Category: Uncategorized

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Eliminating Mother-to-Child Transmission of Viral Hepatitis B in Vietnam

Eliminating Mother-to-Child Transmission of Viral Hepatitis B in Vietnam

Co-funded with Ville de Genève. 

GEOGRAPHIC REACH  Asia/Vietnam
PARTNER PATH, in collaboration with Nghe An Province CDC  – Co-funded with the Ville de Genève.

AIM    

Demonstrate the impact of introducing screening & treatment of pregnant women within the Maternal & Child Healthcare (MHC) system as part of Vietnam’s 2030 triple elimination goal. 

EXPECTED RESULTS

The project will provide a hepatitis-free future to newborn babies in Nghe An, which is Vietnam’s largest province, located in the North Central Coast region of the country, with 3,547,247 people living in 21 districts. 

The project will aim to screen 90% of pregnant women receiving antenatal care, treat 80% of eligible pregnant women with Tenofovir (TDF) prophylaxis or treatment, and vaccinate up to 98% of newborns with the HBV birth dose vaccine at the project sites by end of the project life. 

Areas of implementation: Epidemiology, Screening and Testing, Human resources, Treatment and Cure, Policy and Advocacy, Biomedical Prevention 

Grant USD 327,000 for three years.

Read about our other grants. 

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ADVANCING TOWARDS ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HEPATITIS B IN RWANDA

ADVANCING TOWARDS ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HEPATITIS B IN RWANDA


GEOGRAPHIC REACH: Rwanda
PARTNER: Clinton Health Access Initiative (CHAI).  Co-funded by the Canton and Republic of Geneva 

AIM    

To scale HBV screening, diagnosis, and antiviral treatment among pregnant women and demonstrate implementation of timely targeted HepB-BD to prevent mother-to-child transmission (PMTCT) of HBV in Rwanda. 

CONTEXT

In Rwanda, roughly 10,000 newborns are at risk of being exposed to HBV at birth every year. Transmission risk can be decreased to almost 0% through antenatal HBV screening, a combination approach using antiviral treatment in pregnant women and HBV vaccination for infants. However, service gaps and implementation challenges to delivering prevention of MTCT (PMTCT) services exist at antenatal clinics, and they must be addressed to halt the transmission of HBV between mothers and their newborns.

Rwanda has high-performing antenatal care (ANC) platform. Around 93% of Rwanda’s 350,000 pregnant women per year attend ANC facilities for delivery. Despite this, recent data indicates that only 20% of pregnant women are currently screened for HBV during pregnancy.

Rwanda has achieved 96% HBV vaccination coverage by age 5 for children and has successfully rolled out routine HBV vaccination in adults, but HepB-BD given within 24 hours of birth, a key intervention to eliminate mother-to-child transmission, has yet to be introduced.

To advance HBV eMTCT, Rwanda will build upon existing health system infrastructure established for HCV elimination (human resources, diagnostics and treatment platforms, capacity building and procurement systems) established for HCV elimination, a strong vaccination program and strong ANC platform to advance elimination of HBV MTCT. 

ACTION

CHAI will work with the Rwandan government to address critical barriers to scale HBV screening, diagnosis, and antiviral treatment among pregnant women and demonstrate implementation of timely targeted HepB-BD. Specifically, CHAI will support the Rwandan Government to build upon the backbone of its HIV and HCV programs to:

  • assess and develop strategies to address HBV PMTCT service implementation challenges in Rwanda;
  • increase uptake, availability and quality of HBV PMTCT services among pregnant women
  • implement a demonstration project for targeted HepB-BD for infants of high-risk mothers.
  • generate evidence to inform a sustainability plan for HBV services for pregnant women in Rwanda, and inform policies in other AFRO countries.

EXPECTED RESULTS 

  • ≥90% pregnant women presenting at antenatal care receive HBsAg screening  
  • ≥90% pregnant women with high viral load receive antiviral treatment   
  • ≥90% infants of high-risk mothers receive targeted timely HepB-BD 
  • ≥90% all newborns receive complete HBV vaccine schedule (HepB3 vaccine) 

CATALYTIC IMPACT

During the project period, the successful demonstration of HBV BD among newborns of mothers who have high HBV VL levels will be used to advocate for increased government funding to scale HBV BD to all newborns. The implementation of this demonstration project will inform future introduction strategies, generate and leverage evidence to inform the sustainability plan of services in Rwanda and inform policies in AFRO countries. 

Read about our other grants. 

