Day: November 16, 2020

Use of Data to Inform Planning and Financing Hepatitis Elimination in
Africa.

DURATION   18 months
STARTING DATE  September 2020
GEOGRAPHIC REACH   African continent
PARTNER     Center for Disease  Analysis Foundation, Inc. CDAF

AIM
The project aimed to increase domestic and international investments for hepatitis elimination in Africa by providing up-to-date data and analysis on HBV/HCV prevalence, burden, mortality, diagnosis rate and treatment rate by collaborating with country stakeholders and showing the potential impact of action and inaction to drive political will and decision-making at
the national and regional (African continent) level.

CONTEXT
The lack of data, conflicting data, underestimation of the magnitude of hepatitis burden, the impact of action and no action, and fear of the cost of elimination programmes prevent countries and international agencies from taking a stand on viral hepatitis elimination. CDAF used data and advanced decision support analytics to help policymakers understand the national burden, the value and the cost of hepatitis elimination.

ACTION
• Assess hepatitis B and C burden, morbidity and mortality in Africa.

• Provide analytical support to ten African countries to assess hepatitis B & C burden and the corresponding economic impact if countries did nothing or if they eliminated HBV/HCV.

• The results will be used to update/build an HCV and HBV model for every African country with available data. The remaining countries’ data will be extrapolated to estimate HBV/ HCV prevalence, cirrhosis, liver cancer, mortality, diagnosis rate and treatment rate for the African continent.

RESULTS

CDAF’s models and forecasts were developed for 49 African countries for HBV and 23 countries for HCV, and they are published by the Polaris Observatory here. 

• An economic impact & financing analysis to show the cost of different financing strategies (self-funding, patient co-pay, catalytic funding, etc.) and investment cases for national hepatitis elimination programs that can be used in discussions with Ministries of Finance or development banks.

A cost-effectiveness analysis for Egypt showed that the HCV elimination programme was highly cost-effective.  Egypt’s program was unique because it used a loan to fund the national HCV elimination programme.  This paved the way for the government to develop an HBV elimination programme and consider funding that programme through a similar mechanism. 

In Morocco, CDAF found that the national programme would benefit from age cohort screening (40+ expanded to 35+ followed by 18+ year olds) since more than 75% of all HCV cases are in older age cohorts.  The analysis also showed that HBV/HCV elimination has a positive return if the government was willing to negotiate and reduce the price of HCV/HBV diagnostics and treatment.  

In Ghana, the analysis resulted in the MoH appointing a viral hepatitis coordinator. The economic impact analysis showed that under government and commercial pricing, the elimination of HCV will be highly cost-effective as soon as 2026 and could result in a return on investment by 2035. The analysis showed that HCV elimination is cost-saving in Ghana if the government is willing to negotiate diagnostic and medicine prices.    

CATALYTIC IMPACT 

The analysis in Uganda highlighted that HBV and HCV elimination were cost-saving with modest budget requirements. As a result, the MoH announced that it would provide HBV birth-dose vaccination. A current project (supported by CDAF) is assessing the impact of HBV birth-dose vaccination on infants born to mothers with HBV and the treatment of mothers with high HBV+ loads. If successful, this project will lead to a change in the national guidelines. Uganda has started screening pregnant women for targeted birth-dose delivery.  

Read about our other grants. 

Unlocking the power of data: Developing an Operational Guide to assist countries
in collecting monitoring and evaluation indicators for viral hepatitis.

DURATION   18 months
STARTING DATE    September 2020
GEOGRAPHIC REACH South East Asia and the Western Pacific regions
PARTNER     WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute.

AIM                                                                                                                                                           The project aimed to catalyse global viral hepatitis elimination efforts by developing an operational manual to guide national approaches to collecting, utilising and analysing strategic information for focused action in the Western Pacific and Southeast Asia regions.

