World Hepatitis Summit: Samba to Strategic Directions.

Source: World Hepatitis Alliance

Following an energetic dinner where delegates showed off their samba moves, the second day of the Summit was dedicated to strategic directions 2 and 3, which cover the issues of "interventions for impact" and "delivering for equity" - “the what and the how” of elimination.

At morning side meetings, early risers learnt about strategies to eliminate hepatitis E, an often-overlooked form of the hepatitis virus, as well as hearing about the liver societies’ role in elimination. The morning plenary session looked at the five core interventions needed to address viral hepatitis: infant vaccination, prevention of mother-to-child-transmission, blood and injection safety, harm reduction, and diagnosis and treatment.

In a presentation from WHO’s Hande Harmanci, the importance of a public health approach to deliver these interventions was stressed. Director for STI, HIV/AIDS and Viral Hepatitis Department of the Ministry of Health of Brazil, Dr Adele Benzaken echoed the Minister’s comments from yesterday on their treatment for all announcement. The session also featured presentations on challenges and opportunities for hepatitis B services in Nigeria from the Ministry of Health, interventions to prevent hepatitis B infection at birth from John Ward of the U.S. Center for Disease Control, hepatitis C prevention and treatment for people who inject drugs by Greg Dore of the Kirby Institute and hepatitis services for Indigenous Peoples from Luana Silveira de Faria from the Ministry of Health of Brazil.

The “Access to Hepatitis Medicines” session was opened by Portuguese MP Ricardo Leite, who reaffirmed that governments must make access a priority. His speech made a poignant note: “political commitment from governments is a moral and ethical obligation”. This was closely followed by Giten Khwairakpam, amfAR, who provided an overview on how to get generics. His presentation was complemented by Dr. Andrew Hill, Liverpool University, UK, who spoke about the cost and efficacy of generics. His studies have shown that hepatitis C medicine can be purchased for $70 - and, by the end of the year, it could be as low as $50. Both speakers agreed that without greater diagnosis and better linkages to care, the dropping prices won’t make a difference. Dr. Yvan Hutin, World Health Organization, concluded the session by highlighting that price is only one aspect. Access will only be successful when it’s the right product, in the right place, at the right time and for all people who need it.

After the session, participants attended workshops to further explore ways on how to overcome barriers to access. Then attendees spent the afternoon taking part in a range of parallel breakout sessions. Topics ranged from treatment interventions, prevention interventions and delivering for equitable services.

The “Prevention Interventions” session kicked off with Dr. Amr Kandeel, Ministry of Health, Egypt, discussing how the countries’ adoption of a comprehensive prevention control plan in 2003 that has led to 95% hepatitis B coverage and screening of more than 4 million people for hepatitis C. Dr. Arshad Altaf, World Health Organization, added to this update by focusing on injection safety in Uganda and India, underscoring the importance of awareness activities to educate. Likewise, Dr. Huma Qureshi, Pakistan Health Research Council, discussed injection safety challenges and opportunities in Pakistan. With the highest level of therapeutic injections globally with 13-14 infections per person per year, she discussed their campaign to promote injection safety in 26 facilities across Pakistan, which included needle cutting and training of 1500 healthcare workers. Dr. Jinlin Hou, Nanfang Hospital, China, focused on activities to prevent mother-to-child transmission and Dr. Marcelo Addas-Carvalho, Blood Center of Campinas/UNICAMP, discussed blood safety. Dr. Niklas Luhmann, Médecins du Monde, looked at prevention amongst people who inject drugs. He used this opportunity to present the declaration on the hepatitis community on decriminalization.

In the “Testing Interventions” session a panel of four expert speakers reviewed the scientific, logistical, ethical and political processes leading to the implementation of state-of-the-art testing for viral hepatitis. Professor Philippa Easterbrook of World Health Organization said that while there had been much progress in treatment in the past year, there had not been the same progress in testing. But she said that success in increasing testing was possible (following the HIV testing model).

Dr Maud Lemoine of Imperial College London discussed the PROLIFICA project (prevention of liver fibrosis and cancer in Africa). In the other presentations, Dr Radi Hammad, Ministry of Health, Egypt, discussed his country’s highly successful screening programme for hepatitis C. Dr Saleem Kamili, US Centers for Disease Control and Prevention, also gave a presentation present and future innovations in diagnostics.

“Build your services where they are, and they will come” was the main message in the “Delivering High Quality Hepatitis Services” session. This sentiment was echoed by Abigael Lukhwaro from Medicines du Monde in Kenya. Both countries work with general practitioners within the community and peer groups to provide counselling and prevention education. It was generally agreed that the “just say no” approach does not work, and we must work with the community to address their needs and prevent reinfection.

The “Delivering Equitable Services” interactive workshop had delegates working together and applying the PROGRESS framework for equity to imagined country scenarios.

The workshop on “Treatment Interventions” shared lessons to be learnt from successful treatment programmes and discussed differences between treatment in the private sector and public sector.

Complementing the 200+ posters on display in the Golden Hall, oral presentations took place throughout the afternoon. Selected presenters divulged further details on their posters on the topics of service delivery – models for testing and treatment, modelling and cost effective for global scale up, epidemiology and risk factors from a global perspective and experiences with national scale-up.

The day finished with updates on the issue of hepatitis in children where delegates learnt that 52 million children are living with hepatitis B or C. Following this morning’s presentation on Indigenous Peoples, a side meeting examined the challenges of addressing hepatitis D and presented updates from the Indigenous Peoples’ Conference on Viral Hepatitis that took place earlier this year

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