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Eliminating Mother-To-Child Transmission of Hepatitis B in Vietnam

DURATION   3 years
STARTING DATE   1st  November 2021
GEOGRAPHIC REACH   Vietnam
PARTNER     PATH, in collaboration with Nghe An Province CDC and with support from the City of Geneva. 

AIM    

The purpose of this project is to demonstrate the impact of introducing screening & treatment of hepatitis B in pregnant women within the Maternal & Child Healthcare system as part of Vietnam’s 2030 triple elimination goal (HIV, Syphilis & HBV).

< style="color: #000000;">CONTEXT                                                                                                              

In the Asia-Pacific Region, mother-to-child transmission (MTCT) at birth plays a very important role in hepatitis B epidemiology. Approximately 3% to 5% of infants born in this region will acquire chronic hepatitis B infection at birth if not immunized immediately after the delivery. Each year, over 180,000 new-born babies in the region  are newly infected by hepatitis B through mother-to-child transmission.

According to the World Health Organization, Vietnam has one of the highest HBV prevalence in the world at more than 10%. Viral hepatitis is the third cause of death in the country and HBV claims over 25,000 lives annually (Polaris Observatory, 2016). Chronic carriers of hepatitis B are at risk of developing liver diseases such as cirrhosis and liver cancer. 45% of all liver cancer cases are caused by HBV.

To prevent MTCT of HBV, WHO recommends that all children be vaccinated against hepatitis B as soon as possible after birth, including a first dose of the vaccine within 24 hours after birth. Timely diagnosis and treatment of women living with chronic hepatitis B during pregnancy and hepatitis B vaccination for newborns can reduce and prevent MTCT of HBV by more than 95% and thus break the cycle of transmission across generations. While national birth dose of hepatitis B vaccination rate is at 82.2%, the proportion of pregnant women screened for HBV is very low (55%) and the prophylactic treatment for pregnant women is not yet dispensed in district hospitals in Vietnam.

ACTION

The project aims to implement a scalable pilot model towards a hepatitis-free future for newborn babies in Nghe An Province through the following objectives:

  • Provide testing for hepatitis B in pregnant women receiving antenatal care (ANC) or delivery services at district health facilities in Dien Chau and Thai Hoa, Nghe An.
  • Facilitate linkage to HBV prophylaxis or treatment for pregnant women living with hepatitis B to prevent mother-to-child transmission of HBV.
  • Promote newborn HBV birth dose vaccination.
  • Provide clinical and operational evidence for policy formulation at both the provincial and national levels

Nghe An is Vietnam’s largest province, located in North Central Coast region of the country, with 3,547,247 people living in 21 districts.

EXPECTED RESULTS

The project aims to screen 90% of pregnant women receiving antenatal care, treat 80% of eligible pregnant women with Tenofovir (TDF) prophylaxis or treatment, and vaccinate up to 98% of newborns with a birth dose HBV vaccine at the project sites.

CATALYTIC IMPACT                                                                

PATH expects that this pilot project will demonstrate promising results which will be endorsed and expanded by the Government of Vietnam. The project will also build capacity for health care workers and local health authorities in Nghe An province to better screen and treat HBV among pregnant women toward reducing MTCT of HBV after beyond the project duration.

This project was made possible by support from City of Geneva.

Read about our other grants. 

 

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Eliminating Hepatitis in the Andean Region: Supporting National Responses

DURATION   18 months
STARTING DATE   May 5, 2021
GEOGRAPHIC REACH  The Andean Region of South America including Bolivia, Colombia, Chile, Ecuador and Peru. 
PARTNER    Pan American Health Organization PAHO

AIM    

The purpose of this project is to scale-up support to countries of the Andean sub-region working directly with Ministries of Health and financing components of National Responses.

CONTEXT                                                                                                              

South America has a population of 422 million people and is comprised of 13 countries. Between 2016 and 2018, The Pan American Health Organization PAHO, together with Ministries of Health, estimated there to be approximately 2 million people living with hepatitis B (HBV) and 2 million people living with hepatitis C (HCV) in South America. Approximately half of this burden is found in countries of the Andean sub-region. Geographically, the countries part of the Andean – are Bolivia, Colombia, Ecuador, Peru, Venezuela and Chile.

While HBV immunization impact has been strong, efforts beyond immunization – diagnosis and treatment of HBV and HCV – remain insufficient to reach elimination. For example, in 2017 just 2500 people in this region were treated for HCV, around 0.3% of the total.

