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Combating Hepatitis B and C by 2030: Achievements, Gaps, and Options for Actions in China

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Combating Hepatitis B and C by 2030: Achievements, Gaps, and Options for Actions in China Analysis BMJ Glob Health: first published as 10.1136/bmjgh-2020-002306 on 30 June 2020. Downloaded from Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China 1 2 2 3 2 Shu Chen , Wenhui Mao , Lei Guo , Jiahui Zhang, Shenglan Tang To cite: Chen S, Mao W, Guo L, ABSTRACT Summary box et al. Combating hepatitis B China has the highest number of hepatitis B and C cases and C by 2030: achievements, globally. Despite remarkable achievements, China faces ► China has made considerable achievements in con- gaps, and options for actions daunting challenges in achieving international targets in China. BMJ Global Health trolling hepatitis B and C through multiple strategies for hepatitis elimination. As part of a large- scale project 2020;5:e002306. doi:10.1136/ with efforts focused on prevention and increased assessing China’s progress in achieving health- related bmjgh-2020-002306 treatment financing. Sustainable Development Goals using quantitative, ► Formidable challenges remain in combating hepati- qualitative data and mathematical modelling, this paper Handling editor Alberto L tis by 2030. Key health system barriers, including a summarises the achievements, gaps and challenges, Garcia- Basteiro fragmented governance system, insufficient funding, and proposes options for actions for hepatitis B and C inadequate service coverage and unstandardised Received 9 January 2020 control. China has made substantial progress in controlling treatment, and flawed information systems, have Revised 13 May 2020 chronic viral hepatitis. The four most successful strategies compromised the effective control of viral hepatitis. Accepted 18 May 2020 have been: (1) hepatitis B virus childhood immunisation; ► To tackle these challenges, China must take five (2) prevention of mother- to- child transmission; (3) full immediate actions: restructuring the governance coverage of nucleic acid amplification testing in blood system of viral hepatitis, optimising resource al- stations and (4) effective financing strategies to support location and increasing the efficiency of funding, treatment. However, the total number of deaths due to improving access to and the quality of the health hepatitis B and C is estimated to increase from 434 724 benefits package, strengthening information sys- in 2017 to 527 829 in 2030 if there is no implementation tems and boosting investment on hepatitis research of tailored interventions. Many health system barriers, and development. including a fragmented governance system, insufficient funding, inadequate service coverage, unstandardised treatment and flawed information systems, have http://gh.bmj.com/ compromised the effective control of hepatitis B and C in global infections, respectively.4 Chronic HBV China. We suggest five strategic priority actions to help and HCV infection can progress to cirrhosis, eliminate hepatitis B and C in China: (1) restructure the hepatocellular carcinoma and premature viral hepatitis control governance system; (2) optimise death without proper treatment.5 Chronic health resource allocation and improve funding efficiency; HBV infections are associated with increased (3) improve access to and the quality of the health benefits on September 25, 2021 by guest. Protected copyright. package, especially for high- risk groups; (4) strengthen risk of other cancers including stomach information systems to obtain high- quality hepatitis cancer, colorectal cancer, oral cancer, pancre- 6 epidemiological data; (5) increase investment in viral atic cancer and lymphoma. Among people hepatitis research and development. living with chronic HBV and HCV, around © Author(s) (or their 7 million and 2.5 million needed urgent treat- employer(s)) 2020. Re- use permitted under CC BY. ment in China due to advanced liver diseases Published by BMJ. or the high risk of developing into cancer, 4 1Global Health Research Center, INTRODUCTION respectively, in 2016. In 2017, there were an Duke Kunshan University, Infection with chronic viral hepatitis can be estimated 310 079 and 124 645 deaths due to Kunshan, Jiangsu, China caused by exposure to five different types of chronic HBV and HCV infections, respec- 2 Duke Global Health Institute, viruses (hepatitis A, B, C, D, E). Hepatitis B tively, in China, according to the Global Duke University, Durham, North 7 Carolina, USA virus (HBV) and hepatitis C virus (HCV) Burden of Diseases (GBD) 2017 Study. 