Coalition for Global Elimination

Version July 2019

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Eliminate by 2030 and Prevent 7 Million Deaths Viral hepatitis— virus (HBV) and virus (HCV) infection—is a large global health problem. In 2015, more than 1.3 million persons died of HBV or HCV infection, more than 325 million persons were living with HBV or HCV infection placing them at risk for premature death, and over 6 million persons became newly infected with HBV or HCV. Reflecting growing international concern, the United Nations called on the world to combat hepatitis. In response, the World Health Organization targeted HBV and HCV for elimination by 2030, defined as a 65% reduction in mortality to 500,000 deaths per year and 90% reduction in incidence to less than 1 million new infections per year. Viral hepatitis elimination is feasible, cost effective and even cost saving. Hepatitis B vaccination and other interventions prevent transmission. Reliable tests accurately detect infection before onset of disease. Treatment of HBV infection and cure of HCV infection prevents liver cancer and mortality. The achievement of HBV and HCV elimination goals globally by 2030 will prevent over 7 million deaths.

Challenges for HBV and HCV Elimination Commented [SK1]: 5-7 high level bullets The World Health Assembly and the International Task Force for Disease Eradication (ITFDE) endorse the WHO elimination goals. To successfully eliminate viral hepatitis, improvements are most needed in the prevention of mother to child HBV transmission (PMCT); safe injection practices in health care and community settings; and testing, care and treatment for HBV and HCV infected persons. In 2015, of HBV and HCV infected persons, only 9% and 20% have been diagnosed and 8% and 7% have received treatment, respectively. Nations, states/provinces, local communities and others are in various stages of considering, planning, and implementing HBV and HCV elimination programs. Rather than stand-alone elimination programs, the WHO calls for integration of interventions to prevent HBV and HCV transmission and disease within existing prevention (e.g. immunization), primary care and other appropriate settings. This approach strengthens existing health systems, the secondary goal of disease elimination. Programs at the national and sub-national level implementing this global initiatives benefit from collaboration. Currently, HBV and HCV prevention and elimination programs are disconnected and the opportunities for collaboration few. In addition, information to guide program development is often not available or is published or presented over time and in diverse locations. Compounding this information gap, programs have limited access to technical experts or opportunities for participation in operational research.

Most hepatitis elimination programs, planned or ongoing, are resource constrained with scarce capacity for implementation. Building sufficient capacity to achieve elimination requires development of partnerships to open 2 new opportunities for support.

The fragmented and limited capacity for viral hepatitis elimination was recognized by the Commission, convened by Lancet Gastroenterology & Hepatology to examine global and regional challenges and recommend actions to accelerate progress toward hepatitis elimination. The Commission recommended collective global action to improve hepatitis elimination financing and build program capacity. The Commission highlighted the activities of the first elimination programs and how sharing experiences will help all countries make progress towards elimination. The International Task Force for Disease Eradication sounded a similar call for action (5). WHO also recognizes the technical assistance needs of programs. In February 2019, WHO requested the Task Force for Global Health, an official non-state actor of WHO, help national and sub-national hepatitis elimination programs share experiences and lessons learned. The Coalition for Global Hepatitis Elimination

In response, The Task Force for Global Health developed the Coalition for Global Hepatitis Elimination (CGHE). CGHE works to eliminate hepatitis B and hepatitis C by strengthening the capacity of national and sub-national elimination programs through advocacy, technical assistance, knowledge generation and dissemination among partners united in a community of practice CGHE will operate as a technical hub modeled after other Task Force for Global Health disease elimination programs.

Coalition for Global Hepatitis Elimination

Vision A world free of viral hepatitis as a health threat

MISSION STATEMENT CGHE works to eliminate hepatitis B and hepatitis C by strengthening the capacity of national and sub-national elimination programs through technical assistance, knowledge generation, and advocacy among partners united in a community of practice.

COALITION GUIDING PRINCIPLES Collaborate: Develop and operate the coalition in collaboration with partners.

Build trust: Develop a transparent process for disseminating information and providing technical assistance and research opportunities.

Assure integrity: Form governance bodies and policies to guide coalition partnerships and services

3 Operate on the best available evidence: Disseminate and operate on current, best available information to assist HBV and HCV prevention programs.

Stay dynamic: Build processes for frequent updates to the evidence-base, technical assistance and research agenda.

Be responsive: Provide timely responses to requests for information and technical assistance.

CGHE deliver services in five strategic axes.

