Measuring Hepatitis C Virus Elimination as a Public Health Threat: Beyond Global Targets

Daniela K. van Santen; Rachel Sacks-Davis; Joseph S. Doyle; Nick Scott; Maria Prins; Margaret Hellard


J Viral Hepat. 2020;27(8):770-773. 

In This Article

Beyond the Who Global Targets

While the WHO targets are a strong advocacy tool and provide guidance for HCV elimination as a public health threat, in certain circumstances we must look beyond WHO's global impact targets. Tailoring HCV elimination monitoring to the local epidemic is warranted because the global service coverage and impact targets may not apply in all settings. We propose alternative HCV targets and definitions to track progress on decreasing HCV infection and disease burden. First, without quality longitudinal surveillance, cohort data or baseline estimates before broad DAA treatment access, an absolute threshold for incidence and/or chronic prevalence and mortality targets in addition to or instead of relative estimates must be considered. An incidence rate threshold is particularly important in settings with a low baseline transmission risk where relative reduction targets may be hard to achieve. Second, as the ultimate goal is to decrease the HCV disease burden, looking beyond HCV cure is warranted; hence, a post-SVR liver-related screening target other than mortality could be developed. Further studies are needed to assess the frequency of post-SVR screening needed to reduce liver-related mortality by 65%. Evidence must then guide broad consensus across stakeholders including WHO, policy makers, people living with and at risk of hepatitis, and health and research community. Future modelling or epidemiological studies should guide development of local targets by assessing the impact of the epidemic, baseline service coverage and the population at risk on local incidence and mortality reductions.