CONTEXT                                                                                                                     
Although awareness of the global burden of viral hepatitis is rising, the mobilisation of the viral hepatitis response has been slow, with far less investment at the regional and global level compared to other diseases with a similar public health burden.

Few countries have established national action plans that provide solutions for affordable and appropriate care and treatment for people living with viral hepatitis. With limited international funding, many countries will not have the capacity to develop specific viral hepatitis strategic information infrastructure or data collection systems.

The WHO’s Global Health Sector Strategy (GHSS) on Viral Hepatitis 2016-2021 identified information for focused action as a priority area for the viral hepatitis response, highlighting the importance of developing a robust strategic information system to understand viral hepatitis epidemics and focus the response. The GHSS recognises that national and subnational data are often lacking or poorly collected.

Strengthening data systems such as disease surveillance and clinical reporting systems is essential to understand disease burden, monitor programme outcomes and track progress towards viral hepatitis elimination.

In addition, data sources and systems vary within and across different countries, making approaches to collecting and analysing these data for reporting against WHO indicators complicated for many countries.

RESULTS                                                                                               
The guide, developed by the Doherty Institute, is aimed at in-country implementation of WHO’s monitoring and evaluation framework with a focus on ten core indicators to assist Member States in monitoring, evaluating and informing the health sector response to hepatitis B and C. 

Country-specific workshops were held in Bangladesh, Fiji, Indonesia and Lao PDR for feedback on the operational guide. These allowed those involved in the hepatitis response to come together for the first time since the pandemic began and mark the re-engagement with viral hepatitis elimination as a key public health action for the decade ahead.  

CATALYTIC IMPACT 

The grant recipient is committed to assisting WHO in generating and analysing epidemiological and programmatic data to guide public health policy and practice related to viral hepatitis and complications, including liver cancer.  

The development of the guide is a critical catalytic action that will substantially reduce reliance on external experts, WHO staff and repeated missions to each country. The aim is to increase the number of countries reporting against the core indicators. 

The guide will reduce reliance on external experts and give Member States practical, easy-to-follow information and suggestions. Collecting, utilising and analysing strategic information will catalyse viral hepatitis elimination efforts and enable focused action. 

The Doherty Institut, serving on a range of international committees tasked with guiding strategic responses to viral hepatitis, will keep translating the findings of this project into policy and practice globally, sustaining the effectiveness and enduring impact of this work beyond the funded period.

Read about our other grants. 

Decentralized care delivery and linkages for enhanced diagnosis and
treatment of Hepatitis C in six selected districts of Punjab

DURATION: 18 months
GEOGRAPHIC REACH: Punjab, Pakistan
STARTING DATE: 1st September 2020
PARTNER: Association for Social Development (ASD)

AIM
This project aims to develop, pilot and evaluate integrated hepatitis C care-package at 51 rural health centers (RHCs) in six high burden districts of Punjab. The project aims to achieve universal coverage of hepatitis C care in the entire region of Punjab by catalyzing evidence based scale-up in the remaining 30 districts of Punjab.

CONTEXT
Punjab province has 36 districts and a population of around 110 million. The sero-prevalence of hepatitis C infection is exceptionally high at 8.9%. The project will pilot and evaluate integrated hepatitis C care at RHCs in the six highest-prevalence districts of Punjab. 12.5 million people live in these six districts, of which around 75% are living in rural areas. All 22 district and sub-district hospitals are in urban settings, so program-supported hepatitis care at these hospitals is relatively inaccessible to most rural inhabitants, especially women and disadvantaged groups. In these districts 51 RHCs are the main source of general health care for more than 9.5 million rural inhabitants.

ACTION
The project will contextualize and evaluate an existing hospital based integrated and scalable intervention for delivering hepatitis C testing and treatment across all public primary care RHCs in six selected high-prevalence districts of Punjab, Pakistan.

EXPECTED RESULTS
• A care package will be adapted for managing integrated hepatitis care at RHCs.