ACTION

The project will:

  • Increase demand for testing and treatment in affected populations across Andean countries.
  • Develop intersectoral national hepatitis working groups and national plans (Peru, Ecuador, Bolivia) engaging all key actors, including a testing strategy, integrated intonational health insurance systems.
  • National assessment of hepatitis situation and response in South America.
  • Support stakeholder consultation for national planning exchange (sub-regional activity).
  • Increase demand for testing and treatment in affected populations across the Andean countries Investment cases for HBV and/or HCV in South America.
  • Analysis of key barriers impeding screening and diagnosis and treatment among affected communities with special focus on indigenous population.

EXPECTED RESULTS.

  • More people including civil society and government will be aware of the need to test and treat for hepatitis.
  • Development and alignment of National Hepatitis Action and Elimination Plans or region-specific Elimination Plans to include coordinated testing strategies, measurable treatment targets and integration into national health insurance systems.
  • Produce key knowledge pieces as outcomes for this project (1) National assessment of hepatitis situation and response, investment cases for HBV and/or HCV and analysis of key barriers impeding screening and diagnosis and treatment among affected communities with special focus on indigenous population.
 

CATALYTIC IMPACT                                                                

Because of this project, targeted countries will be able to develop, implement and bring to the national scale their efforts to screen, test, diagnose, treat and cure people living with viral hepatitis.

If this project is successful, the ministries of health from relevant countries will continue the advancements, with the support of health organisations. The project could also scale up in remote and rural settings in the Andean countries, particularly in indigenous communities, who are difficult to reach and may have a high burden of disease from hepatitis.

Read about our other grants. 

 

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Strengthening Capacity for National Hepatitis Planning in WHO Regions

DURATION   15 months STARTING DATE   1st February 2021 GEOGRAPHIC REACH   Global PARTNER    World Health Organization( WHO)

AIM    

The project aims to catalyze a strong, focused, costed and well-planned national response to implement and manage action for hepatitis elimination by building technical assistance capacity in WHO regional offices and supporting planning in five WHO member states (Nigeria, Iran, Ukraine, Nepal, Lao People’s Democratic Republic)

CONTEXT                                                                                                              

While national plans for viral hepatitis are now numerous, they are often unfocused, and most of them do not contain an adequate monitoring and evaluation logframe, precise targets, workforce needs, costing, budgeting and financing.

In August 2019 in Kathmandu, Nepal, the WHO Regional Office for the South East Asia Region (SEARO), in collaboration with WHO Secretariat, conducted a workshop with 11 countries of the region to facilitate the development of an outline of national plans that would include quantifications for indicators, targets and costing as well as other resource needs. The workshop was successful and led to the development of planning tools.

WHO will now build on the success of this workshop and replicate this approach in national-level workshops in five WHO regions, along with advocacy for national financing.

ACTION

The recipient will build capacity in WHO Regional Offices to assist countries in the preparation of well-planned and costed national hepatitis plans. WHO will provide technical support to one member state per remaining region (Nigeria, Iran, Ukraine, Nepal, Lao People’s Democratic Republic)

WHO will hold five country-focused workshops to train regional advisors on conducting ToTs (Training of Trainers) workshops. For each workshop WHO will assist the national programmes to review  the  country profile; set priorities;  generate cost effectiveness estimates for HBV and HCV treatment;  prepare a log-frame  for the main activities;  use the One Health Tool to estimate costs and prepare  a  short report with the outline of the national plan, including baseline, impact targets, service coverage targets, logframe, and costing.

Finally, the key elements of the workshop will be summarized to senior leadership at WHO country office, and within each Ministry of Health and, where possible at the Ministry of Finance. This will constitute the basis for a communication and advocacy strategy to secure resource mobilization.

EXPECTED RESULTS

At the end of the funding period, the project will have:

  • Developed a final package of workshop materials.
  • Trained WHO Regional Advisers for hepatitis in the four WHO regions. They will have cofacilitated the workshops to develop costed national plans and will be capable of conducting workshops to develop costed national plans.
  • Implemented five country workshops.
  • Five priority countries will have improved national plans and engagement with senior leadership will be created for viral hepatitis elimination.
  • Newly developed hepatitis module of WHO-One Health Tool will be pilot tested and used after developing it.