3Research Department of Social account for 96% of all deaths related to viral Viral hepatitis control in China is governed 1 Development, Development hepatitis. China is the country experiencing by the Bureau of Disease Prevention and and Research Center of State the highest burden of these infections,2 3 with Control, National Health Commission Council, Beijing, China the WHO estimating that in 2016, 90 million (NHC) and overseen by health commissions Correspondence to people were living with chronic HBV infection at the provincial, prefecture and county levels Dr Shenglan Tang; and 10 million with chronic HCV infection in across the country. Under the regulatory shenglan. tang@ duke. edu China, accounting for one- third and 7% of the supervision of NHC, the Chinese Center for Chen S, et al. BMJ Global Health 2020;5:e002306. doi:10.1136/bmjgh-2020-002306 1 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2020-002306 on 30 June 2020. Downloaded from Disease Control and Prevention (China CDC) is respon- the Prevention and Treatment of Viral Hepatitis in China sible for disease prevention and management, while (2017–2020) was jointly published by 11 ministries in hospitals provide clinical diagnosis and treatment. The 2017, which set out 6 targets, 4 of which corresponded Division of Immunization Planning Management and with WHO’s targets (table 1).10 Despite the priorities Division of HIV/AIDS Prevention and Control within and action recommendations put forward by the inter- NHC is responsible for hepatitis B and C control, respec- national community to eliminate hepatitis globally tively. The same governance structure for hepatitis B and and analysis of eliminating hepatitis B in China,11 12 we C control has been put in place at the China CDC system present key achievements, identify gaps and challenges, nationwide. and proposes next steps to specifically help China end Viral hepatitis is increasingly garnering global atten- hepatitis B and C as a major public health threat by 2030. tion and is included in the United Nations’ 2030 Agenda for Sustainable Development Goals (SDGs) where SDG 3.3 calls for ‘combat viral hepatitis’.8 At the same time, APPROACH in 2016, WHO published its first Global Health Sector This article collected quantitative and qualitative data for Strategy on Viral Hepatitis 2016–2021, which established analysis. Quantitative data were collected from published nine quantitative global targets, such as ‘reducing new literature in Chinese and English, GBD 2017 Study esti- cases of chronic viral hepatitis B and C infections by 90% mates,3 the infectious diseases surveillance reporting and deaths by 65% by 2030’.9 The first Action Plan for system (IDSRS) and reports published by related Table 1 The hepatitis targets set by WHO and China WHO 2020 targets WHO 2030 targets Target area (base year: 2015) (base year: 2015) China 2020 targets Impact targets Incidence: new cases of chronic viral hepatitis 30% reduction 90% reduction Keeping <1% prevalence B and C infections (equivalent to 1% prevalence of (equivalent to 0.1% of HBsAg among children HBsAg among children) prevalence of HBsAg under 5 among children) Mortality: viral hepatitis B and C deaths 10% reduction 65% reduction No quantitative target Service coverage targets HBV vaccination: childhood third dose 90% 90% Keeping >95% vaccination coverage Prevention of HBV mother- to- child 50% 90% Keeping >90% http://gh.bmj.com/ transmission: HBV birth-dose vaccination coverage or other approaches to prevent mother- to- child transmission Blood safety 95% of donations screened in a 100% of donations 100% of donations quality- assured manner screened in a quality- screened in a quality- assured manner assured manner Safe injections: percentage of injections 50% 90% No quantitative target on September 25, 2021 by guest. Protected copyright. administered with safety- engineered devices in and out of health facilities Harm reduction: number of sterile needles and 200 300 No quantitative target syringes provided per person who injects drugs per year Viral hepatitis B and C diagnosis 30% 90% No quantitative target Viral hepatitis B and C treatment Globally 5 million people 80% No quantitative target receiving HBV treatment and 3 million people receiving HCV treatment China-specific service coverage targets Public awareness of viral hepatitis prevention >50% and control knowledge Drug dependence treatment coverage to opioid >70% users Sources: Global health sector strategy on viral hepatitis 2016–2021: towards ending viral hepatitis & Action plan for the prevention and treatment of viral hepatitis in China (2017–2020). HBsAg, HBV surface antigen; HBV, Hepatitis B virus; HCV, hepatitis C virus. 2 Chen S, et al. BMJ Global Health 2020;5:e002306. doi:10.1136/bmjgh-2020-002306 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2020-002306 on 30 June 2020. Downloaded from governmental agencies. The health outcome projection and around ¥1.4 billion has been invested annually to results are estimated using the adjusted model developed cover the HBV- related services,
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