• All 51 RHCs in the six selected districts will be enabled for delivering integrated hepatitis-C care in a region where 9.5 million people live.

• At least 40,000 individuals will be screened with a rapid diagnostic test
• 10,000 of those reactive on rapid testing will receive PCR complementary testing at a designated laboratory.

• 4,000 confirmed cases will be registered and treated for hepatitis.

• Treated cases will be re-tested after 12 weeks of completed treatment and 85% or more will be cured.

• Process evaluation and costing studies will be conducted with data from the 51 project RHCs. Evidence of effectiveness and feasibility of the integrated care-package will be generated to inform the scaling-up of decentralized integrated care delivery package.

• The results and the products will be shared with potential stakeholders within and outside Pakistan for potential application of the pilot model to other settings.

CATALYTIC IMPACT
This intervention will achieve universal coverage of hepatitis C care in the whole of Punjab and possibly three other provinces within the country. The proposed project will not only develop a contextualized hepatitis care intervention but also generate evidence to inform program planning and decision-making for scaling hepatitis care in all RHCs of Punjab.

The continued engagement of the Punjab Hepatitis Control Program and the district health authorities will ensure that the intervention design remains sensitive to contextual realities and that the evidence is owned and used by the local public health authorities.

Read about our other grants. 

Expanding public engagement in HBV/HCV: Crowdsourcing to spur
hepatitis policy

DURATION  18 months
STARTING DATE   1st September 2020
GEOGRAPHIC REACH   Global
PARTNER   London School of Hygiene and Tropical Medicine, in collaboration with the World Hepatitis Alliance. (WHA)

AIM
The project aims to gather and promote the experience of people living with viral hepatitis. This has not been sufficiently highlighted to either policymakers or the general public, in contrast for example to HIV.

This innovative project aims to support the prioritization and effectiveness of the viral hepatitis response in selected countries with high burdens of viral hepatitis.

CONTEXT
Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) contribute substantially to global morbidity and mortality. More than 325 million globally are affected by viral Hepatitis B and C, which is 10 times larger than the global HIV epidemic.

Every hour, over 150 people die of viral hepatitis related liver diseases, including liver cirrhosis and hepatocellular carcinoma (1). People in low and middle-income countries (LMICs) are most affected by the two viral hepatitis (2). Africa and Western Pacific Region bear more than 42% of the world’s deaths caused by hepatitis (3).

To address above challenges, public engagement is important for raising awareness of hepatitis, generating community-centered solutions, and informing messages to spur policy change. Nevertheless, the public voice is often ignored, and powerful human stories of viral hepatitis are missed.
 
Innovative strategies are needed to better engage the public, especially people living with or affected by chronic hepatitis in those regions with a high burden of hepatitis B and C. Crowdsourcing may provide an opportunity to help improve public participation and awareness.

Crowdsourcing shifts traditionally individual tasks to large groups often through challenge contests. By involving the public in multiple stages, such as on steering committees and creating submissions, challenge contests improve public ownership and may help design people-centered health services. 

ACTION
The recipient will conduct a global crowdsourcing challenge contest to solicit stories of people affected by viral hepatitis and infographics describing the impact of HBV/HCV.

The project aims to address two key problems: low public awareness of viral hepatitis and lack of high-level strategies targeting viral hepatitis and its related diseases, especially during this unusual COVID-19 pandemic which may pose additional risks to the community.

The project has three phases:

• A global crowdsourcing challenge contest will be held to identify exceptional stories, images, videos and infographics; through engaging the general public, patients diagnosed with HBV/HCV and at-risk sub-groups, to solicit stories that portray reality of living with hepatitis and infographics that illustrate the local burden, gaps in hepatitis care delivery, and  economic impact.

• Analyzing solicited data to identify barriers to viral hepatitis prevention and care provision, and locally appropriate solutions; incorporating COVID-19 related themes;

• Multisectoral workshops will be held to celebrate excellent submissions, share problems and solutions, and spur actions.