Commmuity of Operational Awareness and Evidence base Practice Technical Assistance Research Advocacy •Convene •Contact •Compile •Connect •Engage •Coordinate •Share •Assess •Respond •Inform •Share •Learn •Dissimenate •Develop •Promote

Strategic Axes

1) Engage partners in a community of practice to achieve elimination. Build a collaborative environment for capacity-building, technical and implementing partners to share program experiences, learn best practices, and receive assistance to resolve issues that limit progress. Activities include: A. Recruit capacity-building partners to support the coalition o Build a solid, sufficient and sustainable base of financial support for operations o Engage organizations that assist provision of vaccination, testing and treatment services o Represent diverse stakeholders participating in viral hepatitis elimination globally o Solicit coalition participation of funded elimination programs B. Recruit technical and implementing partners to develop collaborations for mutual assistance. o Develop and maintain a directory of contact information for implementing programs. o Provide basic program information. o Provide in-depth program information o Enlist technical assistance partners as appropriate o Enlist, as appropriate, WHO regional and country offices, CDC country offices, Coalition members and Task Force affiliates in over 100 countries to develop relationships with key stakeholders o Provide telehealth case-based learning and other training for implementing programs C. Launch the Coalition technical hub www.globalhep.org 4 o Promote communication among all partners and the public o Compile program and country information accessible via a web-based interactive map. o House the evidence base o Serve as a repository of program and research information o Facilitate learning through distance-based technologies D. Convene regular meetings, both distance-based and in person to promote collaborations

2) Build a trusted dynamic evidence base to guide program development and evaluation To help individuals and organizations find and use the information needed to guide the selection and implementation of interventions for the elimination of HBV and HCV transmission and disease, CGHE will serve as a reliable and readily accessible information resource. The evidence base will include information from publications, government reports and other credible sources. Data from implementing programs will include quantitative data and qualitative reports. Activities include: A. Prepare evidence base framework. o Plans for data collection, and synthesis from published and unpublished sources o Development of criteria and standards for data assessment. o Develop a program dictionary of search terms, and meta-tagging information to identify relevant information for building and routinely updating the evidence base. o Plan for additions to the evidence base with qualitative and quantitative data (i.e. dashboards) shared by programs. B. Prioritize topic areas for the evidence base o To pilot the framework, the administration of a birth dose of hepatitis B vaccine is the first topic area added for the evidence base o With assistance of the Executive Board and Technical Advisory Board, CGHE partners, other topic areas will be prioritized for development and addition to the evidence base. C. Assistance o Provide editorial services to help programs contribute to the evidence base and the scientific literature. o Develop information packages (e.g., infographics) that help programs implement interventions. o Help program analyze data for dashboards and the WHO Global Hepatitis Reporting System. o Respond to request for customized searches

3) Provide expert technical assistance for governments and health systems CGHE will assist program planning, implementation and evaluation at the national and sub-national level. Consultative services will be provided distance-based and onsite. The Technical Advisory Board will advise CGHE on the priorities for technical assistance. Activities include: A. Assist all components of program planning, implementation and evaluation. B. Convene stakeholders a. Develop local coalitions b. Discuss and resolve implementation issues C. Develop web-based tools that can assist multiple programs D. With assistance of the Technical Advisory Board prioritize activities i. Areas of technical expertise 1. All 2. Selected e.g., 5 a. Strategic information b. Planning and evaluation c. Testing d. Care and treatment models e. Safe injection E. Develop tools that strengthen health systems to deliver interventions F. Sustain technical assistance for model national and sub-national (i.e., micro elimination) programs. G. Assemble a team of experts to provide technical assistance on a pro bono or consultant basis.

4) Conduct operational research to improve program effectiveness The CGHE creates the forum for stakeholders to collectively identify limitations in program practices and technologies and prioritize the operational research needed for improvement. The CGHE will implement a proven process for operational research developed by the Task Force for other disease elimination programs. The Technical Advisory Board will advise the CGHE on the priorities for operational research. Activities include: A. Convene implementing programs and other partners to discuss, propose and prioritize research. B. Develop a repository of studies that can improve implementation of key interventions; C. Develop an operational research agenda to evaluate new prevention, testing and treatment strategies and tools. o Information to estimate burden of disease and evaluate programs o Prevention of mother to child transmission o Use of new test technologies o Testing and linkage to care policies and systems o Models of care and treatment for target populations D. Solicit resources to conduct research. E. Coordinate research activities. F. Share results, through presentations and publications, on a timely basis G. Add information to the evidence base

5) Support global advocacy and community mobilization Experience from other global initiatives reveal support of civil society is as important as technical proficiency in successfully reaching disease elimination goals. Accordingly, CGHE will collaborate with the , other civil society organizations and partners to educate the public and policy makers of the benefits of viral hepatitis elimination and how elimination can be achieved.

Activities include: A. Provide information appropriate for education of policymakers and other key influencers. B. Profile hepatitis elimination champions whose actions resulted in substantive improvements in prevention, testing, care and treatment; C. Highlight human interest stories of the positive impact of prevention, testing, care and treatment on the lives of those at risk for or living with HBV or HCV; D. Augment distribution of educational materials related to health events (e.g., World Hepatitis Day) and dissemination of other materials to stakeholders and the public.

Over time, CGHE is expected to expand the national and sub-national programs participating in the community of practice, the richness of information resources, the expertise in providing technical assistance, the topics for

6 operational research and the depth of experience in communicating with stakeholders. The CGHE operational plan will be periodically revised to reflect these changes.

Coalition for Global Hepatitis Elimination

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References

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