CATALYTIC IMPACT                                                                

The planned approach will allow the catalyzing of the global, regional and national response by

  • Sharing the results from the workshops with the national authorities and senior leadership to allow countries to develop improved national responses towards viral hepatitis elimination. This will ultimately foster access to improved prevention, testing and treatment services. 
  • Building capacity to the regional advisors who will then be able to further use the developed toolbox to other countries in their entire region.
  • Piloting the newly developed hepatitis module of the WHO – One Health Tool and developing further improvements to the tool where necessary. This will be highly catalytic as this tool will be used as a standard for costing of national hepatitis responses in the future.

Read about our other grants. 

 

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Accelerating the Hepatitis B Response in Zambia (ACCELERATE)

DURATION   18 months
STARTING DATE   1st January 2021
GEOGRAPHIC REACH   Zambia
PARTNER    University Teaching Hospital HIV AIDS Programme (UTH-HAP)

AIM    

The project aims to address fundamental barriers to viral hepatitis in Zambia by putting in place a multi-faceted, decentralized, integrated healthcare worker training program.

The purpose of Accelerating the Hepatitis B Response in Zambia (ACCELERATE) is to catalyse substantial increases in hepatitis B testing and treatment in Zambia by cultivating a core group of local hepatitis experts, increasing healthcare professional competency and raising awareness among community health workers.

CONTEXT                                                                                                              

Zambia is a landlocked country in Southern Africa that has a disproportionately high burden of infectious diseases (ID) including human immunodeficiency virus (HIV), tuberculosis, and viral hepatitis. The Zambian Ministry of Health (MoH) has already put into place several major interventions to control viral hepatitis.

Zambia had already met several 2020 hepatitis elimination targets including (a) >90% coverage of 3 dose vaccine for infants, (b) >95% screening of blood donations, and (c) >50% injection safety. However, several fundamental and operational barriers still exist to achieve the 2030 hepatitis elimination target (a) lack of local hepatitis experts, (b) low awareness among healthcare professionals and the general population, and (c) low competency among healthcare professionals, (d) major gaps in diagnosis and treatment and use of the hepatitis B birth dose vaccination.1

Addressing these barriers will raise awareness among policy makers stakeholders to support a national and sustainable effort to eliminate viral hepatitis in Zambia.

ACTION

A core group of 10-15 professionals will be intensively trained and mentored at UTH-HAP to become local hepatitis experts. These trained experts will provide clinical care to at least 50 hepatitis B monoinfected patients each.

Across the 10 provinces, at least 500 community health workers and 500 health work practitioners will participate in activities at one of at least 100 outlying health facilities, representing a catchment population of approximately 5,000,000 Zambians (~30% of the Zambian population).

To address low population awareness and low clinical capacity among HCPs, ACCELERATE will integrate the project ECHO Sub-Saharan Africa (Extension for Community Healthcare Outcomes – https://hsc.unm.edu/echo/ ) led by the University of Cape Town. ECHO is an established guided practice model for medical education that is already in use in Zambia for other disease areas.

EXPECTED RESULTS

  • 10 to 15 local experts will be trained, and each will provide clinical care to at least 50 hepatitis B mono-infected patients.

  • 10 ECHO hepatitis clinical mentors (one per province) will support 100 sites that will participate in ECHO trainings on treatment of viral hepatitis reaching at least 500 HCPs (80 medical doctors, 250 nurses, 100 pharmacists, and 70 other medical personnel).

  • Hepatitis knowledge will be increased among the training participants.

  • 30,000 individuals will be tested for HBV and at least 2,000 individuals will initiate HBV antiviral therapy.

CATALYTIC IMPACT                                                                

This multi-faceted training experience is expected to help Zambia build a cadre of local experts who can sustain the hepatitis B response beyond the end of ACCELERATE.

By disseminating information about the program and its impact at key Africa meetings, ACCELERATE program can become an evidence-supported training model for other African countries to consider adopting.

Also, the curricula for clinical training and for ECHO-based training will be made available for future use and would also look to extend the reach of the training to other institutions.

ACCELERATE will promote wider use of Project ECHO for hepatitis, not just for experts, but for front-line facilities in other African countries.

  1. World Health Organization. Global health sector strategy on viral hepatitis 2016-2021. Towards ending viral hepatitis. 2016.

Read about our other grants. 

 

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Data to inform elimination in Africa

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

DURATION   18 months
STARTING DATE   1st September 2020
GEOGRAPHIC REACH   Africa
PARTNER     Center for Disease  Analysis Foundation, Inc. CDAF

 



AIM
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 show the potential impact of action and inaction in order to drive political-will and decision-making at
the national and regional (African continent) level.