EXPECTED RESULTS
At the end of the funding period, the project aims to increase community engagement via soliciting personal stories from people living with hepatitis.

The project will raise awareness of the limitations of access to diagnosis and treatment for people living with hepatitis and therefore stimulate interests of leaders in policy changes and/or in generating anti-hepatitis action plans in selected high-burden countries.

CATALYTIC IMPACT
Through engaging key groups affected by hepatitis, working closely with local civil groups and policy makers, the project will catalyze local ownership of hepatitis programs and build capacity for advocacy at regional and national levels. The mentorship program will provide opportunities for further in-country discussions surrounding evidence-based policy changes.

References 
1 WHO Regional Office for Africa. Hepatitis. 2019. https:// www.afro.who.int/health-topics/hepatitis
2 Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic
hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet (London,
England)2015; 386(10003): 1546-55.9.
Madhava V, Burgess C, Drucker E. Epidemiology of chronic hepatitis C virus infection in sub- Saharan Africa.
The Lancet Infectious diseases2002; 2(5): 293-302.
3 WHO Regional Office for Africa. Hepatitis. 2019. https:// www.afro.who.int/health-topics/hepatitis

Read about our other grants. 

Development of a Monitoring and Evaluation Framework for the
Implementation of Elimination of Viral Hepatitis

GEOGRAPHIC REACH: Global
PARTNER: Division of Infectious Diseases Columbia University in the City of New York.

AIM
The project has been designed to develop and implement a monitoring and evaluation framework, which specifically addresses issues and challenges unique to the implementation of action plans to eliminate viral hepatitis as a global health threat.

CONTEXT
The WHO Health Sector Strategy indicators suggest that the goal of viral hepatitis elimination will be achieved if more than 7 million new hepatitis B and C infections are averted and related mortality is reduced to less than 500,000 deaths by 2030. In 2019, EndHep2030 issued a call for proposals in support of this global initiative to eliminate viral hepatitis. Projects were selected for their innovative approaches to inform evidence based policy formulation, to overcome systemic barriers, and to strengthen service delivery by scaling up proven interventions. EndHep2030 aims to accelerate planning and implementation at national and regional levels.

ACTION
The Global Health Services Delivery programme at the Columbia University Division of Infectious Diseases was selected to design a M&E framework for The Hepatitis Fund’s grants programme and to provide training to the grant recipients.

EndHep2030’s contribution towards hepatitis elimination will be measured through a cohesive and consistent M&E approach that helps define and measure catalytic program inputs, outputs and outcomes.

The EndHep2030 M&E framework details the key components of EndHep2030’s strategic approach to assess catalytic impact and forms the foundation for EndHep2030’s monitoring and evaluation plan. The EndHep2030 M&E framework will be further enhanced through the input from grantees and be shared with the broader hepatitis community.

The pathway to catalytic impact includes assessing if achievement of targets would have been attained at the same time or scaled had the program not been implemented. Catalytic impact is expected to be multifold, sustained, and lasting.

EXPECTED RESULTS
The creation and application of a framework to monitor and evaluate the performance of the EndHep2030 portfolio will be critical to enable real-time learning and mitigate the impact of force majeure events (such as disruptions brought about by a global pandemic).

Lessons learned and knowledge accumulated can be valuable contributions to the global campaign to eliminate viral hepatitis in the foreseeable future.

The EndHep2030 M&E framework is a tool for systematically monitoring funded projects for catalytic impact, and at the same creating a community of learning and sharing for capacity building.

EndHep2030 will assess the overall contribution of this program strategy to eliminating viral hepatitis through cycles of funding in consultation with various stakeholders and field experts.

CATALYTIC IMPACT
Monitoring and evaluation of EndHep2030 grants will be a critical part of explaining – if, how and why catalytic projects contributed to The Hepatitis Fund’s mission of eliminating viral hepatitis as a global health threat.

