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- Innovative strategies for the elimination of viral hepatitis at a national level: a country case seriesPublication . Schröeder, Sophia E.; Pedrana, Alisa; Scott, Nick; Wilson, David; Kuschel, Christian; Aufegger, Lisa; Atun, Rifat; Baptista-Leite, Ricardo; Butsashvili, Maia; El-Sayed, Manal; Getahun, Aneley; Hamid, Saeed; Hammad, Radi; Hoen, Ellen ‘t; Hutchinson, Sharon J.; Lazarus, Jeffrey V.; Lesi, Olufunmilayo; Li, Wangsheng; Mohamed, Rosmawati Binti; Olafsson, Sigurdur; Peck, Raquel; Sohn, Annette H.; Sonderup, Mark; Spearman, Catherine W.; Swan, Tracy; Thursz, Mark; Walker, Tim; Hellard, Margaret; Howell, JessicaViral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.
- Beyond viral suppression of HIV - the new quality of life frontierPublication . Lazarus, Jeffrey V.; Safreed-Harmon, Kelly; Barton, Simon E.; Costagliola, Dominique; Dedes, Nikos; Valero, Julia del Amo; Gatell, Jose M.; Baptista-Leite, Ricardo; Mendão, Luís; Porter, Kholoud; Vella, Stefano; Rockstroh, Jürgen KurtBackground: In 2016, the World Health Organization (WHO) adopted a new Global Health Sector Strategy on HIV for 2016-2021. It establishes 15 ambitious targets, including the '90-90-90' target calling on health systems to reduce under-diagnosis of HIV, treat a greater number of those diagnosed, and ensure that those being treated achieve viral suppression. Discussion: The WHO strategy calls for person-centered chronic care for people living with HIV (PLHIV), implicitly acknowledging that viral suppression is not the ultimate goal of treatment. However, it stops short of providing an explicit target for health-related quality of life. It thus fails to take into account the needs of PLHIV who have achieved viral suppression but still must contend with other intense challenges such as serious non-communicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination. We propose adding a 'fourth 90' to the testing and treatment target: ensure that 90 % of people with viral load suppression have good health-related quality of life. The new target would expand the continuum-of-services paradigm beyond the existing endpoint of viral suppression. Good health-related quality of life for PLHIV entails attention to two domains: comorbidities and self-perceived quality of life. Conclusions: Health systems everywhere need to become more integrated and more people-centered to successfully meet the needs of virally suppressed PLHIV. By doing so, these systems can better meet the needs of all of their constituents - regardless of HIV status - in an era when many populations worldwide are living much longer with multiple comorbidities.
- Pathways to ensure universal and affordable access to hepatitis C treatmentPublication . Douglass, Caitlin H.; Pedrana, Alisa; Lazarus, Jeffrey V.; Hoen'T, Ellen F. M.; Hammad, Radi; Leite, Ricardo Baptista; Hill, Andrew; Hellard, MargaretDirect-acting antivirals (DAAs) have dramatically changed the landscape of hepatitis C treatment and prevention. The World Health Organization has called for the elimination of hepatitis C as a public health threat by 2030. However, the discrepancy in DAA prices across low-, middle- and high-income countries is considerable, ranging from less than US 100 to approximately US 40,000 per course, thus representing a major barrier for the scale-up of treatment and elimination. This article describes DAA pricing and pathways to accessing affordable treatment, providing case studies from Australia, Egypt and Portugal. Pathways to accessing DAAs include developing comprehensive viral hepatitis plans to facilitate price negotiations, voluntary and compulsory licenses, patent opposition, joint procurement, and personal importation schemes. While multiple factors influence the price of DAAs, a key driver is a country's capacity and willingness to negotiate with pharmaceutical companies. If negotiations do not lead to a reasonable price, governments have the option to utilise flexibilities outlined in the Agreement on Trade-Related Aspects of Intellectual Property Rights. Affordable access to DAAs is underpinned by collaboration between government, civil society, global organisations and pharmaceutical companies to ensure that all patients can access treatment. Promoting these pathways is critical for influencing policy, improving access to affordable DAAs and achieving hepatitis C elimination.