CONTEXT
The lack of data, conflicting data, underestimation of magnitude of hepatitis burden, the impact of action and no action, and fear of cost of elimination program prevent countries and international agencies from taking a stand on viral hepatitis elimination.

CDAF will use data and advanced decision support analytics to help policy makers understand the national burden, the value and cost of hepatitis elimination.

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

• Provide analytical support to 10 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 country in Africa 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.

EXPECTED RESULTS
• An updated understanding of HBV and HCV burden in African countries accounting for most of the hepatitis burden.

• A national report that uses available data and modelling to outline the current HBV and HCV burden and the requirements to meet the WHO elimination targets in each of the 10 countries.

• 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.

• Results will be published by Polaris Observatory
https://cdafound.org/dashboard/polaris/dashboard.html

CATALYTIC IMPACT
The project hopes to accelerate the financing of national elimination plans in Africa by providing data to support funding decisions. CDAF will quantify the burden of viral hepatitis for national governments, quantify the budget impact and the economic and societal impact of HBV/HCV elimination.

In addition, CDAF will share its approach, successes, challenges, and lessons learned among a global audience of viral hepatitis policy makers, advocates, investors, implementers and others.

Read about our other grants. 

 

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Operational Guide for Action

Information for Action: Developing an Operational Guide to assist countries
in collecting monitoring and evaluation indicators for viral hepatitis.

DURATION   18 months
STARTING DATE    1st 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 aims to catalyze global viral hepatitis elimination efforts by developing an operational manual to guide national approaches to collecting, utilizing and analyzing strategic information for focused action in the WPRO and SEARO regions.

CONTEXT                                                                                                                     
Although awareness of the global burden of viral hepatitis is rising the mobilization 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 burdens.

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 strong strategic information system to understand viral hepatitis epidemics and focus the response. The GHSS recognizes 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 analyzing these data for reporting against WHO indicators complicated for many countries.

ACTION                                                                                                    
The project will develop, pilot and produce an operational guide for the in-country implementation of the WHO core indicators to monitor and evaluate the health sector response to hepatitis B and C.

The operational guide will be developed in partnership with the WHO Western Pacific Regional Office (WPRO) and WHO Regional Office in South-East Asia (SEARO) in conjunction with member states, with the objective of becoming a regional WHO guidance document for these regions.

The Operational Guide will be tested in 4 priority countries to ensure that the approach developed is appropriate, useful and able to be adapted to differences in hepatitis epidemic context and health system architecture, in order to achieve generalizable utility.

The in-country testing will include workshops with key stakeholders, epidemiologists and policy makers who will be evaluating the practical utility of the Operational Guide and associated training.

Countries will also be provided with hands-on support and further guidance to progress the collection and analysis of data to report against the WHO’s Core Indicators to monitor and evaluate the health sector response to hepatitis B and C. 

Feedback from workshop participants, country representatives, WHO staff, and other key stakeholders during the pilot testing will be incorporated back into the Operational Guide.


EXPECTED RESULTS
The development of the Operational Guide will provide countries with a practical handbook to report against WHO’s Core Indicators for viral hepatitis. It will enable countries to:

1. Assist in measuring progress towards elimination of viral hepatitis through improved understanding of epidemiology and the current status of national responses. 

2. Guide advocacy. Effectively utilizing data can create awareness to leverage much needed political will in countries, and across regions.

3. Assist in national planning, resource mobilization and allocation. Viral hepatitis responses must be strategically implemented and resourced according to local context. Strategic information can highlight priority populations, geographic disparities and gaps across the continuum of care, guiding decisions on focused action.

4. Monitor and evaluate programmes. It is critical to track implementation and outputs of programmes to ensure resources and investments are being correctly allocated and the programme is functioning as effectively as possible with the greatest impact achieved.


CATALYTIC IMPACT
The Operational Guide model will be available for implementation for use in other countries and regions to assist government to monitor, evaluate, and inform the response to viral hepatitis B and C.

WPRO and SEARO will continue to use the Operational Guide in their strategic information activities supporting in-country efforts, demonstrating the strong catalytic nature of this work and sustainability of project-supported activities well beyond the funding period.

The Operational Guide will provide relevant MoH staff and other key stakeholders with a foundation for improved approaches to essential data source identification, collection and use. This will substantially reduces the reliance on external experts, WHO staff and repeated missions to each country.

Read about our other grants. 

 

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Accelerating diagnosis in Vietnam

HepLINK: Accelerating HBV/HCV diagnosis and treatment through
community – based screening and linkage to care in Vietnam.