Read about our other grants. 

Planning and development of the World Hepatitis Summit 2022

DURATION: 14 months
STARTING DATE: 1st September 2020.
COUNTRY: Global with focus on South-East Asia.
PARTNER: The World Hepatitis Alliance.

AIM
This grant will contribute to the development of the largest public health summit to drive action towards the elimination of viral hepatitis by 2030.

The summit will build the narrative for hepatitis elimination, will advance the knowledge on eliminating viral hepatitis by 2030 and will build all stakeholders capacity on hepatitis elimination.

The third World Hepatitis Summit (WHS) is to be held in Bangkok, Thailand in June 2022. It will be delivered as a hybrid event with both face-to-face and online components. The theme of WHS 2021 will be “Achieving the elimination of viral hepatitis within evolving health systems”.

CONTEXT
The World Hepatitis Summit is a large-scale, global event to advance the viral hepatitis agenda and the only global hepatitis conference focused on public health.

The first WHS was held in Glasgow, Scotland in 2015. The summit bought together over 500 delegates from 84 countries and it truly signified a turning point in the response to viral hepatitis. The summit helped to build momentum ahead of the 2016 World Health Assembly, where for the first time in history 194 countries adopted the Global Health Sector Strategy (GHSS) which called for the elimination of viral hepatitis as a public health threat by 2030.

The second WHS was held in Sao Paulo, Brazil in 2017 and again this was an important moment in the hepatitis response, coming a year after countries committed to elimination. The summit was truly a launchpad for action with 4 innovative platforms being launched, addressing topics such as financing and policy. It also resulted in the development and release of São Paulo Government Declaration on Viral Hepatitis and the corresponding São Paulo Community Declaration on Viral Hepatitis. The true impact of the summit is best evidenced in the feedback of delegates who were inspired to drive change in their countries by implementing the lessons learnt and new partnerships they developed.

ACTION
2021 will see data across the cascade of care updated as countries report against the 2020 targets and is the final year of the Global Health Sector Strategy on Viral Hepatitis, 2016 –2021.

WHS 2021 will bring together a global audience of 1,000 delegates of civil society groups, WHO and its Member States, patient organisations, policymakers, public health leaders, medical professionals and funders to define how hepatitis elimination can be embedded in UHC programmes and across evolving health systems post COVID-19.

WHS will provide a platform for the communities disproportionally affected by viral hepatitis, such as people who inject drugs and indigenous peoples, to connect with decision makers and the wider global health community to drive action for hepatitis elimination.

EXPECTED RESULTS
The World Hepatitis Summit will support the global community to refocus on the hepatitis elimination efforts and clearly understand how these efforts can be positioned within the broader health agenda both nationally and globally.

The Summit aims:
To motivate governments, health systems and global agencies to increase resources for programmes for the prevention, diagnosis and treatment of viral hepatitis.

To empower governments to accelerate their efforts to reach the 2030 targets of eliminating viral hepatitis by building the knowledge and technical skills of delegates and exploring how disease specific responses can fit within wider UHC efforts.

To establish the importance of patient-centred care, which is decentralized, integrated and embraces task-shifting, in shaping evolving health systems and the role of the hepatitis community in its achievement.

To generate a cross-sectorial response to achieving elimination, highlighting integration opportunities and pathways, by increasing innovation, collaboration and joint-working.

To recognise the achievements made to date, identify gaps in global, regional and national responses and explore opportunities for closing those gaps across the continuum of care, and specifically in regard to access to diagnostics and drugs.

CATALYTIC IMPACT
WHS 2021 will give delegates the tools they need to better advocate at the national, regional and global level and will strengthen the collective voice of those demanding action. WHA is uniquely positioned to drive the meeting outcomes beyond WHS through their wider advocacy and capacity building programmes, further amplifying the impact of WHS2021.

Read about our other grants.