJG
                World Journal of Gastroenterology
                Baishideng Publishing Group Inc
                1007-9327
                2219-2840
                28 November 2018
                28 November 2018
                : 24
                : 44
                : 4959-4961
                Affiliations
                Multidisciplinary Laboratory, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan. yasir.waheed@ 123456fui.edu.pk
                Department of Medicine, Jinnah Memorial Hospital, 2-Civil Lines, Rawalpindi 46000, Pakistan
                Department of Medicine, Fauji Foundation Hospital, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
                Department of Pharmacology and Therapeutics, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
                Author notes

                Author contributions: Waheed Y designed study and wrote manuscript; Waheed Y, Siddiq M, Jamil Z, Najmi MH did literature search, data analysis and gave the final approval of the study.

                Corresponding author to: Yasir Waheed, PhD, Assistant Professor, Multidisciplinary Laboratory, Foundation University Medical College, Foundation University Islamabad, Defense Avenue, DHA 1, Islamabad 44000, Pakistan. yasir.waheed@ 123456fui.edu.pk

                Telephone: +92-300-5338171

                Article
                jWJG.v24.i44.pg4959
                10.3748/wjg.v24.i44.4959
                6262254
                30510370
                db5d56bd-a0cf-44ad-a30d-fe13a82c6430
                ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 30 August 2018
                : 23 October 2018
                : 2 November 2018
                Categories
                Editorial

                hepatitis,global health sector strategy,hepatitis b virus vaccination,injection safety,find missing millions,harm reduction

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