DURATION: 18 months
STARTING DATE: 1st September 2020
GEOGRAPHIC REACH: Vietnam
PARTNER: PATH, in collaboration with the Ministry of Health’s (MOH) Vietnam Administration of Medical Services (VAMS)

 

AIM
HepLINK Vietnam will demonstrate a cost-effective model of decentralized and integrated viral hepatitis service delivery—that effectively engages populations at risk of viral hepatitis in prevention, awareness raising, case detection and treatment—to improve viral hepatitis outcomes and provide evidence for scaling and financing interventions that are integral to the elimination of hepatitis C and B by 2030.

CONTEXT
Viral hepatitis is the third cause of death in Vietnam. With more than 1 million HCV infections and more than 7 million HBV infections, and 22,900 annual deaths (3 deaths per hour) from HBV and 5,900 annual deaths (16 deaths per day from HCV).

The government of Vietnam developed the first national plan on viral hepatitis prevention and control for the period of 2015- 2019, and in 2016, released guidelines for the prevention, care, and treatment of HCV. These steps demonstrate Vietnam’s commitment to hepatitis elimination by 2030. However, significant improvements in awareness of, demand for, and delivery of chronic HBV and HCV diagnosis and treatment has so far been minimal.

Awareness of the disease and associated risk factors remains low in Vietnam, even among those most at risk: an HCV situational analysis conducted by PATH among men who have sex with men (MSM) and people who inject drugs (PWID) in 2018 found that more than 25% did not know that HCV was curable. Just 41% were aware of direct-acting antiviral agents (DAAs), a treatment option for people with HCV infection.

The most fundamental challenge to scaling anti-HCV screening, diagnosis, and treatment has been the legacy of expensive, toxic and poor efficacy of chronic HCV treatment in Vietnam. With limited treatment options, there has historically been less impetus among the MOH and donors to test and
explore ways to significantly increase case detection, treatment, and cure.

Chronic HBV treatment is also relatively neglected and much more needs to be done to train primary health care clinicians in HBV screening, treatment, and long-term management.

ACTION
HepLINK Vietnam will demonstrate a cost-effective model of decentralized and integrated HBV and HCV service delivery to improve health outcomes and provide evidence for scaling and financing interventions that are integral to the elimination of hepatitis B and C by 2030.

The project’s strategic technical approaches include:

• Engaging those most affected by viral hepatitis in raising awareness, generating demand and providing anti-HCV screening services.

• Decentralization of viral hepatitis testing, diagnosis and treatment to the primary care level through engagement of general practitioners, and integration with HIV services, in the public and private sector.

• Ensure a supportive environment for those diagnosed with chronic HCV to successfully complete treatment and remain HCV-free; and those with chronic HBV to successfully stay on treatment.

• Generate and leverage strategic learning from HepLINK to facilitate resource mobilization and implementation of the national program toward ending viral hepatitis by 2030.

HepLINK will be implemented in the two biggest cities of the country: Ho Chi Minh City and Hanoi, representing the two regions (Northern, Southern regions) of Vietnam and the highest burden of chronic viral hepatitis infection.

EXPECTED RESULTS
HepLINK model will reach 30,000 at-risk individuals in Ho Chi Minh City and Hanoi with information about HBV and HCV risk-factors, treatment, and available services.

• Of these, 20,000 will have accessed anti-HCV testing and/or HBsAg testing. We estimate that 90% of those who are HCV antibody positive will be successfully linked to HCV diagnosis and treatment and that more than 80% of those who access treatment will achieve cure.

• Generate data to be used as strategic information for advocacy on the roll-out and domestic financing of innovative interventions and the know-how for scaling this up at the national level.

CATALYTIC IMPACT
PATH intends to generate and leverage strategic learning from HepLINK to facilitate resource mobilization and implementation of the national program toward ending viral hepatitis by 2030. The project will provide empirical evidence on effective approaches and strategies that will support the government to update the national guidelines on viral hepatitis testing, diagnosis, and treatment and facilitate large-scale implementation of viral hepatitis interventions across the country.

In addition, PATH will share the HepLINK approach, successes, challenges, and lessons learned among a global audience of viral hepatitis policy makers, advocates, investors, implementers, and others.

https://www.path.org/resources/heplink-accelerating-hbvhcv-diagnosis-and-treatment-through-community-based-screening-and-linkage-care-vietnam/

 

Read about our other grants. 

 

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Decentralized care in Punjab

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.

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