Data to inform elimination in Africa

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

DURATION   18 monthsThe Hepatitis Fund
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.  

 

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